Empathy examined through the neural mechanisms involved in imagining how I feel versus how you feel pain

Interoceptive awareness mediated the effects of a 15-minute diaphragmatic breathing on empathy for pain: A randomized controlled trial

Although empathy for pain plays an important role in positive interpersonal relationships and encourages engagement in prosocial behavior, it remains largely unknown whether empathy for pain could be effectively altered by psychophysiological techniques. This study aimed to investigate the impact of a single session of diaphragmatic breathing practice on empathy for pain and examine the potential mechanism involving interoceptive awareness. A total of 66 healthy participants were randomly assigned to the intervention group or the control group. The intervention group received a 15-minute diaphragmatic breathing (DB) practice with real-time biofeedback, while the control group was to gaze at a black screen at rest and not engaged in any other activities. Before and after the invention, all participants were instructed to evaluate the intensity and unpleasantness of empathy for pain while watching different pictures with pain or non-pain conditions. The Multidimensional Assessment of Interoceptive Awareness (MAIA) was then administered to measure interoceptive awareness. The results indicated a significant interaction between group and time with regard to empathy for pain and MAIA. The DB group showed a statistically significant decrease in both pain intensity and unpleasantness during the pain picture condition, as well as a noteworthy increase in MAIA scores. The control group did not demonstrate any substantial changes. More importantly, the regulation of attention, a dimension of MAIA, had a significant mediating effect on the impact of diaphragmatic breathing on reported unpleasantness. Diaphragmatic breathing could serve as a simple, convenient, and practical strategy to optimize human empathy for pain that warrants further investigation, which has important implications not only for individuals with impaired empathy for pain but also for the improvement of interoceptive awareness.

Reduced late positive potentials to distress in individuals with high psychopathic traits during pain judgment tasks

This study examined the empathic processing of individuals with psychopathic traits and healthy controls in response to pain, applying affective perspective-taking (Self vs. Other). Twenty subjects with high psychopathic traits and twenty control subjects performed pain judgment tasks in the study. During the tasks, late positive potentials (LPPs) of the participants were measured to assess emotional processing in reaction to visual stimuli depicting painful or non-painful situations. In early LPP time stage (500-700 ms), the control group and the psychopathic trait group exhibited comparable levels of empathic processing regarding pain. However, in late LPP time window (700-1100 ms), the control group showed a greater LPP amplitude to Pain stimuli than No-pain stimuli, whereas the psychopathic trait group exhibited non-significant amplitude differences between Pain and No-pain stimuli. These findings imply that individuals with high psychopathic traits may swiftly terminate the processing and encounter difficulties in reappraising distress cues, especially in the late stage, providing psychophysiological support for distinctive empathic processing with temporal aspects.

The Relationship Between Brain Activation for Taking Others' Perspective and Interoceptive Abilities in Autism Spectrum Disorder: An fMRI Study

Objectives

In this functional magnetic resonance imaging study, we aimed to investigate the differences in brain activation between individuals with autism spectrum disorder (ASD) and typically developing (TD) individuals during perspective taking. We also examined the association between brain activation and empathic and interoceptive abilities.

Methods

During scanning, participants from the ASD (n=17) and TD (n=22) groups were shown pain stimuli and asked to rate the level of the observed pain from both self- and other-perspectives. Empathic abilities, including perspective taking, were measured using an empathic questionnaire, and three dimensions of interoception were assessed: interoceptive accuracy, interoceptive sensibility, and interoceptive trait prediction errors.

Results

During self-perspective taking, the ASD group exhibited greater activation in the left precuneus than the TD group. During other-perspective taking, relative hyperactivation extended to areas including the right precuneus, right superior frontal gyrus, left caudate nucleus, and left amygdala. Brain activation levels in the right superior frontal gyrus while taking other-perspective were negatively correlated with interoceptive accuracy, and those in the left caudate were negatively correlated with perspective taking ability in the ASD group.

Conclusion

Individuals with ASD show atypical brain activation during perspective taking. Notably, their brain regions associated with stress reactions and escape responses are overactivated when taking other-perspective. This overactivity is related to poor interoceptive accuracy, suggesting that individuals with ASD may experience difficulties with the self-other distinction or atypical embodiment when considering another person's perspective.

Social Learning of Placebo Effects in Pain: A Critical Review of the Literature and a Proposed Revised Model

Relatively recently, in 2009, experimental studies were undertaken to determine the role of social observational learning in forming hypoalgesic, analgesic and hyperalgesic responses to a placebo. The research findings obtained in studies published before 2018 were integrated and formed the basis of the theoretical model of social learning of placebo effects in pain proposed by Bajcar and Bąbel. This model considered the involvement of different types of modeling (ie, behavioral modeling, symbolic modeling, and verbal modeling) in shaping placebo hypoalgesia/analgesia and nocebo hyperalgesia. The model assumed that pain expectancies might be involved in observationally induced placebo effects in pain and that the effectiveness of observational learning in shaping placebo effects could be moderated by the observer's dispositions, especially empathy. Based on the latest research data, we propose a modified and significantly extended version of this model. The revised model includes the involvement of particular types of modeling in placebo effects and their role in shaping conscious pain-related expectancies. It explains the role of dispositional empathy in shaping observationally induced placebo effects. Notably, the extended version of the model considers the contribution of the characteristics of the observed person to the magnitude of placebo effects induced by social learning. PERSPECTIVE: The paper proposes a comprehensive theoretical approach to explaining the role of observational learning in shaping placebo effects in pain. The proposed model emphasizes the potential of this form of learning in shaping placebo responses and indicates factors that can modify the effectiveness of observational learning.

The Relationship Between Family Functioning and Defending Behaviors Among Junior High School Students: The Mediating Effect of Empathy and Moderating Effect of Gender

Bystanders play a role in school bullying; more specifically, the defending behaviors of bystanders play an important role in stopping bullying. This study explores the relationship between defending behaviors and family functioning in the context of school bullying from a family perspective. The role played by individual characteristics (empathy and gender) in this relationship was also focused on. The participants were 994 adolescents (average age = 13.34 ± 0.92 years) from the east of China. They completed the McMaster Family Assessment Device, the Basic Empathy Scale, and the Defending Behaviors subscale of the Participant Role Questionnaire. After controlling for residence and age, we found that family functioning significantly and positively influenced defending behaviors, and cognitive empathy rather than affective empathy mediated the relationship between family functioning and defending behaviors. In addition, family functioning influenced defending behaviors in boys more strongly than in girls. This study may increase the likelihood that bystanders will engage in defending behaviors by informing interventions for school bullying.

Social cues influence perception of others' pain

BACKGROUND

Accurately perceiving other people's pain is important in both daily life and healthcare settings. However, judging other's pain is inherently difficult and can be biased by various social and cultural factors. Here, we examined whether perception of others' pain and pain management recommendations are socially influenced by seeing the opinions of other raters.

METHODS

In Experiment 1 (N = 50), participants rated pictures depicting injured hands or feet of pre-selected high, medium and low intensities. Each picture was preceded by cues indicating ratings of 10 previous participants. Cues were randomized to indicate low (SocialLOW) or high (SocialHIGH) pain judgements and were not predictive of actual normative pain intensity. In Experiment 2 (N = 209), participants viewed facial video clips of patients with chronic shoulder pain making painful movements. They estimated patients' pain intensity and provided pain management recommendations.

RESULTS

Experiment 1 revealed that perceivers' pain estimates were significantly and substantially higher for stimuli following SocialHIGH than SocialLOW cues (Cohen's d = 1.26, p < 0.001) and paralleled by increased skin conductance responses. Experiment 2 replicated the effect of social cues on pain judgements (d = 0.58, p < 0.001). However, social cues did not influence post-study pain management recommendations, potentially due to memory limitations.

CONCLUSIONS

Together, these studies reveal that judgements of others' pain are robustly modulated by information about others' opinions. Future research could test the prevalence and strength of such effects in clinical settings.

SIGNIFICANCE

The present study shows that even arbitrary opinions of other raters influence the perception of others' pain. This finding adds new insight into the growing evidence of social and cultural biases in pain estimation.

Observing heroic behavior and its influencing factors in immersive virtual environments

Studying heroism in controlled settings presents challenges and ethical controversies due to its association with physical risk. Leveraging virtual reality (VR) technology, we conducted a three-study series with 397 participants from China to investigate heroic actions. Participants unexpectedly witnessed a criminal event in a simulated scenario, allowing observation of their tendency to physically intercept a thief. We examined situational factors (voluntariness, authority, and risk) and personal variables [gender, impulsivity, empathy, and social value orientation (SVO)] that may influence heroism. Also, the potential association between heroism and social conformity was explored. In terms of situational variables, voluntariness modulated participants' tendency to intercept the escaping thief, while perceived risk demonstrated its impact by interacting with gender. That is, in study 3 where the perceived risk was expected to be higher (as supported by an online study 5), males exhibited a greater inclination toward heroic behavior compared to females. Regarding other personal variables, the tendency to engage in heroic behavior decreased as empathy levels rose among males, whereas the opposite trend was observed for females. SVO influenced heroic behavior but without a gender interaction. Finally, an inverse relationship between heroism and social conformity was observed. The robustness of these findings was partly supported by the Chinese sample (but not the international sample) of an online study 4 that provided written descriptions of VR scenarios, indicating cultural variations. These results advance insights into motivational factors influencing heroism in the context of restoring order and highlight the power of VR technology in examining social psychological hypotheses beyond ethical constraints.

Can the neural representation of physical pain predict empathy for pain in others?

The question of whether physical pain and vicarious pain have some shared neural substrates is unresolved. Recent research has argued that physical and vicarious pain are represented by dissociable multivariate brain patterns by creating biomarkers for physical pain (Neurologic Pain Signature, NPS) and vicarious pain (Vicarious Pain Signature, VPS), respectively. In the current research, the NPS and two versions of the VPS were applied to three fMRI datasets (one new, two published) relating to vicarious pain which focused on between-subject differences in vicarious pain (Datasets 1 and 3) and within-subject manipulations of perspective taking (Dataset 2). Results show that (i) NPS can distinguish brain responses to images of pain vs no-pain and to a greater extent in vicarious pain responders who report experiencing pain when observing pain and (ii) neither version of the VPS mapped on to individual differences in vicarious pain and the two versions differed in their success in predicting vicarious pain overall. This study suggests that the NPS (created to detect physical pain) is, under some circumstances, sensitive to vicarious pain and there is significant variability in VPS measures (created to detect vicarious pain) to act as generalizable biomarkers of vicarious pain.

Psychopathic callousness and perspective taking in pain processing: an ERP study

Psychopathy is a multifaceted personality disorder characterized by distinct affective/interpersonal traits, including callousness-unemotionality/meanness, which are often considered the hallmarks of empathic deficits. It has been posited that the processing of others' pain could play an important role in empathy capabilities. This study aimed to investigate the influence of perspective taking on electrocortical responses during pain processing in relation to psychopathic callousness. The late positive potential (LPP) -a well-established electrophysiological indicator of sustained attention to motivationally significant stimuli- was measured while 100 female undergraduates viewed images depicting bodily injuries while adopting an imagine-self or an imagine-other perspective. Callousness factor scores -computed as regression-based component scores from EFA on three relevant self-report measures of this dimension- predicted reduced LPP amplitudes to pain pictures under the imagine-other (but not imagine-self) perspective, even after controlling for other LPP conditions. This result suggests that high-callous individuals exhibit diminished brain responsiveness to others' distress, potentially contributing to the empathic deficits observed in psychopathy. This finding highlights the usefulness of the LPP and perspective taking in studies on pain processing to refine our understanding of the low empathy characteristics of psychopathy in biobehavioral terms.

The Lack of Alterations in Metabolites in the Medial Prefrontal Cortex and Amygdala, but Their Associations with Autistic Traits, Empathy, and Personality Traits in Adults with Autism Spectrum Disorder: A Preliminary Study

Proton magnetic resonance spectroscopy (1H-MRS) has shown inconsistent alterations in brain metabolites of adults with autism spectrum disorder (ASD). We investigated brain metabolites in the medial prefrontal cortex and amygdala of 24 drug-naive adults with ASD and no intellectual disability and 24 non-ASD control subjects, using 3 T 1H-MRS. Adults with ASD showed no significant differences from control in glutamate, glutamate plus glutamine, N-acetylaspartate, glycerophosphorylcholine plus phosphorylcholine, creatine plus phosphocreatine, or myo-inositol in either region. However, ASD subjects did show significant correlations of localized brain metabolites with autistic traits, empathy deficits, and personality traits using the Autism-Spectrum Quotient, Questionnaire of Cognitive and Affective Empathy, Interpersonal Reactivity Index, and NEO Personality Inventory-Revised. These findings should be taken as preliminary or exploratory.

Graded brain fMRI response to somatic and visual acupuncture stimulation

Increased stimulation can enhance acupuncture clinical response; however, the impact of acupuncture stimulation as "dosage" has rarely been studied. Furthermore, acupuncture can include both somatic and visual components. We assessed both somatic and visual acupuncture dosage effects on sensory ratings and brain response. Twenty-four healthy participants received somatic (needle inserted, manually stimulated) and visual (needle video, no manual stimulation) acupuncture over the leg at three different dosage levels (control, low-dose, and high-dose) during functional magnetic resonance imaging (fMRI). Participants reported the perceived deqi sensation for each acupuncture dose level. Blood-oxygen-level dependent imaging data were analyzed by general linear model and multivariate pattern analysis. For both somatic and visual acupuncture, reported deqi sensation increased with increased dosage of acupuncture stimulation. Brain fMRI analysis demonstrated that higher dosage of somatic acupuncture produced greater brain responses in sensorimotor processing areas, including anterior and posterior insula and secondary somatosensory cortex. For visual acupuncture, higher dosage of stimulation produced greater brain responses in visual-processing areas, including the middle temporal visual areas (V5/MT+) and occipital cortex. Psychophysical and psychophysiological responses to both somatic and visual acupuncture were graded in response to higher doses. Our findings suggest that acupuncture response may be enhanced by the dosage of needling-specific and nonspecific components, represented by different neural mechanisms.

Empathy Modulates the Activity of the Sensorimotor Mirror Neuron System during Pain Observation

AIM

The aim of this study is to analyze the brain activity patterns during the observation of painful expressions and to establish the relationship between this activity and the scores obtained on the Interpersonal Reactivity Index (IRI).

METHODS

The study included twenty healthy, right-handed subjects (10 women). We conducted a task-based and resting-state functional magnetic resonance imaging (fMRI) study. The task involved observing pictures displaying painful expressions. We performed a region of interest (ROI) analysis focusing on the core regions of the sensorimotor mirror neuron system (MNS). Resting-state fMRI was utilized to assess the functional connectivity of the sensorimotor MNS regions with the rest of the cortex using a seed-to-voxel approach. Additionally, we conducted a regression analysis to examine the relationship between brain activity and scores from the IRI subtests.

RESULTS

Observing painful expressions led to increased activity in specific regions of the frontal, temporal, and parietal lobes. The largest cluster of activation was observed in the left inferior parietal lobule (IPL). However, the ROI analysis did not reveal any significant activity in the remaining core regions of the sensorimotor MNS. The regression analysis demonstrated a positive correlation between brain activity during the observation of pain and the "empathic concern" subtest scores of the IRI in both the cingulate gyri and bilateral IPL. Finally, we identified a positive relationship between the "empathic concern" subtest of the IRI and the functional connectivity (FC) of bilateral IPLs with the bilateral prefrontal cortex and the right IFG.

CONCLUSION

Observing expressions of pain triggers activation in the sensorimotor MNS, and this activation is influenced by the individual's level of empathy.

The pain hidden in your hands: Facial expression of pain reduces the influence of goal-related information in action recognition

The involvement of the sensorimotor system in the perception of painful actions has been repeatedly demonstrated. Yet the cognitive processes corresponding to sensorimotor activations have not been identified. In particular, the respective role of higher-level and lower-level action representations such as goals and grips in the recognition of painful actions is not clear. Previous research has shown that in a neutral context, higher-level action representations (goals) are prioritized over lower-level action representations (grips) and guide action recognition. The present study evaluates to what extent the general priority given to goal-related information in the processing of visual actions can be modulated by a context of pain. We used the action violation paradigm developed by van Elk et al. (2008). In the present action tasks, participants had to judge whether the grip or the goal of object-directed actions displayed in photographs was correct or not. The actress in the photograph could show either a neutral facial expression or a facial expression of pain. In the control task, they had to judge whether the actress expressed pain. In the action tasks, goals influenced grip judgements more than grips influenced goal judgements overall, corroborating the priority given to goal-related information previously reported. Critically, the impact of irrelevant goal-related information on the identification of incorrect grips disappeared in the pain context. Moreover, judgements in the control task were similarly influenced by grip and goal-related information. Results suggest that a context of pain reduces the reliance on higher-level action for action judgments. Findings provide novel directions regarding the cognitive and brain mechanisms involved in action processing in painful situations and support pluralist views of action understanding.

Neural shifts in alpha rhythm's dual functioning during empathy maturation

INTRODUCTION

Empathy is a social-cognitive process that operates by relying mainly on the suppression of the cortical alpha rhythm. This phenomenon has been evidenced in dozens of electrophysiological studies targeting adult human subjects. Yet, recent neurodevelopmental studies indicated that at a younger age, empathy involves reversed brain responses (e.g., alpha enhancement patterns). In this multimodal study, we capture neural activity at the alpha range, and hemodynamic response and target subjects at approximately 20 years old as a unique time window in development that allows investigating both low-alpha suppression and high-alpha enhancement. We aim to further investigate the functional role of low-alpha power suppression and high-alpha power enhancement during empathy development.

METHODS

Brain data from 40 healthy individuals were recorded in two consecutive sessions of magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) while subjects perceived vicarious physical pain or no pain.

RESULTS

MEG revealed that the alpha pattern shift during empathy happens in an all-or-none pattern: power enhancement before 18 and suppression after 18 years of age. Additionally, MEG and fMRI highlight a correspondence between high-alpha power increase and blood-oxygen-level-dependent (BOLD) decrease before 18, but low-alpha power decrease and BOLD increase after 18. Importantly, this neurodevelopmental transition was not revealed by four other measures: self-reported (a) ratings of the task stimuli, (b) ratings of naturalistic vignettes of vicarious pain, (c) trait empathy, or neural data from (d) a control neuroimaging task.

DISCUSSION

Findings suggest that at the critical age of around 18, empathy is underpinned by an all-or-none transition from high-alpha power enhancement and functional inhibition to low-alpha power suppression and functional activation in particular brain regions, possibly indicating a marker of maturation in empathic ability. This work advances a recent neurodevelopmental line of studies and provides insight into the functional maturation of empathy at the coming of age.

Social Buffering Effects during Craft Activities in Parallel Group Session Revealed by EEG Analysis and Parasympathetic Activity

INTRODUCTION

The therapeutic structure of occupational therapy (OT) includes groups. Although the presence of others is expected to be relaxing due to the social buffering effect and the tend and befriend theory, it has not been sufficiently validated in accordance with the therapeutic structure of OT. The aim of this study was to investigate the electrophysiological evidence for the effectiveness of parallel groups and states of concentration on craft activities used in OT.

METHODS

Thirty healthy young adults were used as controls to measure EEG and autonomic activity during craft activities in three conditions: alone, parallel, and nonparallel. EEG was analyzed using exact low-resolution electromagnetic tomography, and autonomic activity was analyzed using Lorenz plot analysis.

RESULTS

Parasympathetic activity was significantly higher in the parallel condition than in the alone condition. A significant negative correlation was found between current source density and parasympathetic activity in the region centered on the right insular cortex in the α1 band, and functional connectivity in regions including the anterior cingulate cortex and insular cortex was associated with autonomic activity.

CONCLUSION

Craft activities that occurred during frontal midline theta rhythm also increased parasympathetic activity. The results suggest that the parallel groups used in OT and the intensive state of craft activities induce a social buffering effect that increases parasympathetic activity despite the absence of physical contact or social support. This provides evidence for the effectiveness of the therapeutic structure of occupational activities and groups in OT.

Another in need enhances prosociality and modulates frontal theta oscillations in young adults

Introduction

Decision-making is a process that can be strongly affected by social factors. Evidence has shown how people deviate from traditional rational-choice predictions under different levels of social interactions. The emergence of prosocial decision-making, defined as any action that is addressed to benefit another individual even at the expense of personal benefits, has been reported as an example of such social influence. Furthermore, brain evidence has shown the involvement of structures such as the prefrontal cortex, anterior insula, and midcingulate cortex during decision settings in which a decision maker interacts with others under physical pain or distress or while being observed by others.

Methods

Using a slightly modified version of the dictator game and EEG recordings, we tested the hypothesis that the inclusion of another person into the decision setting increases prosocial decisions in young adults and that this increase is higher when the other person is associated with others in need. At the brain level, we hypothesized that the increase in prosocial decisions correlates with frontal theta activity.

Results and Discussion

The results showed that including another person in the decision, setting increased prosocial behavior only when this presence was associated with someone in need. This effect was associated with an increase in frontocentral theta-oscillatory activity. These results suggest that the presence of someone in need enhances empathy concerns and norm compliance, raising the participants' prosocial decision-making.

Acetaminophen changes Mu rhythm power related to pain empathy

Empathy is an intricate ability that entails the subjective feeling and understanding of emotions someone else may be experiencing. Acetaminophen, the active ingredient found in Tylenol, is among the most common pain medications consumed. There is new evidence, however, that suggests this common analgesic may also dampen empathic processes. However, no previous study has investigated the effect acetaminophen may have on pain empathy or mu power during a pain empathy task. Therefore, participants were randomly assigned to either an experimental (acetaminophen) or control (sugar) group in a double-blinded experimental research design aimed to measure mu power (using EEG) and behavioral responses to painful and non-painful images. Participants in the experimental group were administered 1000 mg of acetaminophen, and it was verified that participants were unaware which group they were assigned. We found that mu suppression was greater in the acetaminophen group, which was strongest at electrode C3. Additionally, mu power differences between painful and non-painful images were related to trait empathy, and mu power during the painful images were positively correlated with empathy scores. Results from this study suggest that in addition to reducing physical pain, acetaminophen may also change the brain response when perceiving others in pain. The implications of these findings could possibly lead to changes in how we prescribe and administer this common drug.

The role of empathy in shared intentionality: Contributions from Inter-Processual Self theory

Research in psychology related to the conceptualization of empathy has been on the rise in the last decades. However, we argue that there is still space for further research to help capture the important notion of empathy and its theoretical and conceptual depth. Following a critical review of the current state of the research that conceptualizes and measures empathy, we focus on works that highlight the importance of a shared vision and its relevance in psychology and neuroscience. Considering the state of the art of current neuroscientific and psychological approaches to empathy, we argue for the relevance of shared intention and shared vision in empathy-related actions. Upon review of different models that emphasize a shared vision for informing research on empathy, we suggest that a newly developed theory of self, human growth and action–the so-called Inter-Processual Self theory (IPS)–can significantly and novelly inform the theorization on empathy beyond what the literature has stated to date. Then, we show how an understanding of integrity as a relational act that requires empathy is an essential mechanism for current key research on empathy and its related concepts and models. Ultimately, we aim to present IPS as a distinctive proposal to expand upon the conceptualization of empathy.

Empathy is not so perfect! -For a descriptive and wide conception of empathy

Physician empathy is considered essential for good clinical care. Empirical evidence shows that it correlates with better patient satisfaction, compliance, and clinical outcomes. These data have nevertheless been criticized because of a lack of consistency and reliability. In this paper, we claim that these issues partly stem from the widespread idealization of empathy: we mistakenly assume that physician empathy always contributes to good care. This has prevented us from agreeing on a definition of empathy, from understanding the effects of its different components and from exploring its limits. This is problematic because physicians' ignorance of the risks of empathy and of strategies to manage them can impact their work and wellbeing negatively. To address this problem, we explore the effects of the potential components of empathy and argue that it should be conceived as a purely descriptive and wide term. We end by discussing implications for medical education.

Pain Empathy and Its Association with the Clinical Pain in Knee Osteoarthritis Patients

Objective

Knee osteoarthritis (KOA) is a painful chronic disorder. Evidence has shown that a history of chronic pain plays an important role in shaping empathy. Empathy, a valuable indicator of social functioning that refers to an individual's ability to share the experiences of others, however, has been overlooked in KOA patients. This study aimed to investigate empathy and its association with clinical pain in KOA patients.

Methods

KOA patients (n=47) and healthy controls (HCs, n=44) completed two empathy-for-pain tasks: a pain judgment task in which participants judged whether a person in an image felt pain or not, and a pain rating task in which they estimated pain intensity for themselves and others. The Interpersonal Reactivity Index was used to measure participants' trait empathy, and clinical severity and psychological factors were assessed using relevant instruments.

Results

Compared to HCs, KOA patients showed higher accuracy when judging pain and non-pain images and reported overall higher pain intensity when rating for themselves and others. KOA patients also showed greater personal distress than HCs in terms of their self-reported empathy. Moreover, pain catastrophizing particularly mediated the relationship between pain severity and pain ratings for others, and depression, anxiety, and pain catastrophizing all mediated the association between pain severity and empathy-induced personal distress.

Conclusion

These findings suggest that patients with KOA have increased empathy, demonstrated by elevated sensitivity to pain-related scenes and intense emotional responses.

Sympathy-Empathy and the Radicalization of Young People

BACKGROUND

The sympathy-empathy (SE) system is commonly considered a key faculty implied in prosocial behaviors, and SE deficits (also called callous-unemotional traits, CUTs) are associated with nonprosocial and even violent behaviors. Thus, the first intuitive considerations considered a lack of SE among young people who undergo radicalization. Yet, their identification with a cause, their underlying feelings of injustice and grievance, and the other ways in which they may help communities, suggest that they may actually have a lot of empathy, even an excess of it. As a consequence, the links between SE and radicalization remain to be specified. This critical review aims to discuss whether and how SE is associated with developmental trajectories that lead young people to radicalization.

METHOD

We first recall the most recent findings about SE development, based on an interdisciplinary perspective informed by social neuroscience. Then, we review sociological and psychological studies that address radicalization. We will critically examine the intersections between SE and radicalization, including neuroscientific bases and anthropologic modulation of SE by social factors involved in radicalization.

RESULTS

This critical review indicates that the SE model should clearly distinguish between sympathy and empathy within the SE system. Using this model, we identified three possible trajectories in young radicalized individuals. In individuals with SE deficit, the legitimization of violence is enough to engage in radicalization. Concerning individuals with normal SE, we hypothesize two trajectories. First, based on SE inhibition/desensitization, individuals can temporarily join youths who lack empathy. Second, based on an SE dissociation, combining emotional sympathy increases for the in-group and cognitive empathy decreases toward the out-group.

CONCLUSIONS

While confirming that a lack of empathy can favor radicalization, the counterintuitive hypothesis of a favorable SE development trajectory also needs to be considered to better specify the cognitive and affective aspects of this complex phenomenon.

Neural underpinnings of default mode network on empathy revealed by intracranial stereoelectroencephalography

BACKGROUND

Empathy is the ability to understand and share the feelings of others. It is fundamental to emotional intelligence and social iterations. Neuroimaging studies have demonstrated that empathy activates brain regions associated with the social cognition network.

AIM

To explore the neural underpinnings of empathy revealed by stereoelectroencephalography utilizing recurrence quantification analysis (RQA).

METHODS

This retrospective cohort included 38 epilepsy patients with stereoelectroencephalography implantation. RQA metrics were applied to parameterize the network organization of default mode network (DMN) brain regions. The relationships between DMN, seizure burden activity, and empathy, as measured using the Interpersonal Reactivity Index, were examined using partial least-square regression and mediation analysis.

RESULTS

RQA metrics with DMN (R²  = 0.75, P_Bonferroni  < 0.001) and its subsystems (medial temporal subsystem: R²  = 0.53, P_Bonferroni  < 0.001; core subsystem: R²  = 0.70, P_Bonferroni  < 0.001; dorsal medial subsystem: R²  = 0.48, P_Bonferroni  < 0.001) were positively correlated with empathy scores. Of 13 RQA metrics, the mean diagonal line length, entropy of the diagonal line lengths, trapping time, maximal vertical line length, and recurrence time of second type were found to be statistically higher in patient cohorts with reportedly high empathy. Furthermore, DMN characteristics (b path: F = 3.69, P = 0.04), rather than seizure burdens (direct effect: t = 0.33, P = 0.74, c' = - 0.007), mediated empathy status.

CONCLUSION

The present study used various RQA metrics to parameterize the network organization of DMN and determine the neural underpinning of DMN for empathy modulation.

Neural mechanisms of brand love relationship dynamics: Is the development of brand love relationships the same as that of interpersonal romantic love relationships?

Brand love is a relationship between brands and consumers. Managing the relationship is an important issue for marketing strategy since it changes according to temporal flow. Brand love theories, including their dynamics, have been developed based on interpersonal romantic love theories. Although many brand love studies have provided useful findings, the neural mechanism of brand love remains unclear. Especially, its dynamics have not been considered from a neuroscience perspective. The present study addressed the commonalities and differentiations of activated brain regions between brand love and interpersonal romantic love relationships using a quantitative neuroimaging meta-analytic approach, from the view of brain connectivity. Regarding the mental processes of each love relationship related to these activated brain regions, decoding analysis was conducted using the NeuroQuery platform to prevent reverse inference. The results revealed that different neural mechanisms and mental processes were distinctively involved in the dynamics of each love relationship, although the anterior insula overlapped across all stages and the reinforcement learning system was driven between both love relationships in the early stage. Remarkably, regarding the distinctive mental processes, although prosocial aspects were involved in the mental processes of interpersonal romantic love relationships across all stages, they were not involved in the mental processes of brand love relationships. Conclusively, although common brain regions and mental processes between both love relationships were observed, neural mechanisms and mental processes in brand love relationship dynamics might be innately different from those in the interpersonal romantic love relationship dynamics. As this finding indicates essential distinctiveness between both these relationships, theories concerning interpersonal romantic love should be applied cautiously when investigating brand love relationship dynamics.

Association between empathy and drinking among a community sample of heavy drinkers: Sex differences and neural correlates

Alcohol use disorder (AUD) is a major health problem, yet most individuals with AUD do not perceive a need for formal treatment and do not receive treatment. The lack of treatment seeking among individuals with AUD may suggest a lack of self-awareness and insight into the seriousness of AUD related problems, as well as lack of empathy for the impact of one's drinking on others. Recent work has suggested that empathy may be impaired among individuals seeking treatment for AUD. Further these impairments may differ by sex such that males with lower empathy reported more drinking consequences and greater drinking intensity, but there was no association between empathy and drinking among females. The current study used regression analyses (alpha = 0.05) to examine the association between empathy (as measured by the four scales of the Interpersonal Reactivity Index), independent components of gray matter volume in regions associated with empathy, and drinking variables among non-treatment seeking drinkers with AUD (N = 136) and also examined these effects by sex. Results showed greater perspective taking was associated with less temporoparietal and frontotemporal gray matter volume (B(SE) = -0.912 (0.043), p = 0.034). An interaction between perspective taking and sex was associated with craving, such that higher perspective taking was associated with less craving for males only (B(SE) = -0.48 (0.243), p = 0.049; R2 = 0.087). Empathic concern was related to lower percent heavy drinking days for both males and females (B(SE) = -1.57 (0.743), p = 0.035; R2 = 0.11). The current study found empathy may be an important predictor of craving for males and frequency of heavy drinking for males and females. Future work should investigate whether empathy predicts treatment seeking.

Altered voxel-wise degree centrality associated with patients with comitant exotropia

Objective of the study is to investigate the altered intrinsic functional hubs in patients with comitant exotropia (CE) using the voxel-wise degree centrality (DC) analysis method. A total of 28 CE patients and 28 healthy controls (HCs) similarly matched in sex, age, and education level were recruited in this study. All subjects underwent a resting-state functional MRI scan, the voxel-wise DC method was applied to evaluate brain network hubs alterations in CE patients. Then, the DC maps between two groups were chosen to be classification features to distinguish patients with CE from HCs based on the support vector machine (SVM) model. The algorithm performance was evaluated by a permutation test. Compared with HCs, CE patients exhibited significant enhanced DC value in the left cerebelum 8 and the right cerebelum 3; and remarkably decreased DC value in the right precentral gyrus, right anterior cingulated, and paracingulate gyri (two-tailed, voxel level: P < 0.01; GRF correction, cluster level: P < 0.05). However, no relationship was found between the observed average DC of the different brain regions and the clinical features ( P > 0.05). In addition, the SVM model showed an accuracy of 83.93% to clarify CE patients from HCs using the DC maps as a classification feature. CE patients displayed altered functional network hubs in multiple brain areas associated with cognition and motor control, and the DC variability could classify patients from HCs with high accuracy. These findings may assist to understand the neuropathological mechanism for the disease.

Single-dose testosterone administration modulates instant empathic responses to others' pain: An EEG study

Whether or not testosterone can impair empathy remains unclear in the literature. Given that empathic responses to others' emotional experiences depend strongly upon top-down controlled mechanisms of attention, here we investigated whether the effects of testosterone administration on pain empathy could be modulated by manipulating attention. We used a double-blind, placebo-controlled within-participant design, in which either testosterone or placebo was administrated in separate sessions. Images depicting painful or nonpainful scenes were presented to induce instant empathic responses. Experiment 1 adopted the pain-judgment and hands-counting tasks to direct attention toward painful or nonpainful aspect of the images, respectively. Experiment 2 employed the pain-rating task to estimate affective and cognitive aspects of pain empathy. When discriminating nonpainful aspects of the images in the hands-counting task, accuracies were lower and empathic late positive potential responses were greater in testosterone sessions than in placebo sessions. This suggested that testosterone enhanced empathic responses to task-irrelevant pain-related features, which interfered with task performance. When providing empathic ratings to the images in the pain-rating task, empathic event-related potentials in the early stage were only observed in the testosterone session. This suggested that testosterone facilitated automatic affective reactivity to others' pain when elaborately processing empathic stimuli. Nevertheless, when discriminating painful aspects of the images in the pain-judgment task, we did not observe any significant differences between the two sessions. These results demonstrated that testosterone effects on enhancing brain reactivity to empathic stimuli were dependent upon task demands deploying attention allocation. The enhancement likely arose from the altered brain state (e.g., increased vigilance and arousal levels) after testosterone administration, as evidenced by the reduced amplitude of spontaneous α-oscillation recorded before the onset of the images. It expands our understanding of the neurobiological mechanisms that affect empathy, and highlights the role of testosterone.

Psychogenic (nociplastic) pain: Current state of diagnosis, treatment options, and potentials of neurosurgical management

Classification of pain syndromes is quite multifaceted. However, pathogenetic classification by which chronic pain syndromes are usually divided into nociceptive, neuropathic and psychogenic, is crucial in choosing treatment tactics. In modern classifications, psychogenic pain is distinguished from nociceptive pain (associated with direct tissue injury or damage) and neuropathic pain (in which lesion can only be determined morphologically). Mental disorders play a leading role in psychogenic pain. Here, somatic/neurological disorders, if any, are of no pathogenetic significance in the dynamics of pain syndrome. There are certain algorithms (though not yet fully developed) and even guidelines for diagnosing and treating nociceptive and neuropathic pain, whereas psychogenic pain has been and still is almost out of sight for a long time. Despite its considerable prevalence, attitude towards it is still uncertain. Until now, it has no single classification, nor any strategy with regards to diagnosis, treatment and prevention.

Psychopathic traits modulate functional connectivity during pain perception and perspective-taking in female inmates

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PCL-R scores are associated with altered functional connectivity in female inmates.

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PCL-R Factor 1 and Factor 2 subscores predicted opposite shifts in connectivity.

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Functional connectivity in the salience network is altered during pain perception.

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Connectivity in the social cognition network is altered during perspective-taking.

The ability to share and understand the distress of others is critical for successful social interactions and is a fundamental building block of morality. Psychopathy is a personality disorder that includes lack of empathy and concern for others. In the present study, functional MRI was used to examine neural responses and functional connectivity associated with empathy and affective perspective-taking in female inmates (N = 109) with various levels of psychopathic traits, as measured with Psychopathy Checklist-Revised (PCL-R). Participants viewed hands and feet in painful or non-painful situations while adopting a first person or third person perspective. All participants demonstrated robust neural responses in anterior insula (aINS), anterior cingulate (ACC), temporoparietal junction (TPJ) and supplementary motor area (SMA) when viewing pain, both during imagine-self and imagine-other blocks. Psychopathy shifted the functional connectivity seeded in core nodes of the salience and social cognition networks. Perceiving stimuli depicting somatic pain led to decreased functional coupling from right temporoparietal junction to superior temporal sulcus, which correlated with scores on PCL-R Factor 1 (Affective/Interpersonal). In contrast, connectivity from right insula to precuneus increased with Factor 2 (Lifestyle/Antisocial) scores. When adopting a third-person perspective, psychopathic traits modulated connectivity from the social cognition network, but not the salience network, with Factor 1 scores associated with increased connectivity to sensorimotor cortex and temporal pole, while Factor 2 scores were associated with decreased connectivity with ACC/SMA and inferior frontal gyrus. Overall, these results demonstrate that psychopathic traits in incarcerated females are associated with atypical functional connectivity within the salience network during pain-empathy processing and within the social cognition network during affective perspective-taking.

Better I than He: Personal perspective modulates counterfactual processing

First-person narratives are more attentively and emotionally engaging than third-person narratives. This study examined whether and how personal perspective modulates counterfactual processing. Participants read counterfactual and causal conditionals written from the first-person or third-person perspective (e.g., If/Because I/he had read enough literature before, I/he would have finished my/his thesis easily.), followed by factual consequences that contained a critical word either consistent or inconsistent with preceding contexts (e.g., Therefore, when I/he was about to defend the thesis I/he felt panicked/confident). In both perspectives, inconsistent words showed a prolonged N400 vs. consistent words in the counterfactual condition, but a larger P600 in the causal condition. The critical word showed a larger P600 in the first- than the third-person condition in counterfactual scenarios, but not in causal scenarios. These findings suggest that personal perspective exerts different influences on counterfactual processing, presumably by modulating the amount of attentional resources involved.

Reappraisal and empathic perspective-taking - More alike than meets the eyes

Emotion regulation and empathy represent highly intertwined psychological processes sharing common conceptual ground. Despite the wealth of research in these fields, the joint and distinct functional nature and topological features of these constructs have not yet been investigated using the same experimental approach. This study investigated the common and distinct neural correlates of emotion regulation and empathy using a meta-analytic approach. The regions that were jointly activated were then characterized using meta-analytic connectivity modeling and functional decoding of metadata terms. The results revealed convergent activity within the ventrolateral and dorsomedial prefrontal cortex as well as temporal regions. The functional decoding analysis demonstrated that emotion regulation and empathy were related to highly similar executive and internally oriented processes. This synthesis underlining strong functional and neuronal correspondence between emotion regulation and empathy could (i) facilitate greater integration of these two separate lines of literature, (ii) accelerate progress toward elucidating the neural mechanisms that support social cognition, and (iii) push forward the development of a common theoretical framework for these psychological processes essential to human social interactions.

The role of right supra-marginal gyrus and secondary somatosensory cortex in age-related differences in human emotional egocentricity

Emotional egocentric bias (EEB) occurs when, due to a partial failure in self-other distinction, empathy for another's emotion is influenced by our own emotional state. Recent studies have revealed a higher EEB in children, adolescents and older adults compared to young adults, but the neural correlates of this finding are largely unknown. We asked female participants (N = 95) from three different age groups (adolescents, young and older adults) to perform a well-validated EEB task in an MRI scanner. We assessed task-based changes in activity and effective connectivity as well as morphometric changes in regions of interest to pinpoint functional and structural age-related differences. Results revealed higher EEB in older compared to young adults and adolescents. Connectivity between right supramarginal gyrus (rSMG) and somatosensory cortices acted as a partial mediator between age and EEB. The findings suggest that an intact connectivity of rSMG, rather than its regional activity, with sensory-perceptual brain areas is crucial for overcoming egocentric biases of empathic judgments.

The importance of pro-social processing, and ameliorating dysfunction in schizophrenia. An FMRI study of oxytocin

Schizophrenia is often a severe and debilitating mental illness, frequently associated with impairments in social cognition that hinder individuals' abilities to relate to others and integrate effectively in society. Oxytocin has emerged as a putative therapeutic agent for treating social deficits in schizophrenia, but the mode of action remains unclear. This placebo-controlled crossover study aimed to elucidate the neural underpinnings of oxytocin administration in patients with schizophrenia. 20 patients with schizophrenia were examined using functional magnetic resonance imaging under oxytocin (40 IU) or placebo nasal spray. Participants performed a stochastically rewarded decision-making task that incorporated elements of social valence provided by different facial expressions, i.e. happy, angry and neutral. Oxytocin attenuated the normal bias in selecting the happy face accompanied by reduced activation in a network of brain regions that support mentalising, processing of facial emotion, salience, aversion, uncertainty and ambiguity in social stimuli, including amygdala, temporo-parietal junction, posterior cingulate cortex, precuneus and insula. These pro-social effects may contribute to the facilitation of social engagement and social interactions in patients with schizophrenia and warrant further investigation in future clinical trials for social cognitive impairments in schizophrenia.

Assessing and Optimizing Socio-Moral Reasoning Skills: Findings From the MorALERT Serious Video Game

Background

Social cognition and competence are a key part of daily interactions and essential for satisfying relationships and well-being. Pediatric neurological and psychological conditions can affect social cognition and require assessment and remediation of social skills. To adequately approximate the complex and dynamic nature of real-world social interactions, innovative tools are needed. The aim of this study was to document the performance of adolescents on two versions of a serious video game presenting realistic, everyday, socio-moral conflicts, and to explore whether their performance is associated with empathy or sense of presence, factors known to influence social cognition.

Methods

Participants (12–17 years, M = 14.39; SD = 1.35) first completed a pre-test measure of socio-moral reasoning based on three dilemmas from a previously validated computer task. Then, they either played an evaluative version (n = 24) or an adaptive (n = 33) version of a video game presenting nine social situations in which they made socio-moral decisions and provided justifications. In the evaluative version, participants’ audio justifications were recorded verbatim and coded manually to obtain a socio-moral reasoning maturity score. In the adaptive version (AV), tailored feedback and social reinforcements were provided based on participant responses. An automatic coding algorithm developed using artificial intelligence was used to determine socio-moral maturity level in real-time and to provide a basis for the feedback and reinforcements in the game. All participants then completed a three-dilemma post-test assessment.

Results

Those who played the adaptive version showed improved SMR across the pre-test, in-game and post-test moral maturity scores, F(1.97,63.00) = 9.81, p_HF < 0.001, ϵ² = 0.21, but those who played the Evaluative version did not. Socio-moral reasoning scores from both versions combined did not correlate with empathy or sense of presence during the game, though results neared significance. The study findings support preliminary validation of the game as a promising method for assessing and remediating social skills during adolescence.

Eye Gaze in Autism Spectrum Disorder: A Review of Neural Evidence for the Eye Avoidance Hypothesis

Reduced eye contact early in life may play a role in the developmental pathways that culminate in a diagnosis of autism spectrum disorder. However, there are contradictory theories regarding the neural mechanisms involved. According to the amygdala theory of autism, reduced eye contact results from a hypoactive amygdala that fails to flag eyes as salient. However, the eye avoidance hypothesis proposes the opposite-that amygdala hyperactivity causes eye avoidance. This review evaluated studies that measured the relationship between eye gaze and activity in the 'social brain' when viewing facial stimuli. Of the reviewed studies, eight of eleven supported the eye avoidance hypothesis. These results suggest eye avoidance may be used to reduce amygdala-related hyperarousal among people on the autism spectrum.

Investigating the Influence of Intergroup Contact in Virtual Reality on Empathy: An Exploratory Study Using AltspaceVR

Virtual Reality (VR) has often been referred to as an "empathy machine." This is mostly because it can induce empathy through embodiment experiences in outgroup membership. However, the potential of intergroup contact with an outgroup avatar in VR to increase empathy is less studied. Even though intergroup contact literature suggests that less threatening and more prosocial emotions are the key to understanding why intergroup contact is a powerful mean to decrease prejudice, few studies have investigated the effect of intergroup contact on empathy in VR. In this study, we developed a between-participants design to investigate how VR can be used to create a positive intergroup contact with a member of a stigmatized outgroup (ethnic minority) and present the results of the effect of intergroup contact in VR on empathy. Sixty four participants experienced either positive contact (i.e., equal intergroup status, collaborative) with a black (experimenter-controlled) avatar (experimental condition) or no intergroup contact (i.e., ingroup contact with a white avatar; control condition), with situational empathy (personal distress and empathic interest) being measured through a self-report questionnaire up to a week before and right after the VR contact experience. The experiment showed that satisfying degrees of body ownership of participants' own avatar and co-presence with the contacted avatar can be achieved in simple and universally accessible virtual environments such as AltspaceVR. The results indicated that while VR intergroup contact had no significant direct effect on empathy, exploratory analyses indicated that post-intervention empathic interest increased with stronger feelings of co-presence in the intergroup contact condition.

The pain in the Emergency Department: Choosing and treating wisely before and during the COVID-19 era

Pain is a frequent reason for referral to the Emergency Department (ED). Adequate management of pain is a moral and ethical imperative. If not correctly treated, acute pain can cause physical and psychological complications, and become chronic with severe consequences such as anxiety, depression, and social isolation. As consequence, emergency clinicians should treat pain as soon as possible, avoiding delays even in case of acute abdominal pain. Pain management is particularly complex in the elderly and emergency clinicians should always consider AGS Beers criteria ® to avoid inappropriate medications, severe side-effects, and drug-drug interactions. Pain is also a common cause of delirium in older patients. The SARS CoV-2 infection not only can cause acute pain, but also exacerbate chronic pain, particularly in the elderly, who are at high risk to be infected. Looking at all this evidence, emergency clinicians should treat pain with different strategies according to their experience and cultural background, making the right choice for each patient. This work is a critical review of the pain management in the ED, with a particular attention on the effects of COVID-19 in the EDs. We conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline from 2000 to 2020, using the keywords of “pain”, “emergency”, “COVID19”, “elderly”, “palliative care”, “ketamine”, “dexmedetomidine”, and “post-traumatic stress disorder”. The aim of this review is to help emergency clinicians to correctly manage pain in the ED with a new point of view regarding the pain management in COVID-19 patients.

The effect of sleep deprivation on empathy for pain: An ERP study

Empathy for pain has a strong adaptive function. It plays a protective role in survival and exerts a vital impact on successful social interaction. Sleep loss, however, is commonplace in current society, and people are increasingly plagued by it. Previous studies have investigated whether sleep loss affects empathy for pain, yet the results were undecided. We aimed to determine whether this effect is existed and further explore the temporal and frequency dynamics of neural activities involved in this effect by recording the electroencephalogram (EEG) signals. We recruited 25 healthy adults (11 females) who were required to perform a pain judgement and unpleasantness rating about the presented nociceptive and neutral pictures after nocturnal sleep (NS) and sleep deprivation (SD), and their neuronal activities were recorded by event-related potentials (ERPs). Results showed a significantly decreased amplitude in the early components (N2, N340) of vicarious pain processing after SD. In further time-frequency (TF) analysis, a reduced energy occurred in theta2 (5-7 Hz) band under SD condition. Moreover, the decreased theta2 was positively correlated with the subjective ratings of both other's pain and self-unpleasantness only under SD condition. Our results indicated that SD impairs affective sharing of empathy for pain.

Neural shifts in alpha rhythm's dual functioning during empathy

INTRODUCTION

Alpha oscillations are unique in their capacity to relay neuronal information through a dual-process named "gating by inhibition": rhythmic enhancement inhibits task-irrelevant regions while rhythmic suppression engages task-relevant regions in the brain. A social-cognitive process that operates by relying on the suppression of the alpha rhythm in the primary somatosensory cortex (S1) is the ability to generate empathy. This phenomenon has been evidenced in dozens of electrophysiological studies targeting adult human subjects. Yet, recent studies on the neurodevelopment of empathy indicate that in younger age, empathy does not involve alpha suppression in S1 but only enhancement. More interestingly, right before adulthood, this rhythm is still enhanced, but in a remarkable shift, a pattern of suppression emerges. In this registered magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) study, we will capture frequency-decomposed neural activity particularly at the alpha range and its corresponding hemodynamic response and target subjects at around 20 years old as a unique time-window in development that allows investigating in parallel both low-alpha suppression and high-alpha enhancement. We aim to address two questions: (a) Does alpha power suppression in the S1 region during empathy correspond to BOLD increase in this region? (b) What is the functional role of alpha power enhancement during empathy development (BOLD signal increase or decrease)? Addressing these questions will particularly advance knowledge on the process of empathy in the brain, and the way in which it is underpinned by alpha oscillations. Moreover, examining these experimental outcomes can potentially lay the ground for future studies that would further examine the role of alpha oscillations in empathy during the course of development.

METHODS

Brain data of forty healthy individuals close to 20 years old will be recorded in two consecutive MEG and fMRI sessions while subjects observing physical pain versus neutral stimuli. Besides, each participant's subjective experiences wll be measred by questionnaires, interviews and rating of the stimuli.

The Effect of Empathy on the Attentional Processing of Painful and Emotional Stimuli

Background

Empathy is shown to affect the attentional processing of painful stimuli and emotional stimuli. However, whether the attentional effects on emotional stimuli depend on emotional valence and the nature of the relationship between the attentional effects on different stimuli are still unknown.

Methods

In the present study, 25 high-empathy (HE) participants and 25 low-empathy (LE) participants were recruited to perform dot-probe tasks on painful stimuli and emotional stimuli.

Results

The results showed that HE individuals had weak attentional disengagement to painful pictures. More importantly, regarding emotional pictures, HE individuals showed attentional avoidance to negative emotion pictures, while LE individuals showed attentional bias to positive emotion pictures. Correlation analysis showed that the attentional bias score and attentional disengagement score were only associated with each other within the same category of stimuli (painful, positive or negative stimuli).

Conclusion

These results revealed that HE individuals mainly showed attentional avoidance to negative stimuli, while LE individuals mainly showed attentional bias to positive stimuli.

The Impact of Parental Pain-attending and Non-pain-attending Responses on Child Pain Behavior in the Context of Cancer-related Painful Procedures: The Moderating Role of Parental Self-oriented Distress

OBJECTIVES

Literature has demonstrated inconsistent findings regarding the impact of parental responses on child pain-related outcomes. Yet, research into factors that may underlie inconsistent findings regarding the variable impact of parental responses is lacking. The current study investigated the moderating role of parental distress in understanding the impact of parental pain-attending (eg, reassuring the child) and non-pain-attending (eg, distracting the child with humor) responses on child pain behavior (eg, crying).

METHODS

Children (18 y and younger) with leukemia, undergoing a lumbar puncture (LP) and/or bone marrow aspiration procedure, and one of their parents, were recruited from the Pediatric Ghent University Hospital. Parent-child interactions were videotaped after the procedure allowing coding of parental responses and child pain behavior. Parents self-reported on experienced personal distress.

RESULTS

Participants consisted of 42 children (24 boys, 18 girls) with leukemia and one of their parents. Children were 0.6 to 15 (7.08±4.39) years old. Findings indicated a positive association between parental pain-attending and child pain behavior, but only when parents reported high levels of distress (β=0.56, P=0.001). No association was observed for parents reporting low levels of distress (β=-0.09, ns). Parental non-pain-attending responses contributed to lower child pain behavior (β=-0.24, P=0.045), independently of parental distress (β=-0.07, ns).

DISCUSSION

The current findings point to the moderating role of parental distress in understanding the impact of parental responses on child pain behavior and highlight the importance of interventions targeting parental emotion regulation to promote optimal child pain outcomes.

Shared and distinct functional networks for empathy and pain processing: a systematic review and meta-analysis of fMRI studies

BACKGROUND

Empathy for pain is a complex phenomenon incorporating sensory, cognitive and affective processes. Functional neuroimaging studies indicate a rich network of brain activations for empathic processing. However, previous research focused on core activations in bilateral anterior insula (AI) and anterior cingulate/anterior midcingulate cortex (ACC/aMCC) which are also typically present during nociceptive (pain) processing. Theoretical understanding of empathy would benefit from empirical investigation of shared and contrasting brain activations for empathic and nociceptive processing.

METHOD

Thirty-nine empathy for observed pain studies (1112 participants; 527 foci) were selected by systematic review. Coordinate based meta-analysis (activation likelihood estimation) was performed and novel contrast analyses compared neurobiological processing of empathy with a comprehensive meta-analysis of 180 studies of nociceptive processing (Tanasescu et al., 2016).

RESULTS

Conjunction analysis indicated overlapping activations for empathy and nociception in AI, aMCC, somatosensory and inferior frontal regions. Contrast analysis revealed increased likelihood of activation for empathy, relative to nociception, in bilateral supramarginal, inferior frontal and occipitotemporal regions. Nociception preferentially activated bilateral posterior insula, somatosensory cortex and aMCC.

CONCLUSION

Our findings support the likelihood of shared and distinct neural networks for empathic, relative to nociceptive, processing. This offers succinct empirical support for recent tiered or modular theoretical accounts of empathy.

Placebo Analgesia Does Not Reduce Empathy for Naturalistic Depictions of Others' Pain in a Somatosensory Specific Way

The shared representations account postulates that sharing another's pain recruits underlying brain functions also engaged during first-hand pain. Critically, direct causal evidence for this was mainly shown for affective pain processing, while the contribution of somatosensory processes to empathy remains controversial. This controversy may be explained, however, by experimental paradigms that did not direct attention towards a specific body part, or that did not employ naturalistic depictions of others' pain. In this preregistered functional magnetic resonance imaging study, we aimed to test whether causal manipulation of first-hand pain affects empathy for naturalistic depictions of pain in a somatosensory-matched manner. Forty-five participants underwent a placebo analgesia induction in their right hand and observed pictures of other people's right and left hands in pain. We found neither behavioral nor neural evidence for somatosensory-specific modulation of pain empathy. However, exploratory analyses revealed a general effect of the placebo on empathy, and higher brain activity in bilateral anterior insula when viewing others' right hands in pain (i.e., corresponding to one's own placebo hand). These results refine our knowledge regarding the neural mechanisms of pain empathy, and imply that the sharing of somatosensory representations seems to play less of a causal role than the one of affective representations.

Simulation and social behavior: an fMRI study of neural processing during simulation in individuals with and without risk for psychosis

Social dysfunction is a risk indicator for schizophrenia spectrum disorders, with at-risk individuals demonstrating a range of social behavior impairments. Variability in social ability may be explained by individual differences in the psychological processes of social behavior. In particular, mental simulation, the process by which an individual generates an internal representation of the thoughts or feelings of another, may explain variation in social behavior. This study investigates the neural process of simulation in healthy individuals and individuals at risk for psychosis. Using a novel fMRI pain paradigm, individuals watch videos of another person’s hand or foot experiencing pain. After each video, individuals are asked to simulate the observed painful situation on their own hand or foot. Neural activity during simulation in the somatosensory cortex was associated with real-world self-reported social behavior, such that a stronger neural response in the somatosensory cortex was associated with greater rates of positive social experiences and affective empathy across all participants. These findings suggest that the neural mechanisms that underlie simulation are important for social behavior, and may explain individual variability in social functioning in healthy and at-risk populations.

Brief Self-Compassion Training Alters Neural Responses to Evoked Pain for Chronic Low Back Pain: A Pilot Study

OBJECTIVE

Self-compassion meditation, which involves compassion toward the self in moments of suffering, shows promise for improving pain-related functioning, but its underlying mechanisms are unknown. This longitudinal, exploratory pilot study investigated the effects of a brief (eight contact hours, two weeks of home practice) self-compassion training on pain-related brain processing in chronic low back pain (cLBP).

METHODS

We evaluated functional magnetic resonance imaging (fMRI) response to evoked pressure pain and its anticipation during a self-compassionate state and compared altered brain responses following training with changes on self-reported measures of self-compassion (Self-Compassion Scale [SCS]), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness [MAIA]), and clinical pain intensity.

RESULTS

In a sample of participants with cLBP (N = 20 total, N = 14 with complete longitudinal data) who underwent self-compassion training, we observed reduced clinical pain intensity and disability (P < 0.01) and increased trait self-compassion and interoceptive awareness (all P < 0.05) following training. Evoked pressure pain response in the right temporo-parietal junction (TPJ) was reduced following training, and decreases were associated with reduced clinical pain intensity. Further, increased fMRI responses to pain anticipation were observed in the right dorsolateral prefrontal cortex (dlPFC) and ventral posterior cingulate cortex (vPCC), and these increases were associated with mean post-training changes in SCS scores and scores from the body listening subscale of the MAIA.

DISCUSSION

These findings, though exploratory and lacking comparison with a control condition, suggest that self-compassion training supports regulation of pain through the involvement of self-referential (vPCC), salience-processing (TPJ), and emotion regulatory (dlPFC) brain areas. The results also suggest that self-compassion could be an important target in the psychotherapeutic treatment of cLBP, although further studies using controlled experimental designs are needed to determine the specificity of these effects.

Altered brain network organization in romantic love as measured with resting-state fMRI and graph theory

Romantic love is a complex state that has been seen as similar to addiction. Previous task-based functional magnetic resonance imaging (fMRI) studies have shown that being in love is closely associated with functional brain changes in the reward and motivation system. However, romantic love-related functional connectivity network organization in resting-state fMRI has yet to be elucidated. To that end, here we used resting-state fMRI and graph theory to compare whole-brain functional network topology between an "in-love" group (n = 34, 16 females, currently in love and in a romantic relationship) and a "single" group (n = 32, 14 females, never in love and not in a romantic relationship). Compared to the single group, we found lower network segregation in the love group (i.e., lower small-worldness, mean clustering coefficient, and modularity), and these metrics were negatively associated with scores on the Passionate Love Scale (PLS) (an index of intense passionate/romantic love). Additionally, the love group displayed altered connectivity degree (reflecting the importance of a node): decreased degree in left angular gyrus and left medial orbitofrontal cortex, but increased degree in left fusiform gyrus. Furthermore, local efficiency or degree of these regions was significantly correlated to PLS scores. Taken together, results showed decreased overall brain functional segregation but enhanced emotional-social processing in romantic lovers. These findings provide the first evidence of love-related brain network organization changes and suggest similar but different brain network alterations between romantic love and addiction, providing new insights on the neural systems underlying romantic love.