Empathic pain: Exploring the multidimensional impacts of biological and social aspects in pain

Empathic pain refers to an individual's perception, judgment, and emotional response to others' pain. This complex social cognitive ability is crucial for healthy interactions in human society. In recent years, with the development of multidisciplinary research in neuroscience, psychology and sociology, empathic pain has become a focal point of widespread attention in these fields. However, the neural mechanism underlying empathic pain remain a controversial and unresolved area. This review aims to comprehensively summarize the history, influencing factors, neural mechanisms and pharmacological interventions of empathic pain. We hope to provide a comprehensive scientific perspective on how humans perceive and respond to others' pain experiences and to provide guidance for future research directions and clinical applications. This article is part of the Special Issue on "Empathic Pain".

Revisiting the Structure of the Chinese Version of the Questionnaire of Cognitive and Affective Empathy and Its Relationships with Schizotypy and Paranoia Using Network Approaches

Empathy is predominantly assessed with self-report questionnaires. However, their structural validities were not well-supported. This study aimed to re-explore and refine the factor structure of the Chinese version of the Questionnaire of Cognitive and Affective Empathy (QCAE) and investigate the pathways linked between dimensions of empathy and schizotypy. Data from a valid sample of 1,360 community-dwelling adults (aged 18-35) were subjected to the exploratory graph analysis (EGA) and bootstrap EGA for factor retention. A goodness-of-fit evaluation was conducted using confirmatory factor analysis (CFA). Lastly, a Gaussian graphical model with sum scores of the resultant empathy dimensions, positive, negative, and disorganized schizotypy, and paranoia as nodes was estimated. Results supported a three-factor structure for the revised 20-item QCAE, demonstrating a good model fit. The new Online simulation subscale was associated with reduced disorganized schizotypy, whereas the new Perspective-taking subscale was associated with decreased disorganized schizotypy and increased positive schizotypy. The composite Affective empathy subscale was associated with decreased negative schizotypy and increased positive and disorganized schizotypy and paranoia. Overall, the revised QCAE demonstrated good structural validity, measuring three separable and internally cohesive factors of empathy. Each factor possessed unique and differential relationships with schizotypy dimensions that merit research and clinical attention.

Assessing Autistic Traits, Hikikomori Tendencies, Pathological Videogaming, and Eating Disorders in University Students: Are Pathological Videogaming and Eating Disorders Gender-Specific Manifestations of the Autism Spectrum?

In the previous literature, specific attention has been paid to investigate autism spectrum symptoms and traits in university students. In this framework, we aimed to evaluate the presence and correlates of autistic traits, hikikomori tendencies, altered eating behaviors, and pathological videogaming in a sample of Italian university students enrolled in bachelor's degree courses. A total of 1192 students were recruited via an online survey and assessed with the Hikikomori Questionnaire-25, the Adult Autism Subthreshold Spectrum Questionnaire, the Eating Attitude test-26, and the Assessment of Internet and Computer Game Addiction. Our results highlighted significant differences in the prevalence of autistic traits, social withdrawal tendencies, altered eating habits, and pathological videogame use in university students based on gender, age, parents' level of instruction, and field of study. A significant effect of the presence of autistic traits and gender on the scores obtained with the other questionnaires was reported. Our results not only support the role of autistic traits as a vulnerability factor for the development of a set of psychopathological conditions but also suggest that gender could modulate this vulnerability, supporting the hypothesis of gender-specific phenotypes in the autism spectrum.

Gender Representations, Empathy, and Gender-Based Violence Awareness Among Medical Students: A Proposal for a Specific Training Program

INTRODUCTION

In recent decades, the topic of gender differences has become central to many areas of study, including medicine. The present study explored gender differences in empathy, gender role ideologies, and gender sensitivity among medical students, highlighting significant variations that can inform medical education and training programs.

MATERIALS AND METHODS

The study involved 155 students (52.1% male; mean age: 22.68±2.48 years) from the Department of Medicine, Surgery, and Dentistry of the University of Salerno in Baronissi, Southern Italy. Participants completed two standardized scales: the Jefferson Scale of Empathy (JSE) to assess empathy, and the Nijmegen Gender Awareness in Medicine Scale (N-GAMS) to evaluate gender awareness. Six open-ended questions were also included in the gender-based violence representations.

RESULTS

The ANOVA analysis reveals significant differences in scores between male and female students across the N-GAMS scales, indicating a strong role of gender in these variations. These findings suggest the necessity for further research to understand the contributing factors and inform targeted interventions in medical education. Additionally, there are significant differences in compassionate care (Factor 2) and walking in the patient's shoes (Factor 3), highlighting the substantial impact of gender on these latter aspects of empathy.

CONCLUSIONS

These gender differences have significant implications for medical education. Training programs should be tailored to address the specific needs and characteristics of both male and female students. For example, encouraging male students to maintain their gender sensitivity while challenging traditional gender role ideologies can promote a more inclusive approach to patient care. For female students, fostering confidence in their compassionate care abilities and providing opportunities to express empathy in diverse ways can help overcome societal constraints.

Chemical cousins with contrasting behavioural profiles: MDMA users and methamphetamine users differ in social-cognitive functions and aggression

Methamphetamine (METH, "Crystal Meth") and 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") share structural-chemical similarities but have distinct psychotropic profiles due to specific neurochemical actions. Previous research has suggested that their impact on social cognitive functions and social behaviour may differ significantly, however, direct comparisons of METH and MDMA users regarding social cognition and interaction are lacking. Performances in cognitive and emotional empathy (Multifaceted Empathy Test) and emotion sensitivity (Face Morphing Task), as well as aggressive social behaviour (Competitive Reaction Time Task) were assessed in samples of n = 40 chronic METH users, n = 39 chronic MDMA users and n = 86 stimulant-naïve controls (total N = 165). Self-reports and hair samples were used to obtain subjective and objective estimates of substance use patterns. METH users displayed diminished cognitive and emotional empathy towards positive stimuli, elevated punitive social behaviour regardless of provocation, and self-reported heightened trait anger relative to controls. MDMA users diverged from the control group only by exhibiting a distinct rise in punitive behaviour when faced with provocation. Correlation analyses indicated that both higher hair concentrations of MDMA and METH may be associated with reduced cognitive empathy. Moreover, greater lifetime MDMA use correlated with increased punitive behaviour among MDMA users. Our findings confirm elevated aggression and empathy deficits in chronic METH users, while chronic MDMA users only displayed more impulsive aggression. Dose-response correlations indicate that some of these deficits might be a consequence of use. Specifically, the dopaminergic mechanism of METH might be responsible for social-cognitive deficits.

Effects of paternal deprivation on empathetic behavior and the involvement of oxytocin receptors in the anterior cingulate cortex

Paternal deprivation (PD) impairs social cognition and sociality and increases levels of anxiety-like behavior. However, whether PD affects the levels of empathy in offspring and its underlying mechanisms remain unknown. The present study found that PD increased anxiety-like behavior in mandarin voles (Microtus mandarinus), impaired sociality, reduced the ability of emotional contagion, and the level of consolation behavior. Meanwhile, PD reduced OT neurons in the paraventricular nucleus (PVN) in both male and female mandarin voles. PD decreased the level of OT receptor (OTR) mRNA in the anterior cingulate cortex (ACC) of male and female mandarin voles. Besides, OTR overexpression in the ACC reversed the PD-induced changes in anxiety-like behavior, social preference, emotional contagion, and consolation behavior. Interference of OTR expression in the ACC increased levels of anxiety-like behaviors, while it reduced levels of sociality, emotional contagion, and consolation. These results revealed that the OTR in the ACC is involved in the effects of PD on empathetic behaviors, and provide mechanistic insight into how social experiences affect empathetic behaviors.

Impact of Empathic Concern on Prosocial Behavior in Gain and Loss Contexts: Evidence from Event-Related Potential

This study employs event-related potential (ERP) to examine the impact of empathic concern on prosocial decision-making with costs in both gain and loss contexts. In this experiment, participants can choose between two types of lottery tickets and pay lottery money to help the target person gain more money or lose less money. The behavioral results showed that regardless of the context of the decision (financial loss or gain), participants tended to help individuals who had induced high empathic concern. ERP results show that compared to the low-empathic-concern condition, the high-empathic-concern condition induced greater P3 amplitude in the gain context. However, this change in P3 amplitude caused by empathic concern did not occur in the context of loss. These findings indicate that empathic concern has different psychological mechanisms that moderate prosocial behavior in gain and loss contexts.

Neural correlates of cognitive behavioral therapy-based interventions for bipolar disorder: A scoping review

Cognitive Behavioral Therapy (CBT) is among the gold-standard psychotherapeutic interventions for the treatment of psychiatric disorders, including bipolar disorder (BD). While the clinical response of CBT in patients with BD has been widely investigated, its neural correlates remain poorly explored. Therefore, this scoping review aimed to discuss neuroimaging studies on CBT-based interventions in bipolar populations. Particular attention has been paid to similarities and differences between studies to inform future research. The literature search was conducted on PubMed, PsycINFO, and Web of Science databases in June 2023, identifying 307 de-duplicated records. Six studies fulfilled the inclusion criteria and were reviewed. All of them analyzed functional brain activity data. Four studies showed that the clinical response to CBT was associated with changes in the functional activity and/or connectivity of prefrontal and posterior cingulate cortices, temporal parietal junction, amygdala, precuneus, and insula. In two additional studies, a peculiar pattern of baseline activations in the prefrontal cortex, hippocampus, amygdala, and insula predicted post-treatment improvements in depressive symptoms, emotion dysregulation, and psychosocial functioning, although CBT-specific effects were not shown. These results suggest, at the very preliminary level, the potential of CBT-based interventions in modulating neural activity and connectivity of patients with BD, especially in regions ascribed to emotional processing. Nonetheless, the discrepancies between studies concerning aims, design, sample characteristics, and CBT and fMRI protocols do not allow conclusions to be drawn. Further research using multimodal imaging techniques, better-characterized BD samples, and standardized CBT-based interventions is needed.

Adolescent substance use outcomes in response to social consequences of use: the role of empathy

Evidence suggests empathy deficits have a temporal relationship with substance use severity by late adolescence theorized to decrease use via recognition of social consequences. However, this has yet to be tested empirically along with differences in cognitive and affective empathy. Adolescents admitted to substance use treatment (n= 3,382) were followed through treatment and 12 months after treatment. Variable trajectories were fit using growth curve models; and cross-lagged effects of cognitive and affective empathy on response to social consequences of use were tested along with how response to social consequences affected the mean trajectory of substance use. Results indicate higher cognitive empathy predicted greater response to social consequences of use and response to these consequences at the end of treatment predicted a steeper decrease in substance use. This evidence highlights the importance of cognitive empathy for responding to social consequences of use for motivating less substance use in adolescents.

A systematic review and meta-analysis of socio-cognitive impairments in multiple sclerosis

Socio-cognitive impairment is frequent in multiple sclerosis (MS). However, little is known about the relationship between other potentially relevant clinical symptoms (i.e., cognition, depression, fatigue) and the degree of socio-cognitive impairment, and neural mechanisms underlying socio-cognitive deficits in MS. Therefore, we meta-analytically quantified socio-cognitive impairment in MS. A systematic literature search in MEDLINE Ovid, Web of Science Core Collection, CENTRAL, and PsycInfo was conducted until December 2022. Studies investigating affective or cognitive theory of mind (a/cToM), visual perspective taking (VPT) and social decision making (SDM) in MS patients relative to healthy controls were included. Risk-of-bias (RoB) was assessed using the CLARITY group "Tool for Assessing RoB in Cohort Studies". Mediation analysis investigated the contribution of clinical symptoms to socio-cognitive impairment. In total, n = 8534 studies were screened, 58 were included in the systematic review, 27 in the meta-analyses. Most studies were rated with a moderate RoB. Meta-analyses confirmed impairment of both aToM and cToM in MS patients, with larger effect sizes for aToM. Mediation analysis demonstrated that higher levels of fatigue selectively predicted the degree of cToM impairment. There was insufficient data available to quantify impairment in other socio-cognitive domains. Fourteen structural and functional imaging studies were identified and characterized by substantial heterogeneity. Summarized, this study confirmed substantial socio-cognitive impairment in MS and highlights the potential exacerbating role of comorbid clinical symptoms. We identify several evidence gaps that need to be addressed in future large-scale studies using comprehensive and coordinated assessments of socio-cognitive parameters, potential mediators, and neural correlates.Trial registration: The pre-registered review protocol can be assessed at www.crd.york.ac.uk/PROSPERO/ (ID: CRD42020206225).

The relationship between empathy, theory of mind and facial affect recognition in schizophrenia patients

Although impairments in social cognition are a core feature in schizophrenia, the relationship between its subcomponents is less clear. Nineteen schizophrenia patients and 20 matched healthy controls were tested for emotion recognition, and for the cognitive and affective subcomponents of empathy and theory of mind (ToM). Patients scored significantly worse than controls on cognitive empathy and both subcomponents of ToM. Group differences disappeared for cognitive empathy and affective ToM when emotion recognition was included as a covariate. Our results indicate that emotion recognition is an important factor involved in the deficits on higher levels of social cognition in schizophrenia.

Newborn Brain Function and Early Emerging Callous-Unemotional Traits

Importance

Children with high callous-unemotional traits are more likely to develop severe and persistent conduct problems; however, the newborn neurobiology underlying early callous-unemotional traits remains unknown. Understanding the neural mechanisms that precede the development of callous-unemotional traits could help identify at-risk children and encourage development of novel treatments.

Objective

To determine whether newborn brain function is associated with early-emerging empathy, prosociality, and callous-unemotional traits.

Design, Setting, and Participants

In this prospective, longitudinal cohort study, pregnant women were recruited from obstetric clinics in St Louis, Missouri, from September 1, 2017, to February 28, 2020, with longitudinal data collected until March 20, 2023. Mothers were recruited during pregnancy. Newborns underwent brain magnetic resonance imaging shortly after birth. Mothers completed longitudinal follow-up when the children were aged 1, 2, and 3 years.

Exposures

The sample was enriched for exposure to socioeconomic disadvantage.

Main Outcome and Measure

Functional connectivity between hypothesized brain regions was assessed using newborn-specific networks and voxel-based connectivity analyses. Children's callous-unemotional traits were measured using the Inventory of Callous-Unemotional Traits. Empathy and prosociality were assessed using the Infant and Toddler Socio-Emotional Assessment.

Results

A total of 283 children (mean [SD] gestational age, 38 [2] weeks; 159 male [56.2%]; 2 Asian [0.7%], 171 Black [60%], 7 Hispanic or Latino [2.5%], 106 White [38%], 4 other racial or ethnic group [1.4%]) were included in the analysis. Stronger newborn functional connectivity between the cingulo-opercular network (CO) and medial prefrontal cortex (mPFC) was associated with higher callous-unemotional traits at age 3 years (β = 0.31; 95% CI, 0.17-0.41; P < .001). Results persisted when accounting for parental callous-unemotional traits and child externalizing symptoms. Stronger newborn CO-mPFC connectivity was also associated with lower empathy and lower prosociality at ages 1, 2, and 3 years using multilevel models (β = -0.12; 95% CI, -0.21 to -0.04; P = .004 and β = -0.20; 95% CI, -0.30 to -0.10; P < .001, respectively).

Conclusions and Relevance

Newborn functional connectivity was associated with early-emerging empathy, prosociality, and callous-unemotional traits, even when accounting for parental callous-unemotional traits and child externalizing symptoms. Understanding the neurobiological underpinnings of empathy, prosociality, and callous-unemotional traits at the earliest developmental point may help early risk stratification and novel intervention development.

The effect of psilocybin on empathy and prosocial behavior: a proposed mechanism for enduring antidepressant effects

Psilocybin is a serotonergic psychedelic shown to have enduring antidepressant effects. Currently, the mechanism for its enduring effects is not well understood. Empathy and prosocial behavior may be important for understanding the therapeutic benefit of psilocybin. In this article we review the effect of psilocybin on empathy and prosocial behavior. Moreover, we propose that psilocybin may induce a positive feedback loop involving empathy and prosocial behavior which helps explain the observed, enduring antidepressant effects.

Can people empathize with offenders and victims during violent scenes? Behavioral and brain correlates of affective and cognitive empathy considering victim vs. offender perspective using the Bochumer affective and cognitive empathy task (BACET)

Empathy is defined as the capacity to resonate with others' emotions and can be subdivided into affective and cognitive components. Few studies have focused on the role of perspective-taking within this ability. Utilizing the novel Bochumer Affective and Cognitive Empathy Task (BACET), the present study aims to determine the characteristics of specific empathy components, as well as the impact of offender vs. victim perspective-taking. A total of 21 male participants (mean age = 30.6) underwent functional magnetic resonance imaging (fMRI) while watching 60 videos showing two protagonists in neutral (n = 30) or violent interactions (n = 30) thereby adopting the perspective of the (later) offender or victim. Our data show that videos showing emotional (violent) content, compared to those with neutral content, were rated more emotionally negative and induced higher affective empathic involvement, particularly when adopting the victim's perspective compared to the offender's point of view. The correct assignment of people's appropriate emotion (cognitive empathy) was found to be more accurate and faster in the emotional condition relative to the neutral one. However, no significant differences in cognitive empathy performance were observed when comparing victim vs offender conditions. On a neural level, affective empathy processing, during emotional compared to neutral videos, was related to brain areas generally involved in social information processing, particularly in occipital, parietal, insular, and frontal regions. Cognitive aspects of empathy, relative to factual reasoning questions, were located in inferior occipital areas, fusiform gyrus, temporal pole, and frontal cortex. Neural differences were found depending on the perspective, i.e., empathizing with the victim, compared to the offender, during affective empathy activated parts of the right temporal lobe, whereas empathy towards the role of the offender revealed stronger activation in the right lingual gyrus. During cognitive empathy, empathy toward the victim, relative to the offender, enhanced activity of the right supramarginal and left precentral gyri. The opposite contrast did not show any significant differences. We conclude that the BACET can be a useful tool for further studying behavioral and neurobiological underpinnings of affective and cognitive empathy, especially in forensic populations since response patterns point to a significant impact of the observer's perspective.

The role of external factors in affect-sharing and their neural bases

Affect-sharing, the ability to vicariously feel another person's emotions, is the primary component of empathy that is typically thought to rely on the observer's capacity to feel the emotions of others. However, external signals, such as the target's physical characteristics, have been demonstrated to influence affect-sharing in the neuroscientific literature that speaks to the underappreciated role of external factors in eliciting affect-sharing. We consider factors that influence affect-sharing, including physical cues, emotional cues, situational factors, and observer-target relationships, as well as the neural circuits involved in these processes. Our review reveals that, while neural network activation is primarily responsible for processing affect-sharing, external factors also co-activate a top-down cognitive processing network to modulate the conscious process of affect-sharing. From this knowledge, an integrative framework of external factor interactions with affect-sharing are explained in detail. Finally, we identify critical areas for future research in social and affective neuroscience, including research gaps and incorporation of ecologically valid paradigms.

The Association Between Emotional Expressions and Empathic Accuracy

Empathic accuracy, the ability to accurately represent and understand another's emotional state, is integral to socio-emotional functioning. It is also inherently an interpersonal process that requires active engagement of the emotional systems of both interaction partners. The emotional expressivity of the partner sharing their emotions restricts empathic accuracy and the perceiver's emotional expressivity might also affect empathic accuracy as they behaviorally simulate and thus share the emotions they see in the other's face. We explored a potential role of emotional expressivity in people's ability to understand another's emotions in a face-to-face dyadic interaction. Participants took turns sharing emotional experiences while their facial expressions were recorded. They then watched the recordings while continuously rating their own and their partner's affect at any given point during the recording. Empathic accuracy was indexed as the epoch by-epoch emotion change detection. We found that emotional expressivity of the listener, but not of the partner, was associated with increased empathic accuracy, even when controlling for partner's expressivity. Our findings highlight the active role the person empathizing takes in face-to-face emotional sharing.

Boosting interpersonal emotion regulation through facial imitation: functional neuroimaging foundations

Empathic function, which is primarily manifested by facial imitation, is believed to play a pivotal role in interpersonal emotion regulation for mood reinstatement. To explore this association and its neural substrates, we performed a questionnaire survey (study l) to identify the relationship between empathy and interpersonal emotion regulation; and a task-mode fMRI study (study 2) to explore how facial imitation, as a fundamental component of empathic processes, promotes the interpersonal emotion regulation effect. Study 1 showed that affective empathy was positively correlated with interpersonal emotion regulation. Study 2 showed smaller negative emotions in facial imitation interpersonal emotion regulation (subjects imitated experimenter's smile while followed the interpersonal emotion regulation guidance) than in normal interpersonal emotion regulation (subjects followed the interpersonal emotion regulation guidance) and Watch conditions. Mirror neural system (e.g. inferior frontal gyrus and inferior parietal lobe) and empathy network exhibited greater activations in facial imitation interpersonal emotion regulation compared with normal interpersonal emotion regulation condition. Moreover, facial imitation interpersonal emotion regulation compared with normal interpersonal emotion regulation exhibited increased functional coupling from mirror neural system to empathic and affective networks during interpersonal emotion regulation. Furthermore, the connectivity of the right orbital inferior frontal gyrus-rolandic operculum lobe mediated the association between the accuracy of facial imitation and the interpersonal emotion regulation effect. These results show that the interpersonal emotion regulation effect can be enhanced by the target's facial imitation through increased functional coupling from mirror neural system to empathic and affective neural networks.

Effects of multidomain environmental and mental health factors on the development of empathetic behaviors and emotions in adolescence

Empathy is at the core of our social world, yet multidomain factors that affect its development in socially sensitive periods, such as adolescence, are incompletely understood. To address this gap, this study investigated associations between social, environmental and mental health factors, and their temporal changes, on adolescent empathetic behaviors/emotions and, for comparison, callous unemotional (CU) traits and behaviors, in the early longitudinal Adolescent Brain Cognitive Development sample (baseline: n = 11062; 2-year follow-up: n = 9832, median age = 119 and 144 months, respectively). Caregiver affection towards the youth, liking school, having a close friend, and importance of religious beliefs/spirituality in the youth's life were consistently positively correlated with empathetic behaviors/emotions across assessments (p<0.001, Cohen's f = ~0.10). Positive family dynamics and cohesion, living in a neighborhood that shared the family's values, but also parent history of substance use and (aggregated) internalizing problems were additionally positively associated with one or more empathetic behaviors at follow-up (p<0.001, f = ~0.10). In contrast, externalizing problems, anxiety, depression, fear of social situations, and being withdrawn were negatively associated with empathetic behaviors and positively associated with CU traits and behaviors (p<0.001, f = ~0.1-0.44). The latter were also correlated with being cyberbullied and/or discriminated against, anhedonia, and impulsivity, and their interactions with externalizing and internalizing issues. Significant positive temporal correlations of behaviors at the two assessments indicated positive (early) developmental empathetic behavior trajectories, and negative CU traits' trajectories. Negative changes in mental health adversely moderated positive trajectories and facilitated negative ones. These findings highlight that adolescent empathetic behaviors/emotions are positively related to multidomain protective social environmental factors, but simultaneously adversely associated with risk factors in the same domains, as well as bully victimization, discrimination, and mental health problems. Risk factors instead facilitate the development of CU traits and behaviors.

Impairments in Cognitive and Emotional Empathy as Markers of General versus Specific Personality Pathology

INTRODUCTION

The alternative model for personality disorders (AMPD) of the Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-5) considers impairments in empathy a basic feature of personality disorders (PDs). In contrast, the AMPD pathological personality trait model and the categorical DSM-5 Section II PD model associate deficits in empathy to specific forms of personality pathology. The present study investigated to what extent impairments in cognitive and emotional empathy are markers of general versus specific personality pathology.

METHODS

In a clinical sample (n = 119), the Multifaceted Empathy Test was used to assess cognitive empathy, emotional empathy for positive emotions, and emotional empathy for negative emotions. Personality functioning, pathological personality traits, and DSM-5 Section II PDs were assessed via interviews and self-reports. Confirmatory factor analyses were applied to associate the three empathy facets with the three personality pathology approaches, each modeled with general personality pathology (common factor) and specific personality pathology (residuals of indicators).

RESULTS

Impairments in cognitive empathy and emotional empathy for positive emotions were significantly correlated with general personality pathology. All three empathy facets were also correlated to specific personality pathology when controlling for general personality pathology, respectively. Impairments in cognitive empathy were incrementally associated with identity and empathy (personality functioning), psychoticism (pathological personality traits), and paranoid and dependent PD (DSM-5 Section II PDs). Deficits in emotional empathy for positive emotions were incrementally associated with self-direction and intimacy (personality functioning) and detachment (pathological personality traits). Impairments in emotional empathy for negative emotions were incrementally associated with antagonism (pathological personality traits) and antisocial PD (DSM-5 Section II PDs).

CONCLUSION

The results suggest that impairments in cognitive empathy and emotional empathy for positive emotions, but not for negative emotions, are markers of general personality pathology, while deficits in the three empathy facets are also markers for specific personality pathology.

Empathy deficits, callous-unemotional traits and structural underpinnings in autism spectrum disorder and conduct disorder youth

Distinct empathy deficits are often described in patients with conduct disorder (CD) and autism spectrum disorder (ASD) yet their neural underpinnings and the influence of comorbid Callous-Unemotional (CU) traits are unclear. This study compares the cognitive (CE) and affective empathy (AE) abilities of youth with CD and ASD, their potential neuroanatomical correlates, and the influence of CU traits on empathy. Adolescents and parents/caregivers completed empathy questionnaires (N = 148 adolescents, mean age = 15.16 years) and T1 weighted images were obtained from a subsample (N = 130). Group differences in empathy and the influence of CU traits were investigated using Bayesian analyses and Voxel-Based Morphometry with Threshold-Free Cluster Enhancement focusing on regions involved in AE (insula, amygdala, inferior frontal gyrus and cingulate cortex) and CE processes (ventromedial prefrontal cortex, temporoparietal junction, superior temporal gyrus, and precuneus). The ASD group showed lower parent-reported AE and CE scores and lower self-reported CE scores while the CD group showed lower parent-reported CE scores than controls. When accounting for the influence of CU traits no AE deficits in ASD and CE deficits in CD were found, but CE deficits in ASD remained. Across all participants, CU traits were negatively associated with gray matter volumes in anterior cingulate which extends into the mid cingulate, ventromedial prefrontal cortex, and precuneus. Thus, although co-occurring CU traits have been linked to global empathy deficits in reports and underlying brain structures, its influence on empathy aspects might be disorder-specific. Investigating the subdimensions of empathy may therefore help to identify disorder-specific empathy deficits.

Empathy: a case study in the historical epistemology of psychiatry

The hybrid constitution of psychiatry carries important implications for understanding the discipline and the legitimacy of its research approaches. One implication concerns the central role of concepts in forming the knowledge base of psychiatry. Because of this, it is vital to explore the structures and interrelationships of concepts through their historical constitution. Using this approach to compare concepts of empathy as articulated by R Vischer, T Lipps and E Stein shows that, despite overlap, the concepts vary in structure, in meaning and in the aspect of reality they capture. This suggests that the concept of empathy carries an unstable ontology and epistemology. In turn, this carries implications for the concept itself, for psychiatry and for research approaches in this field.

Gender differences in empathy and clinical symptoms in chronic schizophrenia patients: a large sample study based on a Chinese Han population

BACKGROUND

Empathy is social cognition and reduced empathy in schizophrenia (SCZ) has been noted; however, whether there are gender differences in empathy remains unclear. Therefore, the purpose of this study was to explore this issue by examining a large sample of the population with SCZ.

METHODS

We recruited 987 SCZ patients (M/F = 638/349). The empathy was assessed by The Interpersonal Reactivity Index (IRI). The Positive and Negative Syndrome Scale (PANSS) was adopted to assess their clinical psychiatric symptoms and their ability to recognise the facial emotions of others was assessed by the Pictures Of Facial Affect (POFA).

RESULTS

Female SCZ patients had higher IRI total score than male patients. In male patients, Pearson correlation analysis showed that empathy was negatively correlated with PANSS total score and negative symptom subscale scores, but positively correlated with anger identification. In female patients, IRI total score was negatively correlated with PANSS total score as well as its positive and negative symptom subscale scores (all p < 0.05).

CONCLUSION

There are gender differences in the empathy of SCZ patients, with female patients having greater empathy and a correlation with their clinical symptoms. This gender difference may provide potential clinical value for the treatment of SCZ.KEY POINTSFemale SCZ were more likely to empathise than males;Female patients had more severe clinical symptoms than males;There were gender differences in the association between certain specific clinical presentations and empathy.In future studies, it may be useful to investigate gender differences in schizophrenia empathy for the diagnosis and treatment of the disorder.

Designing a neuroclinical assessment of empathy deficits in psychopathy based on the Zipper Model of Empathy

Ho, M.H., Kemp, B.T., Eisenbarth, H. & Rijnders, R.J.P. Designing a neuroclinical assessment of empathy deficits in psychopathy based on the Zipper Model of Empathy. NEUROSCI BIOBEHAV REV YY(Y) XXX-XXX, 2023. The heterogeneity of the literature on empathy highlights its multidimensional and dynamic nature and affects unclear descriptions of empathy in the context of psychopathology. The Zipper Model of Empathy integrates current theories of empathy and proposes that empathy maturity is dependent on whether contextual and personal factors push affective and cognitive processes together or apart. This concept paper therefore proposes a comprehensive battery of physiological and behavioral measures to empirically assess empathy processing according to this model with an application for psychopathic personality. We propose using the following measures to assess each component of this model: (1) facial electromyography; (2) the Emotion Recognition Task; (3) the Empathy Accuracy task and physiological measures (e.g., heart rate); (4) a selection of Theory of Mind tasks and an adapted Dot Perspective Task, and; (5) an adjusted Charity Task. Ultimately, we hope this paper serves as a starting point for discussion and debate on defining and assessing empathy processing, to encourage research to falsify and update this model to improve our understanding of empathy.

Boosting the Theory of Mind Network: Specific Psychotherapy Increases Neural Correlates of Affective Theory of Mind in Euthymic Bipolar Disorder

BACKGROUND

In bipolar disorder, impaired affective theory of mind (aToM) performance and aberrant neural activation in the ToM brain network partly explain social functioning impairments. However, it is not yet known whether psychotherapy of bipolar disorder influences neuroimaging markers of aToM.

METHODS

In this study, conducted within the multicentric randomized controlled trial of the BipoLife consortium, patients with euthymic bipolar disorder underwent 2 group interventions over 6 months (mean = 28.45 weeks): 1) a specific, cognitive behavioral intervention (specific psychotherapeutic intervention [SEKT]) (n = 31) targeting impulse regulation, ToM, and social skills and 2) an emotion-focused intervention (FEST) (n = 28). To compare the effect of SEKT and FEST on neural correlates of aToM, patients performed an aToM task during functional magnetic resonance imaging before and after interventions (final functional magnetic resonance imaging sample of pre- and postcompleters, SEKT: n = 16; FEST: n = 17). Healthy control subjects (n = 32) were scanned twice with the same time interval. Because ToM was trained in SEKT, we expected an increased ToM network activation in SEKT relative to FEST postintervention.

RESULTS

Both treatments effectively stabilized patients' euthymic state in terms of affective symptoms, life satisfaction, and global functioning. Confirming our expectations, SEKT patients showed increased neural activation within regions of the ToM network, bilateral temporoparietal junction, posterior cingulate cortex, and precuneus, whereas FEST patients did not.

CONCLUSIONS

The stabilizing effect of SEKT on clinical outcomes went along with increased neural activation of the ToM network, while FEST possibly exerted its positive effect by other, yet unexplored routes.

Altruistic responses to the most vulnerable involve sensorimotor processes

Introduction

Why do people help strangers? Prior research suggests that empathy motivates bystanders to respond to victims in distress. However, this work has revealed relatively little about the role of the motor system in human altruism, even though altruism is thought to have originated as an active, physical response to close others in immediate need. We therefore investigated whether a motor preparatory response contributes to costly helping.

Methods

To accomplish this objective, we contrasted three charity conditions that were more versus less likely to elicit an active motor response, based on the Altruistic Response Model. These conditions described charities that (1) aided neonates versus adults, (2) aided victims requiring immediate versus preparatory support, and (3) provided heroic versus nurturant aid. We hypothesized that observing neonates in immediate need would elicit stronger brain activation in motor-preparatory regions.

Results

Consistent with an evolutionary, caregiving-based theory of altruism, participants donated the most to charities that provided neonates with immediate, nurturant aid. Critically, this three-way donation interaction was associated with increased BOLD signal and gray matter volume in motor-preparatory regions, which we identified in an independent motor retrieval task.

Discussion

These findings advance the field of altruism by shifting the spotlight from passive emotional states toward action processes that evolved to protect the most vulnerable members of our group.

Whose emotion is it? Perspective matters to understand brain-body interactions in emotions

Feeling happy, or judging whether someone else is feeling happy are two distinct facets of emotions that nevertheless rely on similar physiological and neural activity. Differentiating between these two states, also called Self/Other distinction, is an essential aspect of empathy, but how exactly is it implemented? In non-emotional cognition, the transient neural response evoked at each heartbeat, or heartbeat evoked response (HER), indexes the self and signals Self/Other distinction. Here, using electroencephalography (n = 32), we probe whether HERs' role in Self/Other distinction extends also to emotion - a domain where brain-body interactions are particularly relevant. We asked participants to rate independently validated affective scenes, reporting either their own emotion (Self) or the emotion expressed by people in the scene (Other). During the visual cue indicating to adopt the Self or Other perspective, before the affective scene, HERs distinguished between the two conditions, in visual cortices as well as in the right frontal operculum. Physiological reactivity (facial electromyogram, skin conductance, heart rate) during affective scene co-varied as expected with valence and arousal ratings, but also with the Self- or Other- perspective adopted. Finally, HERs contributed to the subjective experience of valence in the Self condition, in addition to and independently from physiological reactivity. We thus show that HERs represent a trans-domain marker of Self/Other distinction, here specifically contributing to experienced valence. We propose that HERs represent a form of evidence related to the 'I' part of the judgement 'To which extent do I feel happy'. The 'I' related evidence would be combined with the affective evidence collected during affective scene presentation, accounting at least partly for the difference between feeling an emotion and identifying it in someone else.

Empathy moderates the relationship between cognitive load and prosocial behaviour

Cognitive load reduces both empathy and prosocial behaviour. However, studies demonstrating these effects have induced cognitive load in a temporally limited, artificial manner that fails to capture real-world cognitive load. Drawing from cognitive load theory, we investigated whether naturally occurring cognitive load from the ongoing COVID-19 pandemic moderated the relationship between empathy and prosocial behaviour (operationalised as support for public health measures). This large study in an Australian sample (N = 600) identified negative relationships between pandemic fatigue, empathy for people vulnerable to COVID-19, and prosocial behaviour, and a positive relationship between empathy and prosocial behaviour. Additionally, we found that the negative effect of the pandemic on prosocial behaviour depended on empathy for vulnerable others, with pandemic fatigue's effects lowest for those with the highest empathy. These findings highlight the interrelationships of cognitive load and empathy, and the potential value of eliciting empathy to ease the impact of real-world cognitive load on prosocial behaviour.

The validation of a Mandarin version of the Empathy Components Questionnaire (ECQ-Chinese) in Chinese samples

Empathy involves both empathic ability and empathic motivation. An important topic has been how to measure empathic ability and motivation simultaneously in both clinical and non-clinical samples and across different cultures. The Empathy Components Questionnaire (ECQ) is a self-report questionnaire that measures empathic ability and motivation in a questionnaire. The current study aimed to validate the Mandarin Chinese version of the ECQ (ECQ-Chinese) in three Chinese samples. In study 1, a total of 538 Chinese participants (Sample 1) completed the ECQ-Chinese via an online survey, and existing measures of empathy and related constructs which were used for criterion validity. In study 2, a total of 104 participants (Sample 2) were recruited again from sample 1 and completed the ECQ-Chinese three weeks later to investigate test-retest reliability. In study 3, a further 324 participants (Sample 3) completed the ECQ-Chinese for confirmatory factor analysis. The results showed that the ECQ-Chinese has a good internal consistency reliability, split-half reliability, and criterion validity (Study 1), and a good test-retest reliability (Study 2). Further, Study 3 found that a 22-item ECQ-Chinese consisting of five subscales had a good construct validity, convergence validity and discriminate validity, demonstrating it to be a suitable tool for the measurement of empathic ability and motivation in Chinese samples and to carry out cross-cultural studies of empathy and its components.

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.

Imitation encourages empathic capacity toward other individuals with physical disabilities

Many people have difficulty empathizing with others who have dissimilar characteristics, such as physical disabilities. We hypothesized that people with no disabilities imitating the movements of individuals with disabilities could improve the empathic capacity toward their difficulties. To evaluate this hypothesis, we used functional magnetic resonance imaging to measure the neural activity patterns of 26 healthy participants while they felt the difficulties of individuals with hemiplegia by adopting their perspective. The participants initially either imitated or observed hemiplegic hand movements shown in video clips. Subsequently, the videos were rewatched and their difficulties were rated. Analysis of the subjective rating scores indicated that after imitating the hemiplegic movements, the participants felt into the difficulties of hemiplegia better than if they simply observed them. The cross-validation approach of multivoxel pattern analyses demonstrated that the information regarding the effect of imitation on empathizing with the difficulties was represented in specific activation patterns of brain regions involved in the mirror neuron system and cognitive empathy by comparing to other conditions that did not contain the information. The cross-classification approach detected distinct activation patterns in the brain regions involved in affective and cognitive empathy, commonly while imitating the hemiplegic movements and subsequently feeling them. This indicated that the common representation related to these two types of empathy existed between imitating and feeling the hemiplegic movements. Furthermore, representational similarity analysis revealed that activity patterns in the anterior cingulate cortex linked to affective empathy tuned to the subjective assessment of hemiplegic movements. Our findings indicate that imitating the movements of individuals with hemiplegia triggered the affective empathic response and improved the cognitive empathic response toward them. The affective empathic response also linked the subjective assessment to the difficulties of hemiplegia, which was especially modulated by the experience of imitation. Imitating the movements of individuals with disabilities likely encourages empathic capacity from both affective and cognitive aspects, resulting in people with no disabilities precisely feeling what they are feeling.

The bright and dark sides of egoism

Despite its negative reputation, egoism - the excessive concern for one's own welfare - can incite prosocial behavior. So far, however, egoism-based prosociality has received little attention. Here, we first provide an overview of the conditions under which egoism turns into a prosocial motive, review the benefits and limitations of egoism-based prosociality, and compare them with empathy-driven prosocial behavior. Second, we summarize studies investigating the neural processing of egoism-based prosocial decisions, studies investigating the neural processing of empathy-based prosocial decisions, and the small number of studies that compared the neural processing of prosocial decisions elicited by the different motives. We conclude that there is evidence for differential neural networks involved in egoism and empathy-based prosocial decisions. However, this evidence is not yet conclusive, because it is mainly based on the comparison of different experimental paradigms which may exaggerate or overshadow the effect of the different motivational states. Finally, we propose paradigms and research questions that should be tackled in future research that could help to specify how egoism can be used to enhance other prosocial behavior and motivation, and the how it could be tamed.

The negative impact of xenophobia on compassion with suffering out-group members is attenuated by trait empathy

Empathy enables human beings to understand and share the internal states of others. Studies show that empathy for pain is higher for in-group compared to out-group members. This might be driven by attitudes and biases towards out-groups. In a between subject design, N = 621 participants filled in questionnaires measuring xenophobia and trait empathy and were presented with photos of suffering individuals either from the in-group or an out-group, which had to be rated with respect to negative affect and the willingness to help the depicted persons. Results do not show more compassion with members of the in-group in general, but a negative effect of xenophobia on state empathy in the out-group condition. Additional moderation analyses show that this effect is less evident in presence of high trait empathy scores. Our results highlight the importance of empathy trainings to attenuate the effects of xenophobic attitudes on social cohabitation in our increasingly polarized and culturally diverse societies.

Enhanced Mirror Neuron Network Activity and Effective Connectivity during Live Interaction Among Female Subjects

Facial expressions are indispensable in daily human communication. Previous neuroimaging studies investigating facial expression processing have presented pre-recorded stimuli and lacked live face-to-face interaction. Our paradigm alternated between presentations of real-time model performance and pre-recorded videos of dynamic facial expressions to participants. Simultaneous functional magnetic resonance imaging (fMRI) and facial electromyography activity recordings, as well as post-scan valence and arousal ratings were acquired from 44 female participants. Live facial expressions enhanced the subjective valence and arousal ratings as well as facial muscular responses. Live performances showed greater engagement of the right posterior superior temporal sulcus (pSTS), right inferior frontal gyrus (IFG), right amygdala and right fusiform gyrus, and modulated the effective connectivity within the right mirror neuron system (IFG, pSTS, and right inferior parietal lobule). A support vector machine algorithm could classify multivoxel activation patterns in brain regions involved in dynamic facial expression processing in the mentalizing networks (anterior and posterior cingulate cortex). These results indicate that live social interaction modulates the activity and connectivity of the right mirror neuron system and enhances spontaneous mimicry, further facilitating emotional contagion.

Emotion regulation and delusion-proneness relate to empathetic tendencies in a transdiagnostic sample

Empathetic tendencies (i.e., perspective taking and empathic concern) are a key factor in interpersonal relationships, which may be impacted by emotion regulation (i.e., reappraisal and suppression) and mental health symptoms, such as psychotic-like experiences. However, it is unclear if certain psychotic-like experiences, such as delusion-proneness, are still associated with reduced empathetic tendencies after accounting for emotion regulation style and dimensions of psychopathology that are often comorbid. In the current study, linear models tested these associations in a transdiagnostic community sample (N = 128), using the Interpersonal Reactivity Index (IRI), Emotion Regulation Questionnaire, and the Peter's Delusion Inventory. Results indicated that perspective taking was positively associated with reappraisal and negatively associated with delusion-proneness, after controlling for age, sex, race, intelligence, and symptoms of anxiety and depression. A significant change in R 2 supported the addition of delusion-proneness in this model. Specificity analyses demonstrated perspective taking was also negatively associated with suppression, but this relationship did not remain after accounting for the effects of reappraisal and delusion-proneness. Additional specificity analyses found no association between empathic concern and reappraisal or delusion-proneness but replicated previous findings that empathic concern was negatively associated with suppression. Taken together, delusion-proneness accounts for unique variance in perspective taking, which can inform future experimental research and may have important implications for psychosocial interventions.

Effects of emotional valence and intensity on cognitive and affective empathy after insula lesions

The insula plays a central role in empathy. However, the complex structure of cognitive (CE) and affective empathy (AE) deficits following insular damage is not fully understood. In the present study, patients with insular lesions (n = 20) and demographically matched healthy controls (n = 24) viewed ecologically valid videos that varied in terms of valence and emotional intensity. The videos showed a person (target) narrating a personal life event. In CE conditions, subjects continuously rated the affective state of the target, while in AE conditions, they continuously rated their own affect. Mean squared error (MSE) assessed deviations between subject and target ratings. Patients differed from controls only in negative, low-intensity AE, rating their own affective state less negative than the target. This deficit was not related to trait empathy, neuropsychological or clinical parameters, or laterality of lesion. Empathic functions may be widely spared after insular damage in a naturalistic, dynamic setting, potentially due to the intact interpretation of social context by residual networks outside the lesion. The particular role of the insula in AE for negative states may evolve specifically in situations that bear higher uncertainty pointing to a threshold role of the insula in online ratings of AE.

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.

Attachment Insecurity and Altruistic Behavior among Chinese Adolescents: Mediating Effect of Different Dimensions of Empathy

Although Western studies showed that attachment insecurity was negatively related to adolescent altruistic behavior, few studies have investigated this issue among Chinese adolescents, and little is known about the mechanisms underlying the impact of attachment avoidance and attachment anxiety on adolescent altruistic behaviors. This study investigated the mediating role of different dimensions of empathy (empathic concern, perspective taking, and personal distress) on the association of attachment avoidance and attachment anxiety with altruistic behavior among Chinese adolescents. A total of 1005 7th and 8th grade Chinese students (M_age = 12.86 years, SD = 0.69) from three middle schools in Chengdu, China completed measures of attachment insecurity, interpersonal reactivity index, and altruistic behavior. Results indicated that attachment avoidance, not attachment anxiety, negatively predicted adolescent altruistic behavior among Chinese adolescents. Moreover, higher attachment avoidance predicted less empathic concern and perspective taking, which in turn predicted less altruistic behavior, while higher attachment anxiety predicted more empathic concern and personal distress, which further predicted more and less altruistic behavior, respectively. These findings highlight the importance of promoting adolescent empathic concern and perspective taking and reducing personal distress to strengthen adolescent altruistic behavior.

How resource sharing resists scarcity: the role of cognitive empathy and its neurobiological mechanisms

Resource scarcity challenges individuals' willingness to share limited resources with other people. Still, lots of field studies and laboratory experiments have shown that sharing behaviors do not disappear under scarcity. Rather, some individuals are willing to share their scarce resources with others in a similar way as when the resource is abundant, which is crucial for the maintenance and development of human society. Here, we designed a novel paradigm in which subjects decided whether (and how much) to share an amount of "relieving resources" for counteracting unpleasant noises, which mimics real-life situations that people cost their own resources to help others escape from adversity. Overall, the robustness of resource sharing under scarcity was positively correlated with individual level of the cognitive component of empathy across two independent experiments. Resource insufficiency modulated the activations of several brain regions (including the TPJ, mPFC, and PCC) as well as the functional connection (from the rTPJ to the mPFC) within the mentalizing brain network, but the modulatory effect decreased as a function of cognitive empathy. We also applied the administration of oxytocin and found significant effects on sharing behavior among individuals with a higher level of cognitive empathy, but not their low-level counterparts. These findings highlight the importance of empathy to resource sharing under scarcity and explain the underlying neurobiological mechanisms.

To Blame or Not? Modulating Third-Party Punishment with the Framing Effect

People as third-party observers, without direct self-interest, may punish norm violators to maintain social norms. However, third-party judgment and the follow-up punishment might be susceptible to the way we frame (i.e., verbally describe) a norm violation. We conducted a behavioral and a neuroimaging experiment to investigate the above phenomenon, which we call the "third-party framing effect". In these experiments, participants observed an anonymous perpetrator deciding whether to keep her/his economic benefit while exposing a victim to a risk of physical pain (described as "harming others" in one condition and "not helping others" in the other condition), then they had a chance to punish that perpetrator at their own cost. Our results showed that the participants were more willing to execute third-party punishment under the harm frame compared to the help frame, manifesting a framing effect. Self-reported anger toward perpetrators mediated the relationship between empathy toward victims and the framing effect. Meanwhile, activation of the insula mediated the relationship between mid-cingulate cortex activation and the framing effect; the functional connectivity between these regions significantly predicted the size of the framing effect. These findings shed light on the psychological and neural mechanisms of the third-party framing effect.

Contagious Depression: Automatic Mimicry and the Mirror Neuron System - A Review

Contagious depression is a theory proposing that depression can be induced or triggered by our social environment. This theory is based on emotional contagion, the idea that affective states can be transferred during social interaction, since humans can use emotional contagion to communicate feelings and emotions in conscious and unconscious ways. This review presents behavioral, physiological, and neuroanatomical aspects of two essential contagious depression mechanisms, automatic mimicry and the mirror neuron system.

Neural processing associated with Cognitive Empathy in Pedophilia and Child Sexual Offending

Behavioral studies found evidence for superior cognitive empathy (CE) in pedophilic men without a history of child sexual offending (P-CSO) compared to pedophilic men with a history of CSO (P+CSO). Functional magnetic resonance imaging (fMRI) studies also point to differences between P-CSO and P+CSO. Neural processing associated with CE has not yet been investigated. Therefore, the present study aimed to explore the neural correlates of CE in subjects with pedophilia with (P+CSO) and without (P-CSO) child sexual offending. 15 P+CSO, 15 P-CSO, and 24 teleiophilic male controls (TC) performed a CE task during fMRI. We observed reduced activation in the left precuneus (Pcu) and increased activation in the left anterior cingulate cortex (ACC) in P-CSO compared to P+CSO. P-CSO also showed stronger connectivity between these regions, which might reflect a top-down modulation of the Pcu by the ACC toward an increased self-focused emotional reaction in social situations. There was also evidence for increased right superior temporal gyrus activation in P-CSO that might constitute a potentially compensatory recruitment due to the dampened Pcu activation. These findings provide first evidence for altered neural processing of CE in P-CSO and underline the importance of addressing CE in pedophilia and CSO in order to uncover processes relevant to effective prevention of child sexual abuse.

Tryptophan-enriched diet or 5-hydroxytryptophan supplementation given in a randomized controlled trial impacts social cognition on a neural and behavioral level

Understanding of emotions and intentions are key processes in social cognition at which serotonin is an important neuromodulator. Its precursor is the essential amino acid tryptophan (TRP). Reduced TRP availability leads to weaker impulse control ability and higher aggression, while TRP supplementation promotes confidence. In a double-blind placebo-controlled fMRI study with 77 healthy adults, we investigated the influence of a 4 week TRP enriched diet and an acute 5-hydroxytryptophan (5-HTP) intake on two social-cognitive tasks, a moral evaluation and an emotion recognition task. With 5-HTP, immoral behavior without negative consequences was rated as more reprehensible. Additionally, during story reading, activation in insula and supramarginal gyrus was increased after TRP intake. No significant effects of TRP on emotion recognition were identified for the whole sample. Importantly, emotion recognition ability decreased with age which was for positive emotions compensated by TRP. Since the supramarginal gyrus is associated with empathy, pain and related information integration results could be interpreted as reflecting stricter evaluation of negative behavior due to better integration of information. Improved recognition of positive emotions with TRP in older participants supports the use of a TRP-rich diet to compensate for age related decline in social-cognitive processes.

Unzipping empathy in psychopathy: Empathy and facial affect processing in psychopaths

Psychopathy is a neurodevelopmental disorder that has a highly deleterious effect upon both individuals and society at large. Psychopaths grossly neglect and disrespect the interests of others. Their antisocial behavior is thought to originate from a lack of empathy. However, empathy is multidimensional in nature, as evidenced by the considerable heterogeneity in extant theorizing on the subject. Here, we present the "Zipper model of empathy" that reconsiders how both its affective and cognitive components converge in mature empathic behavior. Furthermore, the Zipper model of empathy is expedient for explaining the empathy deficits in psychopathy, insofar as it brings together current theories on the dysfunctional affective components of empathy, violence inhibition, and automatic versus goal-directed attention. According to the literature, the neurobiological underpinnings of these theories are amygdala-centered; however, this article traces this specifically to the basolateral and central amygdala subregions. When viewed together, the cognitive and affective components of empathy are zipped together in a natural fashion in healthy empathic behavior, whereas psychopaths leave the zipper substantially unzipped in pursuit of their purely self-centered goals.

Modulating the Activity of the VMPFC With tDCS Alters the Social Framing Effect

Numerous experimental studies have replicated the social framing effect-the observation that people’s decisions related to economic benefits and feelings depend on the method of presentation. Previous neuroimaging studies have shown that the ventromedial prefrontal cortex (VMPFC) plays a part in the influence of framing and how individuals think about the feelings of others. Based on this, we used transcranial direct current stimulation (tDCS) to modulate neuronal activity in the VMPFC to determine the likelihood of a direct association between VMPFC activity and the social framing effect. Subsequently, in three stimulation treatments, we assessed the presence of the social framing effect, as demonstrated by a disparity between harm degree and help degree. The findings revealed a social framing effect in the participants in the control group and the sham treatment but no social framing effect in the participants in the anodal or cathodal treatments. Furthermore, sex differences were observed in the sham treatment’s social framing effect, whereas no sex differences were observed in the anodal or cathodal treatments. The participants tended to harm the victim after receiving anodal or cathodal tDCS over the VMPFC and did not change their helping behaviour in any stimulations. Consequently, a clear causal link between the behaviour of the VMPFC and the social framing effect was found in the present research.

Cognitive and Affective Empathy in Huntington's Disease

BACKGROUND

Empathy is a multidimensional construct and a key component of social cognition. In Huntington's disease (HD), little is known regarding the phenomenology and the neural correlates of cognitive and affective empathy, and regarding how empathic deficits interact with other behavioral and cognitive manifestations.

OBJECTIVE

To explore the cognitive and affective empathy disturbances and related behavioral and neural correlates in HD.

METHODS

Clinical and sociodemographic data were obtained from 36 healthy controls (HC) and 54 gene-mutation carriers (17 premanifest and 37 early-manifest HD). The Test of Cognitive and Affective Empathy (TECA) was used to characterize cognitive (CE) and affective empathy (AE), and to explore their associations with grey matter volume (GMV) and cortical thickness (Cth).

RESULTS

Compared to HC, premanifest participants performed significantly worse in perspective taking (CE) and empathic distress (AE). In symptomatic participants, scores were significantly lower in almost all the TECA subscales. Several empathy subscales were associated with the severity of apathy, irritability, and cognitive deficits. CE was associated with GMV in thalamic, temporal, and occipital regions, and with Cth in parietal and temporal areas. AE was associated with GMV in the basal ganglia, limbic, occipital, and medial orbitofrontal regions, and with Cth in parieto-occipital areas.

CONCLUSION

Cognitive and affective empathy deficits are detectable early, are more severe in symptomatic participants, and involve the disruption of several fronto-temporal, parieto-occipital, basal ganglia, and limbic regions. These deficits are associated with disease severity and contribute to several behavioral symptoms, facilitating the presentation of maladaptive patterns of social interaction.

(Un)mask yourself! Effects of face masks on facial mimicry and emotion perception during the COVID-19 pandemic

Face masks have been said to impact face-to-face interaction negatively. Yet, there is limited evidence on the degree to which partial face occlusion is detrimental to empathic processes such as emotion perception and facial mimicry. To address this question, we conducted an online experiment (N=200, U.K. sample) that assessed subjective ratings and facial expressions (mimicry) in response to masked and unmasked faces. Perceivers were able to recognise happiness and sadness in dynamic emotion expressions independent of (surgical) face masks. However, perceived emotion intensity and interpersonal closeness were reduced for masked faces. Facial mimicry, the perceiver's imitation of the expresser's emotional display, was reduced or absent in response to happy but preserved for sad mask-covered expressions. For happy target expressions, the face-mimicry link was partially mediated by perceived emotion intensity, supporting the idea that mimicry is influenced by context effects. Thus, these findings suggest that whether face masks impede emotion communication depends on the emotion expressed and the emotion-communication aspect of interest. With unprecedented changes in nonverbal communication brought about by the COVID-19 pandemic, this research marks a first contribution to our understanding of facial mimicry as an important social regulator during these times.