How do Children with Intellectual Disabilities Empathize in Comparison to Typically Developing Children?

OBJECTIVES

Two studies were conducted to better understand how children with intellectual disabilities (ID) empathize with the feelings of others during social interactions. The first study tested hypotheses of developmental delay or difference regarding empathy in 79 children with ID by comparing them with typically developing (TD) children, matched for developmental age or chronological age. The second study examined specific aspects of empathy in 23 children with Down syndrome (DS), compared with 23 nonspecific ID children, matched for developmental age, and TD children, matched for developmental age or chronological age.

METHOD

An empathy task was administered to the children while their parents completed the French versions of the Empathy Questionnaire and the Griffith Empathy Measure.

RESULTS

The first study showed that ID children showed delayed empathy development but were perceived by their parents as deficient in cognitive empathy. The second study showed that DS children were perceived as being more attentive to the feelings of others than TD children and non-specific ID children, matched for developmental age, and as having affective empathy that was similar to that of TD children matched for chronological age.

CONCLUSION

These studies have drawn attention to delays or differences in different dimensions of empathy in children with ID and DS, which need to be taken into account in interventions.

Validation of the Basic Empathy Scale in an Arabic-speaking population: The BES-Ar

PURPOSE

The aim of this work was to test the psychometric properties of the Arabic version of the BES (Basic Empathy Scale) by establishing its factor structure, its internal consistency and construct validity in the general population.

DESIGN AND METHODS

The BES was tested among 526 Tunisian adults.

FINDINGS

The two-factor structure of the BES-20 was confirmed. Internal consistency and concurrent validity were very satisfactory.

DISCUSSION

This scale will be useful for clinicians in various fields (mental health, psychiatry) in Arabic countries.

Remember walking in their shoes? The relation of self-referential source memory and emotion recognition

Deficits in the ability to read the emotions of others have been demonstrated in mental disorders, such as dissociation and schizophrenia, which involve a distorted sense of self. This study examined whether weakened self-referential source memory, being unable to remember whether a piece of information has been processed with reference to oneself, is linked to ineffective emotion recognition. In two samples from a college and community, we quantified the participants' ability to remember the self-generated versus non-self-generated origins of sentences they had previously read or partially generated. We also measured their ability to read others' emotions accurately when viewing photos of people in affect-charged situations. Multinomial processing tree modelling was applied to obtain a measure of self-referential source memory that was not biased by non-mnemonic factors. Our first experiment with college participants revealed a positive correlation between correctly remembering the origins of sentences and accurately recognising the emotions of others. This correlation was successfully replicated in the second experiment with community participants. The current study offers evidence of a link between self-referential source memory and emotion recognition.

Cognitive and affective perspective taking amongst adolescent offenders with variants of callous-unemotional traits

Evidence suggests that associations between antisocial behaviour, callous-unemotional (CU) traits and cognitive empathy (e.g. perspective taking) vary depending on more fine-grained dimensions of these constructs. This study examined associations between adolescent antisocial behaviour and individual differences in cognitive and affective perspective taking ability. Based on current theory regarding distinct variants of CU traits, we further tested whether the correlates of CU traits differed amongst youth with high versus low levels of anxiety. Participants were 130 male adolescents (81 youth offenders; 49 non-offenders) aged 13-20 years, of predominantly Caucasian and Aboriginal Australian ethnicity. Perspective taking skills were indexed using performance-based testing, and self-report data was collected on CU traits and anxiety in a cross-sectional design. Offender status was associated with poorer cognitive and affective perspective taking. In addition, associations between CU traits and perspective taking skills were moderated by anxiety. Specifically, CU traits were associated with poorer skills for second-order cognitive perspective taking amongst high-anxiety youth, whereas CU traits were associated with better cognitive and affective perspective taking skills amongst low-anxiety youth. More fine-grained assessment of such factors stands to enhance understanding of, and effective intervention for, antisocial youth.

A meta-analytic review of the relations between anxiety and empathy

Although theory suggests that empathy may signal a risk for anxiety (Tone & Tully, 2014), the relation between these constructs remains unclear due to the lack of a quantitative synthesis of empirical findings. We addressed this question by conducting three meta-analyses assessing anxiety and general, cognitive, and affective empathy (k's = 70-102 samples; N's = 19,410-25,102 participants). Results suggest that anxiety has a small and significant association with general empathy (r = .08). The relation of clinical anxiety with cognitive empathy was significant but very weak (r = -.03), and small for affective empathy (r = .16). Geographic region and the type of cognitive (e.g., perspective taking, fantasy) and affective empathy (e.g., affective resonance, empathic concern) emerged as moderators. Results suggest that anxiety has a weaker association with general empathy but a stronger association with affective empathy in participants from predominantly collectivistic geographic regions. Further, greater anxiety was weakly associated with less perspective-taking and greater fantasy, and anxiety had a more modest association with empathic concern than other types of affective empathy. Targeting affective empathy (e.g., promoting coping strategies when faced with others' distress) in interventions for anxiety may be beneficial.

Mood congruency affects physiological synchrony but not empathic accuracy in a naturalistic empathy task

Empathy is a crucial aspect of our daily lives, as it enhances our wellbeing and is a proxy for prosocial behavior. It encompasses two related but partially distinct components: cognitive and affective empathy. Both are susceptible to context, biases and an individual's physiological state. Few studies have explored the effects of a person's mood on these empathy components, and results are mixed. The current study takes advantage of an ecological, naturalistic empathy task - the empathic accuracy (EA) task - in combination with physiological measurements to examine and differentiate between the effects of one's mood on both empathy components. Participants were induced with positive or negative mood and presented videos of targets narrating autobiographical negative stories, selected from a Chinese empathy dataset that we developed (now publicly available). The stories were conveyed in audio-only, visual-only and full-video formats. Participants rated the target's emotional state while watching or listening to their stories, and physiological measures were taken throughout the process. Importantly, similar measures were taken from the targets when they narrated the stories, allowing a comparison between participants' and targets' measures. We found that in audio-only and visual-only conditions, participants whose moods were congruent with the target showed higher physiological synchrony than those with incongruent mood, implying a mood-congruency effect on affective empathy. However, there was no mood effect on empathic accuracy (reflecting cognitive empathy), suggesting a different influence of mood on the two empathy components.

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.

Emotional and socio-cognitive processing in young children with symptoms of anxiety

Many children with anxiety disorders exhibit significant and persistent impairments in their social and interpersonal functioning. Two components essential for successful social interaction are empathy and theory of mind (ToM). Both constructs develop rapidly in childhood, but no study has simultaneously examined these skills in young children with emerging mental health problems, including those with symptoms of anxiety. This study investigated empathy and ToM in children with anxiety symptomatology and examined their relationship with anxiety severity. A cross-sectional study was carried out with 174 children aged 4-8 years with emerging mental health difficulties who were referred by school teachers for an assessment because of emotional, cognitive, or behavioural problems at school. Participants completed empathy and ToM tasks. Parents were interviewed and rated children's emotional and behavioural problems. Correlational analyses indicated that elevated anxiety was associated with better cognitive ToM and worse affective empathy; there were no associations between anxiety and either cognitive empathy or affective ToM. Subsequent regression analyses demonstrated that whilst enhanced cognitive ToM was explained by age and verbal IQ, anxiety symptoms uniquely predicted impaired affective empathy. These results indicate that children with symptoms of anxiety have difficulty in sharing in other people's emotions. As a result, they may find it difficult to behave in socially adequate ways in interactions with others that involve affective sharing. These findings encourage the use of early and targeted interventions that improve affective empathy development in children with anxiety symptoms.

Cognitive and Affective Empathy as Indirect Paths Between Heterogeneous Depression Symptoms on Default Mode and Salience Network Connectivity in Adolescents

Depression amongst adolescents is a prevalent disorder consisting of heterogeneous emotional and functional symptoms-often involving impairments in social domains such as empathy. Cognitive and affective components of empathy as well as their associated neural networks (default mode network for cognitive empathy and salience network for affective empathy) are affected by depression. Depression commonly onsets during adolescence, a critical period for brain development underlying empathy. However, the available research in this area conceptualizes depression as a homogenous construct, and thereby miss to represent the full spectrum of symptoms. The present study aims to extend previous literature by testing whether cognitive and affective empathy indirectly account for associations between brain network connectivity and heterogeneous depression symptoms in adolescents. Heterogeneous functional and emotional symptoms of depression were measured using the child depression inventory. Our results indicate that cognitive empathy mediates the association between default mode network functional connectivity and emotional symptoms of depression. More specifically, that adolescents with a stronger positive association between the default mode network and cognitive empathy show lower emotional depression symptoms. This finding highlights the importance of cognitive empathy in the relationship between brain function and depression symptoms, which may be an important consideration for existing models of depression in adolescents.

Theory of mind in older adults: the nature of the decline

Successful social interaction depends (among others) on one's ability to understand other people's emotional states (known as "affective-Theory-of-Mind"; aToM). A decline in this ability could be associated with changes in awareness with age. Awareness can be estimated by comparing one's subjective and objective abilities. Here we explored the sequence of changes in aToM with age, with reference to objective and subjective capacities. One hundred and eight participants were divided into three age groups: young (18-39), adults (60-69), and elders' group (70-86). Objective aToM performance was assessed using the Frith-Happé animation task (including meaningful and meaningless interactions). The subjective performance was evaluated by a Short Subjective ToM Questionnaire (sToM10). The results in the animation task showed reduction in the ability to correctly categorize meaningless interaction among the adult participants (compared to young) and a further decrease in the ability to correctly categorize meaningful interactions among the elderly participants (compared to young participants). Subjective aToM results revealed that while older participants reported a reduction in general ability to infer feelings in others, they could not report a decrease in their ability to recognize specific feelings. Our results may indicate a unique characteristic of aToM decline, which may start in adults (60-69; only reflected when the social demands are high) and further aggravates as people grow older (70th and above). In addition, results of the self-report questionnaire may indicate that while the elders are fully aware of their general decline in aToM ability, awareness of their capability to identify specific emotions is impaired.

Altered empathy-related resting-state functional connectivity in patients with bipolar disorder

Empathy is the ability to generate emotional responses (i.e., cognitive empathy) and to make cognitive inferences (i.e., affective empathy) to other people's emotions. Empirical evidence suggests that patients with bipolar disorder (BD) exhibit impairment in cognitive empathy, but findings on affective empathy are inconsistent. Few studies have examined the neural mechanisms of cognitive and affective empathy in patients with BD. In this study, we examined the empathy-related resting-state functional connectivity (rsFC) in BD patients. Thirty-seven patients with BD and 42 healthy controls completed the self-report Questionnaires of Cognitive and Affective Empathy (QCAE), the Yoni behavioural task, and resting-sate fMRI brain scans. Group comparison of empathic ability was conducted. The interactions between group and empathic ability on seed-based whole brain rsFC were examined. BD patients scored lower on the Online Simulation subscale of the QCAE and showed positive correlations between cognitive empathy and the rsFC of the dorsal Medial Prefrontal Cortex (dmPFC) with the lingual gyrus. The correlations between cognitive empathy and the rsFC of the temporal-parietal junction (TPJ) with the fusiform gyrus, the cerebellum and the parahippocampus were weaker in BD patients than that in healthy controls. These findings highlight the underlying neural mechanisms of empathy impairments in BD patients.

Interaction between the BDNF rs11030101 genotype and job stress on cognitive empathy

BACKGROUND

Empathy refers to an individual's ability to experience the emotional and cognitive processes of another person during social interactions. Although many studies have examined the effects of genetic variation on emotional empathy, little is currently known about whether genetic factors may influence cognitive empathy. This study investigated the relationship between BDNF rs11030101 genotype, job stress, and empathy, especially cognitive empathy, in a Chinese Han population.

METHODS

A cross-sectional design was used and 340 participants were recruited from a university in Beijing. Interpersonal Reactivity Index (IRI) was used to measure empathy. Job stress was measured using House and Rizzo's Job Stress Scale. The BDNF rs11030101 was genotyped in all participants.

RESULTS

Gender and age were associated with various IRI subscales (p < 0.001). After controlling for gender, age and education level, BDNF rs11030101 genotype had no main effect on all empathy subscales (p > 0.05). Job stress was negatively associated with Perspective Taking (p = 0.006) and positively associated with Personal Distress (p < 0.001). In addition, the BDNF rs11030101 genotype modulated the relationship between job stress and Fantasy (p = 0.013), indicating that T allele carriers had higher Fantasy scores at higher job stress and lower Fantasy scores at lower job stress than AA homozygotes. This interaction was only present in women.

LIMITATIONS

The sample size and single-nucleotide polymorphism are limited, and the cross-sectional design should be improved.

CONCLUSIONS

Female university faculty with the BDNF rs11030101 T allele may utilize higher emotional job demands, thereby fostering their cognitive empathy.

Having Heart: Affective and Cognitive Empathy Scores vs. Residency Specialty Match at an Osteopathic Medical School

BACKGROUND

Past studies examining the cognitive empathy of medical school graduates grouped the various residency selections vs. parsing them out. This study examines both affective and cognitive empathy scores of osteopathic medical school graduates entering eleven different residency specialties.

METHODS

Participants from the Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM) classes of 2017-2019 completed the Balanced Emotional Empathy Scale (BEES; measuring affective empathy) and the Jefferson Scale of Empathy, Student version (JSE-S; measuring cognitive empathy). Empathy scores were compared to residency choice upon graduation. The specialty choices were broken into two groups: Core specialties (i.e., people-oriented) that include Family Medicine, Internal Medicine, Obstetrics and Gynecology (OB/Gyn), Pediatrics, and Psychiatry. The remaining specialties are considered Non-Core specialties (i.e., technical/procedure-oriented) and included Anesthesiology, Diagnostic Radiology, Emergency Medicine, General Surgery, Neurology, and Orthopedics. Results are compared to data from the nationwide Project in Osteopathic Medical Education and Empathy (POMEE).

RESULTS

Women graduates tended to have larger BEES and JSE-S scores than men. Affective empathy scores were the largest for students selecting Core specialties. Four of these Core specialties were in the top four positions out of the eleven specialties selected by eight or more graduates. None of the eleven specialties was ranked higher than the 50th percentile compared to BEES score norms. Cognitive empathy scores were also the largest for students selecting Core specialties. All five of the Core specialties were in the top six positions out of the eleven specialties. None of the eleven specialties ranked greater than the 39th percentile when compared to OMS-III and OMS-IV POMEE data. Only women entering Psychiatry had a JSE-S score that was greater than the 50th percentile.

CONCLUSIONS

Osteopathic graduates selecting the five Core specialties have BEES and JSE-S scores that are, usually, larger than students entering Non-Core specialties. For either survey instrument, both Pediatrics and Family Medicine were first and second out of a possible 11 positions, respectively. Most CUSOM graduates had JSE-S scores lower than their peers in other osteopathic medical schools that participated in the POMEE study. When the CUSOM data are compared to allopathic data, there is no clear evidence that osteopathic students have substantially higher affective or cognitive empathy scores than their allopathic peers. Therefore, it appears that medical students who select osteopathy for its tenant of a more holistic approach to patient care are no more empathetic than students studying allopathic medicine. Several suggestions are made on how to potentially increase student empathy during undergraduate medical education.

Callous-unemotional traits in adolescents moderate neural network associations with empathy

Callous-unemotional (CU) traits in adolescents are a dimensional construct involving a symptom subset of empathy impairments amongst broader affective deficits. Higher CU trait scores associate with less cognitive and affective empathy; and brain regions linked with cognitive and affective empathy show aberrant function in those with CU traits. How CU traits impact the relationship between brain function and both cognitive and affective empathy in adolescents is less clear. Here we examine how functional properties of networks that support cognitive and affective empathy is moderated by CU traits. Eighty-four adolescents underwent resting-state fMRI scanning and completed self-reports for empathy (Interpersonal Reactivity Index) and CU traits (Inventory of Callous-Unemotional Traits). Analysis revealed that CU traits moderate the association between affective empathy and connectivity between the default mode-frontoparietal networks. Weaker between default mode-frontoparietal anticorrelation negatively associated with affective empathy at low to moderate CU traits. Those highest in CU traits had the lowest affective empathy; and negative associations for those highest in CU traits were insignificant as default mode-frontoparietal anticorrelation weakened. Our results indicate that functional properties of networks that support affective empathy is different at varying levels of CU traits. This novel finding demonstrates that CU traits presence changes the relationship between the brain and empathy.

Autistic Traits and Empathy for Others' Pain Among the General Population: Test of the Mediating Effects of First-Hand Pain Sensitivity

Autism spectrum disorders (ASD) are characterized by reduced pain empathy-a process that is grounded in first-hand pain perception. Because autistic traits are continuously distributed in the general population, we hypothesized that first-hand pain sensitivity would mediate the link between autistic traits and pain empathy. After controlling for alexithymia, higher autistic traits were associated with lower cognitive and emotional empathy in response to others' pain, as well as lower sensitivity to cold and heat pain (higher cold pain tolerance and lower laser heat pain-intensity ratings). Importantly, pain sensitivity fully mediated the link between autistic traits and pain empathy. These findings highlight the role of atypical first-hand pain sensitivity in the lack of pain empathy observed in people with high autistic traits or ASD.

Association Between Children's Empathy and Depression: The Moderating Role of Social Preference

Although empathy is typically an adaptive characteristic of children, extreme empathy alone or in combination with a negative environment may contribute to a risk of depression. The present study comprehensively investigated the associations between the three constructs of empathy and depression in children, as well as the potential moderating effect of peer relationships (i.e., social preference) on this association. A total of 1223 children (mean age = 10.50 ± .93 years) completed questionnaires on empathy and depression, and social preference was nominated by their peers. Cognitive empathy and positive empathy exerted a positive quadratic effect on depression, while negative empathy had a positive linear association with depression. For children with a low social preference, all three empathy constructs were positively quadratically correlated with depression, extremely high and low empathy were associated with increased depression, and moderate empathy was associated with the lowest level of depression. For children with a high social preference, higher positive empathy was associated with lower depression.

Increased Ventromedial Prefrontal Cortex Activity in Adolescence Benefits Prosocial Reinforcement Learning

Learning which of our behaviors benefit others contributes to forming social relationships. An important period for the development of (pro)social behavior is adolescence, which is characterized by transitions in social connections. It is, however, unknown how learning to benefit others develops across adolescence and what the underlying cognitive and neural mechanisms are. In this functional neuroimaging study, we assessed learning for self and others (i.e., prosocial learning) and the concurring neural tracking of prediction errors across adolescence (ages 9-21, N = 74). Participants performed a two-choice probabilistic reinforcement learning task in which outcomes resulted in monetary consequences for themselves, an unknown other, or no one. Participants from all ages were able to learn for themselves and others, but learning for others showed a more protracted developmental trajectory. Prediction errors for self were observed in the ventral striatum and showed no age-related differences. However, prediction error coding for others showed an age-related increase in the ventromedial prefrontal cortex. These results reveal insights into the computational mechanisms of learning for others across adolescence, and highlight that learning for self and others show different age-related patterns.

Differences in empathy toward patients between medical and nonmedical students: an fMRI study

There is growing concern about a potential decline in empathy among medical students over time. Despite the importance of empathy toward patients in medicine, it remains unclear the nature of the changes in empathy among medical students. Thus, we systematically investigated affective and cognitive empathy for patients among medical students using neuroscientific approach. Nineteen medical students who completed their fifth-year medical curriculum and 23 age- and sex-matched nonmedical students participated in a functional magnetic resonance imaging study. Inside a brain scanner, all participants read empathy-eliciting scenarios while adopting either the patient or doctor perspective. Brain activation and self-reported ratings during the experience of empathy were obtained. Behavioral results indicated that all participants reported greater emotional negativity and empathic concern in association with the patient perspective condition than with the doctor perspective condition. Functional brain imaging results indicated that neural activity in the posterior superior temporal region implicated in goal-relevant attention reorienting was overall increased under the patient perspective than the doctor perspective condition. Relative to nonmedical students, medical students showed decreased activity in the temporoparietal region implicated in mentalizing under the patient perspective versus doctor perspective condition. Notably, this same region showed increased activity under the doctor versus patient condition in medical students relative to nonmedical students. This study is among the first to investigate the neural mechanisms of empathy among medical students and the current findings point to the cognitive empathy system as the locus of the primary brain differences associated with empathy toward patients.

Sex-hormone status and emotional processing in healthy women

Fluctuations of sex hormones across the menstrual cycle allow investigating the role of 17-β estradiol and progesterone in emotional processing. We examined emotional memory, empathy-related measures, as well as mimic and skin-conductance responses to affective stimuli in 72 women either in the mid-cycle (MC-group: moderate to high estradiol, low progesterone), the later cycle (LC-group: high progesterone, moderate estradiol), or during oral contraceptive use (OC-group: low endogenous ovarian-hormone levels). In the first session, affective pictures were presented (memory encoding) while recording mimic and skin-conductance responses. Additionally, participants were exposed to a post-encoding stressor (cold pressor test). After 24 h, we tested surprise recall as well as empathy-related performance. Emotional memory was not affected by the hormone-status group, stressor, or salivary hormone levels. For the cognitive empathy-related measure, hormone status interacted with the protagonist gender. Women in the LC- and OC-groups identified emotions more accurately if depicted by female protagonists, yet the MC-group identified emotions depicted by men and women equally well. Correspondingly, the number of correctly identified emotions from male protagonists correlated positively with estradiol levels. In the affective empathy-related ratings, the OC-group showed a negativity bias, rating negative (vs. positive) emotions higher, although not associated with hormone levels. Mimic responses were not modulated by hormone-status group or related to hormone levels. Skin-conductance responses to negative pictures were heightened in the LC-group and correlated positively with progesterone levels. These data suggest a differential impact of female sex hormones on emotional processing, i.e., empathy-related performance and affective sympathetic reactivity, but not in emotional memory or affective mimic reactivity.

Associations between cognitive and affective empathy and internalizing symptoms in late childhood

BACKGROUND

Empathy is a multidimensional construct, which includes cognitive and affective components. Studies in adults have demonstrated that both cognitive and affective empathy are associated with anxious and depressive symptoms. The aim of this study was to examine these associations in childhood.

METHODS

Participants were 127 9- and 10-year-old children, recruited from the community. Self-report measures of cognitive and affective empathy, and internalizing symptoms were administered, as well as a task-based measure of cognitive empathy.

RESULTS

Canonical correlation analysis demonstrated that components of affective empathy, specifically affective sharing and empathic distress, were associated with internalizing (particularly social anxiety) symptoms (R_c = 0.63, non-parametric p < .001). Cognitive empathy was not associated with internalizing symptoms.

LIMITATIONS

Most of our findings were based around self-report measures of empathy, which may not accurately reflect empathy ability.

CONCLUSIONS

Findings suggests that children who share each other's emotions strongly are more likely to experience anxiety, particularly of a social nature.

The neuroscience of empathy and compassion in pro-social behavior

Research in the scientific literature increasingly demonstrates that empathy consists of multiple dimensions, and that defining empathy as a single encompassing term may be imprecise. Recent calls have been made for increasing empathy as means to increase pro-social behavior. However, contradictory evidence exists that empathy may reduce pro-social behavior. This debate has sparked confusion around what is empathy, along with the value of empathy in promoting pro-social behavior. This paper will examine recent advances in affective neuroscience to better understand the construct of empathy and its relationship to pro-social behavior. Individuals' responses to affective empathy, seeing the suffering of others can result in personal distress or empathic concern, which may then subsequently affect motivation for pro-social behavior. Current research in affective neuroscience suggests that combining compassion interventions in conjunction with both affective and cognitive empathy offers the most optimal likelihood that individuals will engage in pro-social behavior.

Affective empathy in neurodegenerative disorders: The importance of measurement type

In recent years, there has been increasing attention focused on affective empathy in neurodegenerative disorders (NDs). However, prior studies have identified discrepancies not only between, but sometimes within, specific NDs. These discrepancies may reflect methodological differences in how affective empathy has been operationalized, with three quite distinct approaches to assessment possible (self-report, informant-report and performance-based). Therefore, we conducted the first meta-analytic review of affective empathy in people with NDs, that considered the potential moderating role of measurement type. Across 27 studies that included 1456 people with NDs and 832 controls, the results showed that most NDs are associated with impaired affective empathy, but that the magnitude of these difficulties differs meaningfully across disorders. However, most importantly, the results indicated that measurement type is a critical consideration in this literature, with substantive differences emerging for self- versus informant-rated measures. These results are discussed in relation to their practical implications for clinical assessment, as well as how they help to inform current theoretical understanding of affective empathic processing.

The mediating effect of language on the development of cognitive and affective theory of mind

Theory of mind (ToM) development is critical to effective social functioning and appears to depend on complementary language abilities. The current study explored the mediating influence of language on the development of both cognitive and affective ToM. A total of 151 children aged 5-12 years completed ToM (cognitive and affective) and language assessments, and parents provided ratings of their children's empathic ability. Results showed that language mediated the relationship between age and both cognitive and affective ToM but not parent-reported cognitive empathy. Examination of younger and older subgroups revealed that language mediated cognitive and affective ToM differently across developmental periods. Findings highlight the dynamic role that language plays in the development of both cognitive and affective ToM throughout early and middle childhood.

Personality traits are associated with cognitive empathy in medical students but not with its evolution and interventions to improve it

OBJECTIVE

Cognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined.

METHODS

The cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S.

RESULTS

The cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group.

CONCLUSION

Although personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality.

Network functional connectivity underlying dissociable cognitive and affective components of empathy in adolescence

Empathy, the capacity to understand and share others' emotions, can occur through cognitive and affective components. These components are different conceptually, behaviorally, and in the brain. Neuroimaging task-based research in adolescents and adults document that cognitive empathy associates with the default mode and frontoparietal networks, whereas regions of the salience network underlie affective empathy. However, cognitive empathy is slower to mature than affective empathy and the extant literature reveals considerable developmental differences between adolescent and adult brains within and between these three networks. We extend previous work by examining empathy's association with functional connectivity within and between these networks in adolescents. Participants (n = 84, aged 13-17; 46.4% female) underwent resting state fMRI and completed self-report measures (Interpersonal Reactivity Index) for empathy as part of a larger Nathan-Kline Institute study. Regression analyses revealed adolescents reporting higher cognitive empathy had higher within DMN connectivity. Post hoc analysis revealed cognitive empathy's association within DMN connectivity is independent of affective empathy or empathy in general; and this association is driven by positive pairwise connections between the bilateral angular gyri and medial prefrontal cortex. These results suggest introspective cognitive processes related to the DMN are specifically important for cognitive empathy in adolescence.

The role of olfaction and sex-hormone status in empathy-related measures

Reports of a female advantage in empathy-related measures suggest a role for sex hormones, although the data are inconsistent. Studies also report similar sex differences in human olfactory perception. In rodents, olfaction is involved in detecting and integrating socially relevant information and is modulated by the brain actions of estrogens. We hypothesized that olfaction may untangle the mixed evidence on the relationship between sex hormones and empathy-related measures (cognitive and affective) in humans. To test this, we examined 60 healthy participants in three sex-hormone-status groups: free-cycling women tested in cycle phases with higher 17-β estradiol and progesterone, oral-contraceptive users (low estradiol and progesterone), and men. We assessed empathy-related measures, facial mimicry (from zygomaticus and corrugator muscle activity), and odor discrimination ability. In the empathy-related measures and facial mimicry, we did not find overall group effects or meaningful associations with salivary levels of estradiol, progesterone, or testosterone. Free-cycling women only outperformed men in the recognition of emotions from pictures of the eye region, but sex hormones were unrelated to emotion recognition performance. Oral contraceptive users showed higher scores in the affective empathy-related measure when viewing negative emotions, with no relation to hormone levels. Free-cycling women exhibited the strongest facial mimicry (viewing female, but not male protagonists), positively associated with progesterone. Finally, the groups differed in odor discrimination, with free-cycling women outperforming men. However, odor discrimination ability and empathy-related performance were not correlated. Our results support a role of sex hormones in odor perception and in empathy-related measures, to a certain extent. However, no common underlying mechanism was found.

Emotion recognition in nonhuman primates: How experimental research can contribute to a better understanding of underlying mechanisms

Recognising conspecifics' emotional expressions is important for nonhuman primates to navigate their physical and social environment. We address two possible mechanisms underlying emotion recognition: emotional contagion, the automatic matching of the observer's emotions to the emotional state of the observed individual, and cognitive empathy, the ability to understand the meaning and cause of emotional expressions while maintaining a distinction between own and others' emotions. We review experimental research in nonhuman primates to gain insight into the evolution of emotion recognition. Importantly, we focus on how emotional contagion and cognitive empathy can be studied experimentally. Evidence for aspects of cognitive empathy in different nonhuman primate lineages suggests that a wider range of primates than commonly assumed can infer emotional meaning from emotional expressions. Possibly, analogous rather than homologous evolution underlies emotion recognition. However, conclusions regarding its exact evolutionary course require more research in different modalities and species.

Impact of patient information behaviours in online health communities on patient compliance and the mediating role of patients' perceived empathy

OBJECTIVE

Patient health information seeking and physician-patient communication in OHCs proved to have impacts on patient compliance, but related studies from psychological perspectives are limited. This study aims to investigate the impact of patient health information seeking and physician-patient communication in OHCs on patient compliance.

METHODS

This study established a research model and proposed six hypotheses. An anonymous investigation was conducted using Chinese OHCs. Confirmatory factor analysis, partial least squares, and structural equation modelling were used to test the hypotheses.

RESULTS

We received 371 responses, and 316 of them were valid. Patient health information seeking and physician-patient communication frequency in OHCs had positive impacts on patients' perceived affective and cognitive empathies, which positively impacted patient compliance.

CONCLUSIONS

Patient compliance can be improved by patient health information seeking and physician-patient communication in OHCs and affective and cognitive empathies. Patients' perceived affective empathy is the preferred perspective to improve patient compliance.

PRACTICE IMPLICATIONS

Physicians should encourage patients to seek health information and communicate with them through OHCs, be concerned about patients' experiences, feelings, and attitudes, understand patients' demands and mental states, and show their patients that they can feel patients' pain. Increasing physician-patient communication frequency in OHCs can help improve patient compliance.

The Impact of Meeting Patients with Neurological Disorders on Medical Student Empathy

PURPOSE

Empathy tends to decline during medical education, typically beginning in the third year of medical school and often continuing throughout residency and the physician's medical career. The purpose of this study was to determine if first year medical student empathy is affected by small group interactions with patients with neurological disorders, and to investigate if changes in empathy persisted over time.

MATERIALS AND METHODS

Eighty first year medical students participating in a Neuroscience Module interacted with a variety of neurological patients in a small group informational session. Prior to the experience, participants completed the Jefferson Scale of Physician Empathy-Student (JSPE-S) version. After the experience, students completed a post-test JSPE-S questionnaire, and a final post-post-test JSPE-S questionnaire was completed 5 weeks later. Empathy scores were compared with a repeated measures MANOVA. The relationship between gender and empathy, and the effect of the age of the neurological patients on empathy scores were also examined.

RESULTS

Empathy scores for seventy-one students who completed the JSPE-S questionnaires were analyzed. Students had significantly higher empathy immediately after the patient interaction experience, and the change in empathy was sustained over the course of 5 weeks (p = 0.015). The age of the neurological patients had a significant effect on empathy scores. There was no significant difference between empathy scores and gender.

CONCLUSIONS

This study supports the incorporation of a group patient interaction experience into the medical school curriculum as an inexpensive and practical method of enhancing medical student empathy in a non-clinical setting.

Empathy and Theory of Mind in Alzheimer's Disease: A Meta-analysis

OBJECTIVE

A large literature now shows that Alzheimer's disease (AD) disrupts a number of social cognitive abilities, including social perceptual function and theory of mind (ToM). However, less well understood is how the specific subcomponents of ToM as well as both the broader and specific subcomponents of empathic processing are affected.

METHOD

The current study provides the first meta-analytic review of AD that focuses on both empathy and ToM as broad constructs, as well as their overlapping (cognitive empathy and affective ToM) and distinct (affective empathy and cognitive ToM) subcomponents.

RESULTS

Aggregated across 31 studies, the results revealed that, relative to controls, AD is associated with large-sized deficits in both cognitive ToM (g = 1.09) and affective ToM/cognitive empathy (g = 0.76). However, no statistical differences were found between the AD participants and controls on affective empathic abilities (g = 0.36).

CONCLUSIONS

These data point to a potentially important disconnect between core aspects of social cognitive processing in people with AD. The practical and theoretical implications of these findings are discussed.

Distinct Empathy Profiles in Callous Unemotional and Autistic Traits: Investigating Unique and Interactive Associations with Affective and Cognitive Empathy

Empathy deficits are a hallmark of both callous-unemotional (CU) and autistic traits. However, it is unclear whether each trait is associated with deficits in distinct empathy subcomponents. The aim of the current study was to investigate the main and interactive effects of CU and autistic traits in predicting affective and cognitive empathy. We used data of 163 children (Mage = 7.30, SD = 1.42, 44.2% girls), selected from a large community sample (N = 1652). To ensure variability in empathy, we recruited participants with either low (1 standard-deviation below the mean; n = 78) or average to high (n = 85) levels of empathy. Partial correlation and regression analysis revealed that autistic traits were negatively associated with cognitive empathy, whereas CU traits were negatively related with both cognitive and affective empathy. Importantly, this is the first study testing the moderating effects of gender, revealing that CU traits negatively predicted affective empathy only among girls high on autistic traits. Findings can be used to understand the different empathy profiles of children with CU or autistic traits, and inform the development of effective interventions.

Child maltreatment risk mediates the association between maternal and child empathy

BACKGROUND

Empathy deficits are related to parental maltreatment, and early exposure to maltreatment is associated with later impairments in social and interpersonal skills, possibly as the result of specific deficits in cognitive and emotional empathy.

OBJECTIVE

To examine the association between maternal and child's emotional and cognitive empathy, and how this relationship is mediated by maltreatment risk.

PARTICIPANTS AND SETTING

462 mothers of 4-10 years olds (48 % girls; M = 6.51 ± 1.57) were recruited through an online platform (Prolific Inc.) during 2018.

METHODS

Mothers were asked to report on their own cognitive and emotional empathy, views related to abuse risk, and their child's cognitive and emotional empathy.

RESULTS

Findings show that maternal perspective taking (a measure of cognitive empathy), and maternal personal distress predict child's cognitive empathy through abuse risk (beta = -0.29, p value = 0.0002 and beta = 0.22, p value = 0.0001, respectively). Conversely, for child's emotional empathy there was no mediation through abuse risk, rather direct associations were observed for empathic concern (a measure of emotional empathy; beta = 0.36, p value = 0.0197), personal distress (beta = 0.23, p value = 0.0332), and the fantasy scale (another measure of cognitive empathy; beta = 0.36, p value = 0.0019).

CONCLUSIONS

These findings help clarify the complex links between maternal empathy, abuse risk, and child's empathy, showing that maternal views related to abuse are specifically predictive of child's cognitive but not emotional empathy. As such, these findings raise further questions regarding the mechanism by which maternal characteristics and behavior are associated with child's empathy.

Empathic disequilibrium in two different measures of empathy predicts autism traits in neurotypical population

Background

Features of autism spectrum conditions (ASC) are normally distributed within the population, giving rise to the notion of the autism spectrum. One of the hallmark features of ASC is difficulties in social communication, which relies heavily on our ability to empathize with others. Empathy comprises of both cognitive (CE) and emotional (EE) components that, together, allow us to understand another’s emotions and be affected by them appropriately, while maintaining a self-other distinction. Although CE and EE depend on distinct neural and developmental trajectories, it was suggested that the two empathic capacities can influence, balance, and regulate each other. Previous findings regarding the role of emotional and cognitive empathy in ASC have been mixed. Therefore, our study aimed to investigate whether the intra-personal empathy imbalance between the cognitive and emotional components, a measure we termed empathic disequilibrium (ED), can be associated with autism traits at the neurotypical range.

Methods

Participants were 671 young-adults at the neurotypical range who self-reported their empathy, assessed using two highly validated questionnaires—the Interpersonal Reactivity Index and the Empathy Quotient, autism traits using the Autism-Spectrum Quotient, and the related traits, alexithymia, and systemizing.

Results

Controlling for the total empathy score, greater ED was found to be positively correlated with autism traits. Specifically, autism traits were found to be elevated in groups of individuals with relatively higher EE than CE, underscoring their imbalance.

Conclusions

Our study offers a novel perspective on the understanding of the social difficulties associated with autism tendencies in the general population and has potentially important clinical implications for understanding of ASC. We also propose a novel characterization of autism tendencies based on the imbalance between EE and CE, which we term ED, as opposed to examining EE and CE separately.

Cognitive and Emotional Empathy in Young Adolescents: an fMRI Study

Objectives

We investigated the differences in cognitive and emotional empathic ability between adolescents and adults, and the differences of the brain activation during cognitive and emotional empathy tasks.

Methods

Adolescents (aged 13–15 years, n=14) and adults (aged 19–29 years, n=17) completed a range of empathic ability questionnaires and were scanned functional magnetic resonance imaging (fMRI) during both cognitive and emotional empathy task. Differences in empathic ability and brain activation between the groups were analyzed.

Results

Both cognitive and emotional empathic ability were significantly lower in the adolescent compared to the adult group. Comparing the adolescent to the adult group showed that brain activation was significantly greater in the right transverse temporal gyrus (BA 41), right insula (BA 13), right superior parietal lobule (BA 7), right precentral gyrus (BA 4), and right thalamus whilst performing emotional empathy tasks. No brain regions showed significantly greater activation in the adolescent compared to the adult group while performing cognitive empathy task. In the adolescent group, scores of the Fantasy Subscale in the Interpersonal Reactivity Index, which reflects cognitive empathic ability, negatively correlated with activity of right superior parietal lobule during emotional empathic situations (r=-0.739, p=0.006).

Conclusion

These results strongly suggest that adolescents possess lower cognitive and emotional empathic abilities than adults do and require compensatory hyperactivation of the brain regions associated with emotional empathy or embodiment in emotional empathic situation. Compensatory hyperactivation in the emotional empathy-related brain areas among adolescents are likely associated with their lower cognitive empathic ability.

Overcoming the limits of empathic concern: the case for availability and its application to the medical domain

Empathic concern is essential to our social lives because it motivates helping behavior. It has, however, well-known shortcomings such as its limitation in scope. Here, we highlight a further shortcoming of empathic concern: it contributes little to understanding the relevant features of complex social situations (e.g. the causes of somebody's distress), and unaided by further cognitive inputs, likely fails to produce effective helping. We then elaborate on the conditions needed for an accurate assessment of others' situations: the ability to pay attention and try to understand others for their own sake. We explain that when combining these abilities with the valuing aspect of empathic concern, we obtain "availability", an understudied mental state which plays a crucial role in helping motivation. We provide a detailed definition of that notion and show how availability can be trained and exercised by health professionals in order to improve their care and relationships with patients.

The genetic and environmental origins of emotional and cognitive empathy: Review and meta-analyses of twin studies

Empathy is considered a cornerstone of human social experience, and as such has been widely investigated from psychological and neuroscientific approaches. To better understand the factors influencing individual differences in empathy, we reviewed and meta-analyzed the behavioral genetic literature of emotional empathy- sharing others' emotions (k=13), and cognitive empathy- understanding others' emotions (k = 15), as manifested in twin studies. Results showed that emotional empathy is more heritable, 48.3 % [41.3 %-50.6 %], than cognitive empathy, 26.9 % [18.1 %-35.8 %]. Moreover, cognitive empathy as examined by performance tests was affected by the environment shared by family members, 11.9 % [2.6 %-21.0 %], suggesting that emotional understanding is influenced, to some degree, by environmental factors that have similar effects on family members beyond their genetic relatedness. The effects of participants' age and the method used to asses empathy on the etiology of empathy were also examined. These findings have implications for understanding how individual differences in empathy are formed. After discussing these implications, we suggest theoretical and methodological future research directions that could potentially elucidate the relations between genes, brain, and empathy.

Dimensions of empathy and bystander intervention in bullying in elementary school

The current study investigated associations among cognitive empathy, affective empathy, internalizing problems, and the five steps of the bystander intervention model (notice bullying events, interpret as an event requiring intervention, accept responsibility for intervening, know how to intervene, and act). Participants included 336 fourth and fifth grade students (58.9% boys) at a school in the Midwest region of the United States. Hierarchical regression analyses indicated that greater cognitive empathy was related to noticing bullying events, accepting responsibility to intervene, and knowing how to intervene. Affective empathy was significantly related to the actual act of intervention. Further, significant interactions revealed that affective empathy was positively associated with interpreting bullying as an event that required intervention at low and moderate levels of internalizing problems, but not at high levels of internalizing problems. Overall these findings underscore the need to examine the decision to intervene as the culmination of a series of steps as outlined in the bystander intervention model, with each step potentially influenced by a unique set of precursors.

Longitudinal Effects of Cognitive and Affective Empathy on Adolescent Substance Use

Background: A deficit in either socio-cognitive or socio-affective components of empathy is associated with the severity of substance use by late adolescence. What remains unknown is how longitudinal changes in these components of empathy predict adolescent substance using behavior. Methods: This secondary data analysis used data that followed adolescents in outpatient treatment for substance use (n = 826) during treatment and at 6 months post-treatment. To examine cross-lagged effects of empathy on substance use over time, we used a latent basis growth curve model. Results: Increases in affective empathy predicted reduced substance use over time. However, cognitive empathy did not predict substance use after controlling for other covariates. Conclusions: Lower levels of affective empathy may indicate a developmental vulnerability for substance using behavior. Modifying affective empathy may be a viable treatment target for reducing adolescent substance use.

Trait Autism is a Better Predictor of Empathy than Alexithymia

It has been proposed that atypical empathy in autism spectrum disorder (ASD) is due to co-occurring alexithymia. However, difficulties measuring empathy and statistical issues in previous research raise questions about the role of alexithymia in empathic processing in ASD. Addressing these issues, we compared the associations of trait alexithymia and autism with empathy in large samples from the general population. Multiple regression analyses showed that both trait autism and alexithymia were uniquely associated with atypical empathy, but dominance analysis found that trait autism, compared to alexithymia, was a more important predictor of atypical cognitive, affective, and overall empathy. Together, these findings indicate that atypical empathy in ASD is not simply due to co-occurring alexithymia.

A Preliminary Study for Translation and Validation of the Korean Version of The Cognitive, Affective, and Somatic Empathy Scale in Young Adults

OBJECTIVE

The cognitive, Affective, and Somatic Empathy Scale (CASES) suggests novel three components structure of empathy. Although CASES developed to assess the trait empathy of both children and adult, the validation in adult sample is not yet conducted. This study developed Korean version of CASES (CASES-K) and examined the psychometric properties in young adult for first time.

METHODS

Confirmatory factor analysis was conducted to test whether the factor structure suggested in initial development study is valid in Korean young adult population. 350 young adults participated, and 44 of them also answered to other empathy scales for validation. The construct validity was ascertained through a series of correlational analysis with widely used trait empathy scales.

RESULTS

The result of confirmatory factor analysis supports the three-factor model of empathy consists of affective, cognitive and somatic facets. The construct validity was ascertained through a series of correlational analysis with widely used trait empathy scales. The result of correlational analysis supports the validity of CASES-K, and especially the separation of somatic empathy from affective empathy.

CONCLUSION

The current study provides the first evidence of the validity and utility of the CASES-K in young adult population. The result also supports the commonality of three factor structure of empathy in both East Asian and Caucasian, from the children to adults.

Gender differences in empathic responses to others' economic payoffs: an event-related potentials study

Although gender differences in empathy have been well established through measuring subjective outcomes, some studies of the neural mechanisms of pain empathy have not found gender differences. This inconsistent evidence may be caused by different research methods or different paradigms. The present study adopted a different approach from the pain empathy paradigm to examine gender differences in empathic responses to others' economic payoffs using event-related potentials. The results showed that the N2 amplitudes in female participants were more negative than those in male participants, indicating a greater female than male susceptibility to facial expressions at the early stage of empathy. The LPP amplitudes for male participants were found to be more positive in the observation condition (involving no self-interest) than in the participation condition (involving self-interest), but there was no significant difference in the LPP amplitudes for the female participants between the two conditions. The results suggest that females' empathic responses are more likely to be elicited automatically by the perception of others' emotional states. In contrast, males' empathic responses are more likely to be mediated by self-interest, which subsequently reduces their empathic responses.

Anecdote or Reality: Are People From the South and/or Rural Areas of the USA More Empathetic?

Although numerous studies have analyzed empathy scores of allopathic and osteopathic medical students and how these scores fluctuate throughout undergraduate medical education, little is known about whether demographics have an impact on medical students' empathy scores. Using the Balanced Emotional Empathy Scale (BEES) and Jefferson Scale of Empathy (JSE) surveys to measure affective and cognitive empathy, respectively, this present study examined the relationship between empathy scores with the following demographic data from first and second year students at a southeastern US osteopathic medical school: the classification of whether students came from a rural or urban background, the region of the US students lived in prior to matriculation to medical school, and the town/city size of where they were currently living at the time of applying to medical school. Data analyses showed only one statistically significant data point (p < 0.04) that revealed first year osteopathic medical students (OMS-I) from towns with < 10,000 occupants had higher JSE scores in comparison to students coming from towns with 50,000-99,999 occupants. However, trends could be established. For example, anecdotally, it is often presumed people from the southern United States tend to be friendlier than those from the northern states; however, contrary to this, the data revealed OMS-I students from the southern United States had a slightly lower BEES scores than OMS-I students from the northeastern states. JSE scores were nearly identical across all four US census bureau regions. Additionally, OMS-I students coming from an urban background had a higher BEES scores than those coming from a rural background. Compared to population norms, combined male and female BEES scores for OMS-I and -II students were within ± 0.5 s.d. of the norm and are considered to be "average" scores. Combined OMS-I JSE scores were below the population norm at the 37th percentile, and combined OMS-II JSE scores were also at the 37th percentile, except for students from the western region at the 44th percentile.

The relation between empathy and depressive symptoms in a Dutch population sample

BACKGROUND

Impairments in social functioning are common in individuals with (sub)clinical levels of depression. One possible underlying mechanism of this relationship is low empathy. The present study examined linear and non-linear associations between empathy and depressive symptoms, and whether these associations were moderated by gender.

METHODS

Using the Empathy Quotient scale, cognitive and affective empathy were assessed using a large convenience sample from the general Dutch population (N = 3076). Depressive symptoms were indexed by the Depression, Anxiety and Stress Scale (DASS) and the Quick Inventory of Depressive Symptomatology (QIDS-SR16).

RESULTS

Low cognitive empathy was associated with more depressive symptoms. There was a weak positive relation between affective empathy and depressive symptoms, indexed by the QIDS rather than the DASS.

LIMITATIONS

Generalizing results to the general population remains difficult with a convenience sample. Self-reported data may be affected by social-desirability or sex-stereotypical reporting biases.

CONCLUSIONS

Our results support a linear relationship between cognitive empathy and symptoms of depression. There was some evidence for non-linear associations and a moderating role of gender, but these patterns were not observed across all types of analysis.

The relations between empathy, guilt, shame and depression in inpatient adolescents

BACKGROUND

High levels of affective empathy are associated with increased levels of depressive symptoms. However, studies investigating the mechanisms underlying this relation are limited. Since affective empathy may be associated with a feeling of exaggerated responsibility for alleviating the suffering of others, it may lead to high levels of generalized guilt and various forms of shame, which, in turn, may elevate depressive symptoms. Therefore, these self-conscious emotions are candidate mediators of the affective empathy-depressive symptoms relationship. Accordingly, the aim of the current study was to test the hypothesis that generalized and contextual shame and generalized guilt mediate the relations between affective empathy and depressive symptoms.

METHODS

117 inpatient adolescents completed the Basic Empathy Scale to assess affective and cognitive empathy, the Beck Depression Inventory-II to evaluate severity of depressive symptoms, the Test of Self-Conscious Affect that measures contextual guilt and shame, and the Personal Feelings Questionnaire that assess generalized guilt and shame.

RESULTS

Findings demonstrated that generalized guilt, contextual and generalized shame mediated the relation between affective empathy and depressive symptoms. In contrast, cognitive empathy was shown to be related most strongly to contextual guilt and was unrelated to depressive symptoms.

LIMITATIONS

Characteristics of the sample (predominately Caucasian inpatient adolescents from well-educated and financially stable environments), the lack of a longitudinal design, and over-reliance on self-report measures were main limitations of the study.

CONCLUSIONS

The study provides novel information on the mechanisms underlying the association between affective empathy and depressive symptoms and shows that shame and generalized guilt associated with affective sharing should be considered as possible targets for therapeutic/preventive interventions for adolescents with high levels of depressive symptoms.

The relationship between clinical insight and cognitive and affective empathy in schizophrenia

Background

Schizophrenia is often associated with poor clinical insight (unawareness of mental illness and its symptoms) and deficits in empathy, which are important for social functioning. Cognitive empathy has been linked to clinical insight while affective empathy and its role in insight and pathology have received mixed evidence.

Methods

Instruments assessing symptomatology (Positive and Negative Syndrome Scale; PANSS), clinical insight (Scales to assess awareness of mental disorders; SUMD), and cognitive and affective empathy were administered to 22 participants with first episode and chronic schizophrenia and 21 healthy controls. Self-report, parent-report, and performance based measures were used to assess cognitive and affective empathy (The interpersonal reactivity index; IRI/Reading the Mind in the Eyes Test/Faux Pas) to reduce bias and parse shared variance.

Results

Age of onset, gender, and symptomatology emerged as significant predictors of poor clinical insight. Additionally, the fantasy subscale of the IRI as reported by parents emerged as a positive predictor while the personal distress (parent report) subscale emerged as a negative predictor of awareness into mental illness. There were significant differences on performance-based measures of empathy between the control and schizophrenia groups.

Conclusion

Findings suggest that affective empathy is relatively intact across phases of illness whereas cognitive empathy abilities are compromised and could be targets for psychotherapy intervention.

The Moderating Role of Anxiety in the Associations of Callous-Unemotional Traits with Self-Report and Laboratory Measures of Affective and Cognitive Empathy

In a sample of detained male adolescents (n = 107; Mean age = 15.50; SD = 1.30), we tested whether anxiety moderated the association of CU traits with self-report and computerized measures of affective (emotional reactivity) and cognitive (affective facial recognition and Theory of Mind [ToM]) empathy. Hierarchical regression analyses revealed that CU traits were negatively associated with self-reports of affective empathy and this association was not moderated by level of anxiety. Significant interactions revealed that CU traits were negatively associated with cognitive empathy (self-report) only at high levels of anxiety, whereas CU traits were positively associated with cognitive empathy on the ToM task only at low levels of anxiety. CU traits were also associated with greater fear recognition accuracy at low levels of anxiety. Implications for understanding and treating different variants of CU traits (i.e., primary and secondary) are discussed.

Multidimensional assessment of empathic abilities in patients with insular glioma

Recent studies have provided evidence that there are two possible systems for empathy: affective empathy (AE) and cognitive empathy (CE). Neuroimaging paradigms have proven that the insular cortex is involved in empathy processing, particularly in AE. However, these observations do not provide causal evidence for the role of the insula in empathy. Although impairments in empathy have been described following insular damage in a few case studies, it is not clear whether insular cortex is involved in CE and whether these two systems are impaired independently or laterally in patients with insular gliomas. In this study, we assessed 17 patients with an insular glioma, 17 patients with a noninsular glioma, and 30 healthy controls using a method that combined a self-report empathy questionnaire with the emotion recognition task, assessment of empathy for others' pain, and the emotional perspective-taking paradigm. We found that patients with an insular glioma had lower scores for empathic concern and perspective taking than did either healthy controls or lesion controls. The patients' abilities to recognize facial emotions, perceive others' pain, and understand the emotional perspectives of others were also significantly impaired. Furthermore, we did not observe a laterality effect on either AE or CE among those with insular lesions. These findings revealed that both AE and CE are impaired in patients with an insular glioma and that the insular cortex may be a central neuroanatomical structure in both the AE and CE systems.

Empathizers and systemizers process social information differently

Using the empathizing-systemizing theory as our framework, we investigated how people with high self-reported empathizing (having good social skills and being interested in people) and systemizing (being interested in physical things and processes) differ in the social information processing of emotionally negative photographs of people during "spontaneous watching" and emotional and cognitive empathy tasks. Empathizers evaluated the pictures as more emotionally touching and the reactions in the photographs more understandable than the systemizers. Compared to the empathizers, systemizers had stronger activations in the posterior cingulate cortex, an area related to cognitive empathy, as well as in the left superior temporal gyrus and middle frontal gyrus when watching emotional photographs spontaneously. During guided emotional and cognitive empathy tasks, these differences disappeared. However, during the emotional empathy task, higher systemizing was associated with weaker activation of the right inferior frontal gyrus /insula. Furthermore, during emotional and cognitive empathy tasks, empathizing was related to increased activations of the amygdala which were in turn related to higher behavioral ratings of emotional and cognitive empathy. The results suggest that empathizers and systemizers engage in social information processing differently: systemizers in more cognitive terms and empathizers with stronger automatic emotional reactions.

Callous unemotional traits, autism spectrum disorder symptoms and empathy in boys with oppositional defiant disorder or conduct disorder

This study examined additive and interactive effects of callous unemotional (CU) traits and autism spectrum disorders (ASD) symptoms in relation to trait empathy, in boys with oppositional defiant disorder (ODD) or conduct disorder (CD). Participants were 49 boys with ODD/CD, aged between 7-12 years. Boys completed a questionnaire measure of empathic sadness and a broader questionnaire measure of affective and cognitive empathy. Parents and teachers reported on CU traits, and parents reported on ASD symptoms. In agreement with predictions, results reveal a negative association between CU traits and empathic sadness, particularly strong for ODD/CD boys with low levels of ASD symptoms. Results also reveal a negative association between ASD symptoms and cognitive empathy. Findings suggest that CU traits and ASD symptoms are associated with distinct empathy deficits with poor empathic sadness being more typical of CU traits than ASD symptoms.

Stimulus-dependent amygdala involvement in affective theory of mind generation

Successful social interaction requires knowledge about another person's emotional states, represented in an affective theory of mind (ToM). This information can be acquired either directly or indirectly, i.e., by observing emotional facial expressions (EFE) or indirectly by inferring emotions through cognitive perspective taking. Therefore, it is of great interest how the function of the cortical ToM network and the limbic system in affective ToM depends on the presence of facial expressions. We addressed this question in a functional magnetic resonance imaging (fMRI) study. The experimental paradigm applied a well-established ToM cartoon task to test functional effects of EFE on the activation of the amygdala and the anterior ToM network during affective ToM judgments. During the task, 22 healthy participants had to judge the changes of the emotional state of the stories protagonist in the presence or absence of EFE. After quality control, 21 data sets entered the final analyses. The presence of EFE during affective ToM judgments was associated with shorter reaction times as well as increased activation of the right amygdala, most probably located in the basolateral nucleus (BLA), coincident with reduced activation of ToM-related regions of the prefrontal cortex. Psychophysiological interactions (PPI) revealed EFE-dependent modulation of connectivity between the right BLA and the contralateral ToM network regions. In combination with the functional interaction of EFE and affective ToM in the right amygdala, our data suggest a complementary but parallel organization of EFE processing and affective ToM. In this framework, the amygdala seems to act as an EFE detector when affective ToM judgments are demanded. Additionally, the facts that EFE induced exclusively right-sided amygdala activation and modulated the connectivity with the contralateral ToM network support the idea of a functional lateralization of stimulus driven components of affective ToM.