The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions

Empathy is a concept central to psychiatry, psychotherapy and clinical psychology. The construct of empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. It is proposed, in the light of multiple levels of analysis including social psychology, cognitive neuroscience and clinical neuropsychology, a model of empathy that involves both bottom-up and top-down information processing underpinned by parallel and distributed computational mechanisms. The predictive validity of this model is explored with reference to clinical conditions. As many psychiatric conditions are associated with deficits or even lack of empathy, we discuss a limited number of these disorders including psychopathy/antisocial personality disorders, borderline and narcissistic personality disorders, autistic spectrum disorders, and alexithymia. We argue that future clinical investigations of empathy disorders can only be informative if behavioral, dispositional and biological factors are combined

The detection of intentional contingencies in simple animations in patients with delusions of persecution

Background. It has been proposed that delusions of persecution are caused by the tendency to over-attribute malevolent intentions to other people's actions. One aspect of intention attribution is detecting contingencies between an agent's actions and intentions. Here, we used simplified stimuli to test the hypothesis that patients with persecutory delusions over-attribute contingency to agents' movements. Method. Short animations were presented to three groups of subjects: (1) schizophrenic patients; (2) patients with affective disorders; and (3) normal control subjects. Patients were divided on the basis of the presence or absence of delusions of persecution. Participants watched four types of film featuring two shapes. In half the films one shape's movement was contingent on the other shape. Contingency was either ‘intentional’: one shape moved when it ‘saw’ another shape; or ‘mechanical’: one shape was launched by the other shape. Subjects were asked to rate the strength of the relationship between the movement of the shapes. Results. Normal control subjects and patients without delusions of persecution rated the relationship between the movement of the shapes as stronger in both mechanical and intentional contingent conditions than in non-contingent conditions. In contrast, there was no significant difference between the ratings of patients with delusions of persecution for the conditions in which movement was animate. Patients with delusions of persecution perceived contingency when there was none in the animate non-contingent condition. Conclusions. The results suggest that delusions of persecution may be associated with the over-attribution of contingency to the actions of agents

Why empathy has a beneficial impact on others in medicine: unifying theories

The past decades have seen an explosion of studies on empathy in various academic domains including affective neuroscience, psychology, medicine, and economics. However, the volumes of research have almost exclusively focused on its evolutionary origins, development, and neurobiological bases, as well as how the experience of empathy is modulated by social context and interpersonal relationships. In the present paper, we examine a much less attended side of empathy: why it has a positive impact on others? After specifying what the construct of empathy encompasses, we briefly review the various effects of empathy on health outcomes in the domain of medicine. We then propose two non-mutually exclusive mechanistic explanations that contribute to explain the positive effects of physician empathy on patients. (1) The social baseline theory (SBT), building on social support research, proposes that the presence of other people helps individuals to conserve metabolically costly somatic and neural resources through the social regulation of emotion. (2) The free energy principle (FEP) postulates that the brain optimizes a (free energy) bound on surprise or its complement value to respond to environmental changes adaptively. These conceptualizations can be combined to provide a unifying integrative account of the benefits of physicians' empathetic attitude on their patients and how it plays a role in healing beyond the mere effect of the therapeutic alliance

Empathy in Clinical Practice: How Individual Dispositions, Gender, and Experience Moderate Empathic Concern, Burnout, and Emotional Distress in Physicians

To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced compassion fatigue with little to no compassion satisfaction showed the highest scores on personal distress and alexithymia as well as the strongest indicators of compassion fatigue. Physicians who have difficulty regulating their negative arousal and describing and identifying emotions seem to be more prone to emotional exhaustion, detachment, and a low sense of accomplishment. On the contrary, the ability to engage in self-other awareness and regulate one’s emotions and the tendency to help others, seem to contribute to the sense of compassion that comes from assisting patients in clinical practice.</p

The neurodevelopment of social preferences in early childhood

Human social preferences are the product of gene-culture coevolution, and rely on predispositions that emerge early in development. These social preferences encompasse distinct motivations, mechanisms, and behaviors, that facilitate social cohesion and cooperation. Developmental social neuroscience critically contributes in elucidating the proximate mechanisms involved in social decision-making and prosociality, and their gradual maturation in interaction with the social and cultural environment

Neuromotor Rehabilitation and Cognitive Outcomes in Patients with Traumatic Brain Injury through the Method BAPNE

After the acute phase of hospitalization, patients with severe brain injury, requiring interventions in health and social care in the long term: the work of rehabilitators is to facilitate the recovery of several disorders caused by trauma and involves all possible areas to return the patient to full functionality within the autonomy and satisfaction of basic needs, and psychological support they need.The recent use of body percussion through BAPNE method in neurorehabilitation offers the possibility of studying the development of motor skills, attention, coordination, memory and social interaction of patients with neurological diseases.The experimental protocol involves 52 patients with GCA selected on the basis of shared and structured requirements.The trial will provide the coaching protocol BAPNE (in two weekly sessions of 50 minutes to a maximum of 10 weeks in a group of patients), to the traditional rehabilitation activities. The control group will continue to perform exclusively the cognitive and neuromotor rehabilitation according to traditional protocols.All subjects will be: monitored the levels of cortisol in-time 0 - 75-180 days; recorded beats per minute through a heart rate monitor on your wrist; through the use of Lybra (equilibrium) and Kimeja (virtual reality) will be recorded data regarding the ability to adjust the balance of the patient in standing and sitting using the visual input and data relating to the patient's ability to coordinate fine motor skills in a virtual environment; through the administration of neuropsychological tests (HADS, NPI) will be detected improvements in mood and behavioral disturbances in the regression if available. At 6 months after administration of the protocol is expected to re-test to assess if present, the maintenance of the effects of rehabilitation obtained. The research is led by three neurologists from the center of neurorehabilitation Fondazione Roboris ASL RME in Rome

Neural circuits involved in imitation and perspective-taking

Is it important to adopt the perspective of the model when learning a new skill? Is the “mirror system” equally involved when the teacher is facing or side-by-side with students? In this functional MRI study, we measured the cerebral hemodynamic changes in participants who watched video-clips depicting simple hand or foot actions. The participants either watched passively or imitated these actions. Half the video-clips depicted actions filmed from the perspective of the participant (1st-person perspective) and half from a frontal view as if watching someone else (3rd-person perspective). Behavioral results showed that latency to imitate was significantly shorter for the 1st-person perspective than the 3rd-person perspective. Functional imaging results demonstrate that the observation of intransitive actions engaged primary visual and extrastriate visual areas, but not the premotor cortex. Imitation vs. observation of actions yielded enhanced signal in the contralateral somatosensory and motor cortices, cerebellum, left inferior parietal lobule and superior parietal cortex, and left ventral premotor cortex. Activity in the lateral occipital cortex around the extrastriate body area was significantly enhanced during imitation, as compared to observation of actions confirming that this region involvement reaches beyond the perception of body parts. Moreover, comparisons of the two visual perspectives showed more activity in the left sensory–motor cortex for 1st-person, even during observation alone, and in the lingual gyrus for 3rd-person perspective. These findings suggest that the 1st-person perspective is more tightly coupled to the sensory-motor system than the 3rd-person perspective, which requires additional visuospatial transformation

An fMRI study of affective perspective taking in individuals with psychopathy: imagining another in pain does not evoke empathy

While it is well established that individuals with psychopathy have a marked deficit in affective arousal, emotional empathy, and caring for the well-being of others, the extent to which perspective taking can elicit an emotional response has not yet been studied despite its potential application in rehabilitation. In healthy individuals, affective perspective taking has proven to be an effective means to elicit empathy and concern for others. To examine neural responses in individuals who vary in psychopathy during affective perspective taking, 121 incarcerated males, classified as high (n = 37; Hare psychopathy checklist-revised, PCL-R ≥ 30), intermediate (n = 44; PCL-R between 21 and 29), and low (n = 40; PCL-R ≤ 20) psychopaths, were scanned while viewing stimuli depicting bodily injuries and adopting an imagine-self and an imagine-other perspective. During the imagine-self perspective, participants with high psychopathy showed a typical response within the network involved in empathy for pain, including the anterior insula (aINS), anterior midcingulate cortex (aMCC), supplementary motor area (SMA), inferior frontal gyrus (IFG), somatosensory cortex, and right amygdala. Conversely, during the imagine-other perspective, psychopaths exhibited an atypical pattern of brain activation and effective connectivity seeded in the anterior insula and amygdala with the orbitofrontal cortex (OFC) and ventromedial prefrontal cortex (vmPFC). The response in the amygdala and insula was inversely correlated with PCL-R Factor 1 (interpersonal/affective) during the imagine-other perspective. In high psychopaths, scores on PCL-R Factor 1 predicted the neural response in ventral striatum when imagining others in pain. These patterns of brain activation and effective connectivity associated with differential perspective-taking provide a better understanding of empathy dysfunction in psychopathy, and have the potential to inform intervention programs for this complex clinical problem

What Are You Feeling? Using Functional Magnetic Resonance Imaging to Assess the Modulation of Sensory and Affective Responses during Empathy for Pain

BACKGROUND: Recent neuroscientific evidence suggests that empathy for pain activates similar neural representations as the first-hand experience of pain. However, empathy is not an all-or-none phenomenon but it is strongly malleable by interpersonal, intrapersonal and situational factors. This study investigated how two different top-down mechanisms - attention and cognitive appraisal - affect the perception of pain in others and its neural underpinnings. METHODOLOGY/PRINCIPAL FINDINGS: We performed one behavioral (N = 23) and two functional magnetic resonance imaging (fMRI) experiments (N = 18). In the first fMRI experiment, participants watched photographs displaying painful needle injections, and were asked to evaluate either the sensory or the affective consequences of these injections. The role of cognitive appraisal was examined in a second fMRI experiment in which participants watched injections that only appeared to be painful as they were performed on an anesthetized hand. Perceiving pain in others activated the affective-motivational and sensory-discriminative aspects of the pain matrix. Activity in the somatosensory areas was specifically enhanced when participants evaluated the sensory consequences of pain. Perceiving non-painful injections into the anesthetized hand also led to signal increase in large parts of the pain matrix, suggesting an automatic affective response to the putatively harmful stimulus. This automatic response was modulated by areas involved in self/other distinction and valence attribution - including the temporo-parietal junction and medial orbitofrontal cortex. CONCLUSIONS/SIGNIFICANCE: Our findings elucidate how top-down control mechanisms and automatic bottom-up processes interact to generate and modulate other-oriented responses. They stress the role of cognitive processing in empathy, and shed light on how emotional and bodily awareness enable us to evaluate the sensory and affective states of others