The neural correlates of understanding the other's distress: a positron emission tomography investigation of accurate empathy

The purpose of the present study was to assess the relationship between brain metabolism and empathic response. Six right-handed healthy volunteers were scanned with PET and fluorodeoxyglucose twice: during an interview about neutral story themes and during an empathic response eliciting interview about a story of a character in distress. Metabolic values in the medial and superior frontal gyrus, occipitotemporal cortices, thalamus and the cerebellum were higher during empathic response than during the neutral theme interview. Furthermore, the subjects' empathy scores were positively correlated with metabolism in the medial aspects of the superior frontal gyrus. Our results suggest that empathy consists of both affective and cognitive components and hence may involve cortices that mediate simulation of emotional processing and mental state attribution.     

Emotional contagion, empathic concern and communicative responsiveness as variables affecting nurses'' stress and occupational commitment

Based on data gathered from registered nurses at two hospitals, this research examined the extent to which empathy variables contributed to nursing stress and occupational commitment. The empathy variables examined were emotional contagion (i.e. sharing the emotions of patients), empathic concern (i.e. being concerned for patients) and communicative effectiveness (i.e. effectively communicating with patients and their families). Nursing stress was explored through the variables of depersonalization, reduced personal accomplishment and emotional exhaustion. Multiple regression analyses revealed that the combination of the three emotional communication variables explained significant proportions of the variance in all three of the stress variables, as well as occupational commitment. The analyses further revealed that a lack of empathic concern and poor communicative responsiveness accounted for significant proportions of the variance in depersonalization. Lack of empathic concern, poor communicative responsiveness and high emotional contagion significantly contributed to reduced personal accomplishment. Emotional contagion explained a significant proportion of the variance in emotional exhaustion. Emotional contagion also significantly reduced occupational commitment. The findings are discussed in terms of nursing education and administration.     

The impact of cognitive challenges in major depression: the role of the primary care physician

Nearly 1 in 5 Americans will struggle with major depression in their lives; some will have recurring bouts. Recent psychiatric research has given new attention to the prevalence of cognitive deficits in major depression and the impact such deficits have on remission and overall life functioning. When depression is partially treated i.e., leaving residual symptoms, patients have higher rates of relapse and lower functional outcomes. Impaired cognitive functioning is a frequent residual symptom, persisting in about 45% of patients even when emotional symptoms have improved, and results in a disproportionate share of the functional impairment, particularly in the workplace. Patients with depression have disrupted circuitry in brain regions responsible for cognition and it is therefore important to screen depressed patients for cognitive as well as emotional symptoms. Cognitive dysfunction should be evaluated in every mood disordered patient with validated self-report scales such as the Patient Health Questionnaire-9 or the Beck Depression Inventory and objective measures of cognitive function are also very very useful. Two easily administered tests are the Trails B Test and the Digit Symbol Substitution Test. Each take less than two minutes and measure working memory, executive function, and processing speed and can track cognitive improvement in depressed patients. Treatment of cognitive dysfunction in major depression is complicated by the ‘serotonin conundrum’: SSRI’s frequently do not treat to full remission, and can cause cognitive blunting—actually adding to cognitive problems. Based on recent data including results from a recently completed meta-analysis by McIntyre and colleagues, an evidence-based algorithm for treating cognitive symptoms in depression is presented. A hierarchy of antidepressants and augmentation strategies based on the best available evidence is discussed. In conclusion, cognitive symptoms in major depressive disorder have been recognized as a target of therapeutic improvement by the FDA and have become a focus of clinical importance.     

Neuronal correlates of theory of mind and empathy: a functional magnetic resonance imaging study in a nonverbal task

Theory of Mind (ToM), the ability to attribute mental states to others, and empathy, the ability to infer emotional experiences, are important processes in social cognition. Brain imaging studies in healthy subjects have described a brain system involving medial prefrontal cortex, superior temporal sulcus and temporal pole in ToM processing. Studies investigating networks associated with empathic responding also suggest involvement of temporal and frontal lobe regions. In this fMRI study, we used a cartoon task derived from Sarfati et al. (1997) [Sarfati, Y., Hardy-Bayle, M.C., Besche, C., Widlocher, D. 1997. Attribution of intentions to others in people with schizophrenia: a non-verbal exploration with comic strips. Schizophrenia Research 25, 199-209.]with both ToM and empathy stimuli in order to allow comparison of brain activations in these two processes. Results of 13 right-handed, healthy, male volunteers were included. Functional images were acquired using a 1.5 T Phillips Gyroscan. Our results confirmed that ToM and empathy stimuli are associated with overlapping but distinct neuronal networks. Common areas of activation included the medial prefrontal cortex, temporoparietal junction and temporal poles. Compared to the empathy condition, ToM stimuli revealed increased activations in lateral orbitofrontal cortex, middle frontal gyrus, cuneus and superior temporal gyrus. Empathy, on the other hand, was associated with enhanced activations of paracingulate, anterior and posterior cingulate and amygdala. We therefore suggest that ToM and empathy both rely on networks associated with making inferences about mental states of others. However, empathic responding requires the additional recruitment of networks involved in emotional processing. These results have implications for our understanding of disorders characterized by impairments of social cognition, such as autism and psychopathy.     

Abnormal cortical activity in patients with temporomandibular disorder evoked by cognitive and emotional tasks

Patients with temporomandibular disorder (TMD) perform poorly in neuropsychological tests of cognitive function. These deficits might be related to dysfunction in brain networks that support pain and cognition, due to the impact of chronic pain and its related emotional processes on cognitive ability. We therefore tested whether patients with TMD perform poorly in cognitive and emotion tasks and whether they had abnormal task-evoked brain activity. Seventeen female subjects with nontraumatic TMD and 17 age-matched healthy female subjects underwent functional magnetic resonance imaging while performing counting Stroop tasks comprising neutral words, incongruent numbers, or emotional words, including TMD-specific words. Group differences in task-related brain responses were assessed. Connectivity between 2 pairs of coupled brain regions during the cognitive and emotional tasks (prefrontal-cingulate and amygdala-cingulate) was also examined. The patients had sluggish Stroop reaction times for all Stroop tasks. Furthermore, compared to controls, patients showed increased task-evoked responses in brain areas implicated in attention (eg, lateral prefrontal, inferior parietal), emotional processes (eg, amygdala, pregenual anterior cingulate), motor planning and performance (eg, supplementary and primary motor areas), and activation of the default-mode network (medial prefrontal and posterior cingulate). The patients also exhibited decoupling of the normally correlated activity between the prefrontal and cingulate cortices and between the amygdala and cingulate cortex. These findings suggest that the slow behavioral responses in idiopathic TMD may be due to attenuated, slower, and/or unsynchronized recruitment of attention/cognition processing areas. These abnormalities may be due to the salience of chronic pain, which inherently requires attention.     

Emotional Reactivity to Personally-Relevant and Standardized Sounds in Borderline Personality Disorder

Theoretical conceptualizations highlight emotional reactivity as a core problem for borderline personality disorder (BPD); however, empirical work investigating emotional reactivity in BPD has produced mixed and inconclusive findings. The current study aimed to clarify emotional reactivity in adults diagnosed with BPD (N = 22) and healthy controls (HCs; N = 31) using a controlled, laboratory experiment that assessed multiple indices of emotional reactivity (i.e., subjective, psychophysiological, and facial expressive) in response to auditory stimuli (i.e., standardized vs. personally-relevant; pleasant vs. unpleasant sounds). The BPD group was characterized by higher self-reported arousal and lower valence to personally-relevant unpleasant sounds compared to HCs. Supporting study hypotheses, participants in the BPD group showed heightened skin conductance responses, specifically to unpleasant personally-relevant sounds, compared to HCs. No differences were found between BPD and HC groups on facial expressive responses. Findings replicate and extend previous studies on this topic, and highlight the need to further refine the characterization of emotional reactivity in BPD to include personally-relevant unpleasant stimuli.     

Tracking the Emotional Highs but Missing the Lows: Hypomania Risk is Associated With Positively Biased Empathic Inference

Empathy plays a vital role in emotional and social functioning. Research suggests that empathy may be disrupted in disorders of negative emotion (e.g., depression, anxiety), though less work has examined how empathy is impacted in disorders of positive emotion (e.g., mania), which are associated with positive biases in emotion experience and perception. The present research explored how variation in self-reported hypomania risk was associated with performance on an objective empathic accuracy task with real-world targets. Risk for hypomania was associated with heightened moment-by-moment detection of emotional up-shifts (i.e., increases in positive emotion) for targets describing positive events; however, it was also associated with overly-positive retrospective ratings (i.e., overestimating global positive emotion) for targets describing negative events. These findings suggest that hypomania risk may lead to positive biases in detecting others’ emotion across both positive and negative life events when using both micro-level continuous and global retrospective emotion measures.     

Mirroring others' emotions relates to empathy and interpersonal competence in children

The mirror neuron system (MNS) has been proposed to play an important role in social cognition by providing a neural mechanism by which others' actions, intentions, and emotions can be understood. Here functional magnetic resonance imaging was used to directly examine the relationship between MNS activity and two distinct indicators of social functioning in typically-developing children (aged 10.1 years+/-7 months): empathy and interpersonal competence. Reliable activity in pars opercularis, the frontal component of the MNS, was elicited by observation and imitation of emotional expressions. Importantly, activity in this region (as well as in the anterior insula and amygdala) was significantly and positively correlated with established behavioral measures indexing children's empathic behavior (during both imitation and observation) and interpersonal skills (during imitation only). These findings suggest that simulation mechanisms and the MNS may indeed be relevant to social functioning in everyday life during typical human development.     

Executive functioning deficits in young adult survivors of bronchopulmonary dysplasia

Abstract

Purpose: To assess long-term impairments of executive functioning in adult survivors of bronchopulmonary dysplasia (BPD). Method: Participants were assessed on measures of executive functioning, health-related quality of life (HRQoL) and social functioning. Survivors of BPD (n?=?63; 34 males; mean age 24.2 years) were compared with groups comprising preterm (without BPD) (<1500?g; n?=?45) and full-term controls (n?=?63). Analysis of variance was used to explore differences among groups for outcome measures. Multiple regression analyzes were performed to identify factors predictive of long-term outcomes. Results: Significantly more BPD adults, compared with preterm and term controls, showed deficits in executive functioning relating to problem solving (OR: 5.1, CI: 1.4–19.3), awareness of behavior (OR: 12.7, CI: 1.5–106.4) and organization of their environment (OR: 13.0, CI: 1.6–107.1). Birth weight, HRQoL and social functioning were predictive of deficits in executive functioning. Conclusions: This study represents the largest sample of survivors into adulthood of BPD and is the first to show that deficits in executive functioning persist. Children with BPD should be assessed to identify cognitive impairments and allow early intervention aimed at ameliorating their effects.

• Implications for Rehabilitation

• Adults born preterm with very-low birth weight, and particularly those who develop BPD, are at increased risk of exhibiting defects in executive functioning.

• Clinicians and educators should be made aware of the impact that BPD can have on the long-term development of executive functions.

• Children and young adults identified as having BPD should be periodically monitored to identify the need for possible intervention.

     

本科护生共情能力的研究现状

共情被认为是一种可以习得的沟通技巧,主要包含认知和行为两方面,以用于将对患者的理解传达给患者。因此共情可以通过加强认知结构和行为表现的后天培训得以提高。本文综述了共情、共情能力的概念,共情在护理中的作用、应用以及大学生共情能力的测量工具,目的在于了解本科护生共情能力的研究现状,有针对地加强护生共情能力的培养。     

Is emotional contagion special? An fMRI study on neural systems for affective and cognitive empathy

Empathy allows us to simulate others' affective and cognitive mental states internally, and it has been proposed that the mirroring or motor representation systems play a key role in such simulation. As emotions are related to important adaptive events linked with benefit or danger, simulating others' emotional states might constitute of a special case of empathy. In this functional magnetic resonance imaging (fMRI) study we tested if emotional versus cognitive empathy would facilitate the recruitment of brain networks involved in motor representation and imitation in healthy volunteers. Participants were presented with photographs depicting people in neutral everyday situations (cognitive empathy blocks), or suffering serious threat or harm (emotional empathy blocks). Participants were instructed to empathize with specified persons depicted in the scenes. Emotional versus cognitive empathy resulted in increased activity in limbic areas involved in emotion processing (thalamus), and also in cortical areas involved in face (fusiform gyrus) and body perception, as well as in networks associated with mirroring of others' actions (inferior parietal lobule). When brain activation resulting from viewing the scenes was controlled, emotional empathy still engaged the mirror neuron system (premotor cortex) more than cognitive empathy. Further, thalamus and primary somatosensory and motor cortices showed increased functional coupling during emotional versus cognitive empathy. The results suggest that emotional empathy is special. Emotional empathy facilitates somatic, sensory, and motor representation of other peoples' mental states, and results in more vigorous mirroring of the observed mental and bodily states than cognitive empathy.     

Cognitive outcome in traumatic brain injury survivors

PURPOSE OF REVIEW: This review discusses recent studies investigating the cognitive and psychiatric outcome of posttraumatic brain injury. In addition, it aims to highlight key areas for future research. RECENT FINDINGS: Detailed cognitive assessments have revealed particular deficits in processing speed in the visual domain and the detrimental impact of interference on attentional performance. A pilot functional imaging study revealed neural changes in survivors performing a response inhibition task, even when matched to controls on behavioural indices. Recent psychiatric studies highlight the incidence of these disorders in the survivors and attempt to characterize distinct psychiatric profiles. Adult and child survivors appear to show differential difficulties. Successful rehabilitation strategies addressing these psychiatric and cognitive deficits include holistic intensive neuropsychological interventions and the introduction of electronic devices. Systematic randomized trials are needed to provide an adequate evidence base for clinical practice. The potential for cognitive enhancement using psychopharmacological agents has yet to be exploited. These treatments may lead to improved quality of life for traumatic brain injury survivors and their families. SUMMARY: Survivors of head injury show a diverse pattern of cognitive and psychiatric profiles. Recent research highlights the nature of some of these deficits and possible ways to enhance functioning. However, the area is well poised for rapid progress in the understanding of cognitive and emotional dysfunction following traumatic brain injury (TBI) and its rehabilitation through neuropsychological and psychopharmacological means.     

A meta-analysis of neurofunctional imaging studies of emotion and cognition in major depression

Major depressive disorder (MDD) is characterized by altered emotional and cognitive functioning. We performed a voxel-based whole-brain meta-analysis of functional neuroimaging data on altered emotion and cognition in MDD. Forty peer-reviewed studies in English-language published between 1998 and 2010 were included, which used functional neuroimaging during cognitive-emotional challenge in adult individuals with MDD and healthy controls. All studies reported between-groups differences for whole-brain analyses in standardized neuroanatomical space and were subjected to Activation Likelihood Estimation (ALE) of brain cluster showing altered responsivity in MDD. ALE resulted in thresholded and false discovery rate corrected hypo- and hyperactive brain regions. Against the background of a complex neural activation pattern, studies converged in predominantly hypoactive cluster in the anterior insular and rostral anterior cingulate cortex linked to affectively biased information processing and poor cognitive control. Frontal areas showed not only similar under- but also over-activation during cognitive-emotional challenge. On the subcortical level, we identified activation alterations in the thalamus and striatum which were involved in biased valence processing of emotional stimuli in MDD. These results for active conditions extend findings from ALE meta-analyses of resting state and antidepressant treatment studies and emphasize the key role of the anterior insular and rostral anterior cingulate cortex for altered emotion and cognition in MDD.     

Personal distress and empathic concern in methadone-maintained patients

The purpose of the present study is to contribute to the understanding of empathy in people with addictive disorders. Previous studies have shown decreased empathy in people suffering from addiction to alcohol, cocaine, and methamphetamine and in people consuming combinations of addictive substances. Here, we compare empathy in a sample of methadone-maintained patients (MMPs) to a group of healthy controls by using the Interpersonal Reactivity Index (IRI). The analyses showed that MMPs had lower empathic concern and higher personal distress compared to healthy controls. Our findings expand on previous evidence of opiate addiction corresponding to high personal distress and low empathic concern for this psychiatric condition. They also underline the relevance of measuring personal distress when assessing empathy in populations suffering from similar disorders.     

Deep Brain Stimulation as a Treatment for Neuropathic Pain: A Longitudinal Study Addressing Neuropsychological Outcomes

Deep brain stimulation (DBS) of the periventricular/periaqueductal gray area and sensory thalamus can reduce pain intensity in patients with neuropathic pain. However, little is known about its impact on quality of life, emotional well-being, and cognition. This study followed up 18 patients who had received DBS for neuropathic pain. Each participant had previously undergone psychometric evaluation of each of the above areas as part of a routine presurgical neuropsychological assessment. Commensurate measures were employed at a follow-up assessment at least 6 months postsurgery. DBS significantly improved mood, anxiety, and aspects of quality of life. Improvements correlated with reduced pain severity. However, the sample continued to show impairments in most areas when compared against normative data published on nonclinical samples. There was little change in general cognitive functioning, aside from deterioration in spatial working memory. However, improvements in pain severity were associated with less improvement (and even deterioration) on measures of executive cognitive functioning. Improvements in emotional well-being also were correlated with changes in cognition. These results suggest that DBS of the periventricular/periaqueductal gray and/or sensory thalamus improves quality of life and emotional well-being in sufferers, although there is some indication of executive dysfunction, particularly among those reporting greatest pain alleviation.PerspectiveThis article examines the neuropsychological outcomes of DBS surgery as a treatment for neuropathic pain. This intervention was found to improve pain severity, emotional well-being, and quality of life, although such benefits may be accompanied by reduced ability on tasks measuring executive functioning.     

Neuropsychological performance, impulsivity, and comorbid psychiatric illness in patients with pathological gambling undergoing treatment at the CORE Inpatient Treatment Center

INTRODUCTION: Pathologic gambling is a disorder with features that implicate abnormal functioning in brain regions involved in addiction, mood, anxiety, and impulse control disorders. Our goal was to examine brain function with neurocognitive tasks that target these brain regions in patients with pathologic gambling. METHODS: Patients were evaluated for comorbid psychiatric disorders, impulsivity, and performance on reversal-learning and reward-based decision-making cognitive tasks. RESULTS: Patients had higher impulsivity scores and significant deficits on both cognitive tasks compared with controls. All subjects also had comorbid psychiatric disorders, including mood, anxiety, psychotic, and substance abuse. CONCLUSION: The cognitive deficits and impulsivity are consistent with abnormal activity in orbitofrontal-limbic networks. The high level of comorbidity is consistent with the overall severity in these inpatients undergoing treatment, and adds weight to the concept of a fundamental abnormality in this network.     

Victim Empathy,Social Self-Esteem,and Psychopathy in Rapists

The purpose of the present study was to compare the responses of 27 incarcerated rapists and 27 incarcerated nonsexual offenders using the Rapist Empathy Measure (targeting victim specific empathy deficits) and to examine the relationship between empathy with self-esteem and psychopathy for both groups. The Social Self-Esteem Inventory was used as a measure of perceived social competence and the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) was used as a measure of psychopathy. All participants completed the two self-report questionnaires on empathy and self-esteem; in addition, the rapists were required to complete an extra section of the empathy measure that assessed their empathic responses to their own victims. Demographic information and psychopathy scores were obtained by reviewing institutional files. When psychopathy scores were not available, subjects participated in a semi-structured interview and were scored on the Psychopathy Checklist-Revised by the researcher. Rapists demonstrated more empathy than the nonsexual offenders toward women in general and the same degree of empathy as the nonsexual offenders toward a woman who had been a victim of a sexual assault by another male. Of particular importance were the within-group comparisons across victim type for the rapists which revealed significant empathy deficits toward their own victim(s). Interestingly, no differences were found between the rapists and nonsexual offenders in terms of self-esteem and psychopathy, and neither self-esteem nor psychopathy significantly predicted empathy for either group. It was concluded from the present study that rapists may suppress empathy primarily toward their own victim rather than suffer from a generalized empathy deficit. It is suggested that empathy deficits in rapists might better be construed as cognitive distortions specific to their victims and should be addressed in that manner in treatment.     

Brains "in concert": frontal oscillatory alpha rhythms and empathy in professional musicians

Playing music in ensemble represents a unique human condition/performance where musicians should rely on empathic relationships. Recent theories attribute to frontal Brodmann areas (BAs) 44/45 and 10/11 a neural basis for "emotional" and "cognitive" empathy. We hypothesized that activity of these structures reflects empathy trait in professional musicians playing in ensemble. Simultaneous electroencephalographic (EEG) alpha rhythms (8-12 Hz) were recorded in three saxophone quartets during music performance in ensemble (EXECUTION), video observation of their own performance (OBSERVATION), a control task (CONTROL), and resting state (RESTING). EEG source estimation was performed. Results showed that the higher the empathy quotient test score, the higher the alpha desynchronization in right BA 44/45 during the OBSERVATION referenced to RESTING condition. Empathy trait score and alpha desynchronization were not correlated in other control areas or in EXECUTION/CONTROL conditions. These results suggest that alpha rhythms in BA 44/45 reflect "emotional" empathy in musicians observing own performance.     

Neural correlates of auditory perception in Williams syndrome: an fMRI study

Williams syndrome (WS), a neurogenetic developmental disorder, is characterized by a rare fractionation of higher cortical functioning: selective preservation of certain complex faculties (language, music, face processing, and sociability) in contrast to marked and severe deficits in nearly every other cognitive domain (reasoning, spatial ability, motor coordination, arithmetic, problem solving). WS people are also known to suffer from hyperacusis and to experience heightened emotional reactions to music and certain classes of noise. We used functional magnetic resonance imaging to examine the neural basis of auditory processing of music and noise in WS patients and age-matched controls and found strikingly different patterns of neural organization between the groups. Those regions supporting music and noise processing in normal subjects were found not to be consistently activated in the WS participants (e.g., superior temporal and middle temporal gyri). Instead, the WS participants showed significantly reduced activation in the temporal lobes coupled with significantly greater activation in the right amygdala. In addition, WS participants (but not controls) showed a widely distributed network of activation in cortical and subcortical structures, including the brain stem, during music processing. Taken together with previous ERP and cytoarchitectonic studies, this first published report of WS using fMRI provides additional evidence of a different neurofunctional organization in WS people than normal people, which may help to explain their atypical reactions to sound. These results constitute an important first step in drawing out the links between genes, brain, cognition, and behavior in Williams syndrome.