Week 10-Empathy & Coping with Chronic Pain Flashcards
What are Definitions of empathy? (Vignemont & Singer, 2006)
Empathy is the ability to share the feelings of another’s emotional or sensory state. To be empathetic:
(i) one is in an affective state
(ii) this is congruent to another person’s affective state- isomorphism
(iii) this state is elicited by the observation or imagination of another person’s affective state - causal relationship (you feel sad because you thought or observed it, NOT spontaneous)
(iv) one knows that the other person is the source of one’s own affective state - awareness
Not to be confused with:
Theory of mind: understanding other person’s mental processes, intentions, thoughts. Not necessarily affective or isomorphic.
Sympathy: feel negative response but no isomorphism between the mental state of observer and other person (i.e., without actually feeling the isomorphic state i.e., other’s emotions)
Why are we empathic? (Decety et al., 2016)
Empathy likely has an evolutionary basis because it exists:
– The affective experience of empathy utilises a neuropsychological system evident across species.
– It responds (aversively) to generate discomfort while witnessing others in pain or distress which facilitates the urge to help which helps relieves stress (although empathy can be associated with positive experiences).
– Promotes care-giving for young which benefits survival
– Promotes prosocial and altruistic behaviour – benefit based on increased fitness of helper based in reciprocity
What is the perception-action model of empathy?
Preston and de Waal (2002) formulated an influential theory of empathy (typically based on animal research):
“attended perception of the object’s state automatically activates the subjects’ representations of the state… and that activation of these representations automatically primes or generates the associated autonomic or somatic responses, unless inhibited” (Preston and de Waal, 2002, p.4).
Features of empathy:
“automatically”: empathy occurs spontaneously without conscious effort
“representations”: brain activation patterns during viewing someone else in pain which are similar to pain experience
“somatic responses”: predicts bodily response to observed pain similar to experience of pain e.g., increased heart rate or skin conductance responses (i.e., physical reactions)
What supporting evidence is there for the P-A-M?
-Viewing motor actions activates the motor
mirror neuron system
-Mirror neurons (e.g., Rizzolatti, 1996) are visuomotor neurons first identified in monkeys which discharged during both the execution and observation of a particular action (Researcher ate a banana and the neurons in the monkey went off during observation not just in the execution i.e., being rewarded with a banana). Therefore mirror neurons underpin empathy.
-Vogt et al. (2007): guitarists and non-guitarists observed video clips of guitar chords being played in fMRI scanned. Observation of someone playing the guitar activates both the visual areas but also the motor areas even if they cannot play the guitar. This demonstrates similar neural representations to (attempted) execution of the chords (i.e. you are putting yourself in the place even if you can’t). The same pattern is seen when trying and observing
What supporting evidence is there for the P-A-M relating to pain?
Viewing images with implicit pain activates the pain matrix (Jackson et al., Neuroimage, 2005).
* fMRI research to investigate neural activations associated with empathy for pain showing them videos and sounds related to pain.
- Compared brain activations associated with pain images to graphically similar non-painful images (active and controlled and take these away from each other to see differences in brain activations to know what is specific to the pain content).
- Enhanced BOLD activation in anterior
cingulate/anterior mid-cingulate cortex
(ACC/aMCC) and anterior insula (AI) cortices - Positively correlated with subjective pain ratings (i.e., how painful they thought it was)
What supporting evidence is there for the P-A-M relating to pain? Meta-analysis to look for consistencies across studies (Lamm et al., 2011)
-Meta-analysis of brain activations related to pain empathy
-Anterior mid-cingulate cortex and
bilateral anterior insula consistently
activated in 9 pain empathy studies –
e.g. similar to the Jackson paradigm.
Both ‘pain matrix’ regions.
-Other regions are likely but these are
most consistent from evidence.
What Evidence is there for a biological basis for empathy - Pain empathy in mice (Langford et al., 2006)
- Empathy was classically considered to be unique to higher primates or humans alone.
- Mice were given identical levels of noxious stimulus in isolation or in pairs and pain behaviours were quantified (if empathy seen in lower order animals, then it suggests empathy is a basic biological thing everything has)
- They display increased pain behaviour (behaviourally) in the presence of another mouse (even with the same level of noxious stimuli)
- Presence of social modulation of pain behaviour is evidence for biological basis, or automaticity, of empathy (i.e., mouse A thinks mouse B can help hence shows social signs of distress)
- Dyads (relationships) comprising cagemates and siblings enhanced the effect, i.e., produced greater increases in pain responses in familiar pairs and then even greater with sibling pairs than pairs comprising strangers – modulation by familiarity/familial bond suggests something beyond mere biology? (if it was biology it would be steady across all levels)
-Was published in a journal indicating these findings are important (hard for animal research to get published)
SLIDE 11 CHECK SLIDES
-Evidence of bottom-up processes for empathy (i.e., biological basis)
-The free rat shared the treats with the trapped rat once freed
What is empathy like in Lower-order mammals when looking at in-group and out-group bias (Bartal….Mason et al., 2015)
-Empathic behaviour in rats – is modulated by social experience. Will rats help others who are different to themselves? E.g., a different strain?
- In mammals, helping is preferentially provided to members of one’s own group.
- Rats helped trapped strangers by releasing them from a restraining device, just as they did cagemates.
- However, rats did not help strangers of a different strain, unless previously housed with the trapped rat.
- To test if genetic relatedness alone can motivate helping, rats were fostered from birth with another strain and were not exposed to their own strain. As adults, fostered rats helped strangers of the fostering strain but not rats of their own strain.
- Thus, familiarity is required for the expression of pro-social behaviour.
-It is not the genetic alignment but rather the learned social strain to whether they would help or not.
What is the Top-down modulation of empathy (Singer and Lamm, 2009)?
Theoretical contribution (Singer and Lamm, 2009) suggested that brain imaging from empathy research differentiates distinct neural processes:
1. bottom-up processes : perception = representation of pain (automaticity/mirror neurons?)
2. top-down processes: includes appraisal of context, attention, preparations for action etc.
Evidence for top-down modulation of empathy come from studies of the following:
– affection for object of empathy
– social proximity
– attention
– group membership
– expertise
What evidence is there suggesting Positive affect (emotions) for the person in pain modulates Empathy (Cheng, 2010)
- Participants where instructed to imaging the image depicting pain was either a loved one or a stranger.
- Activations in ACC and Insula were enhanced in ‘Love’ condition.
- Activation in tempero-parietal junction is also modulated in the ‘other’ condition – self other distinction?
-The closeness of the relationship seems to matter (seen in rats too)
What evidence is there suggesting Jealousy (intrasexual competition) modulates
empathic responses (Zheng et al., 2016)?
-Participants were introduced via video to a couple who would later be the targets to be exposed to pain.
-Either ‘lucky guy’ much more attractive partner (punching above his weight)
-Or ‘not so lucky’ with matched partner (similar level of attractiveness)
-Participants attributed lower empathy scores for the ‘lucky guy’ condition.
-Something as basic as being jealous (why does he have that partner) impacts and manipulates the level of empathy given with pain.
-Neural responses in ACC and AI were reduced compared to those seen for control condition
-Sample was men
What evidence is there for In-group bias and pain empathy (Azevedo et al., 2012)?
- Caucasian and black participants viewed
video clips of a hypodermic needle (pain) or
earbuds (touch) with black or Caucasian
hands. - Anterior insula showed increased BOLD
activation during viewing pain in own race
group compared to other race – increased
in-group empathy?
-Preferential anterior insula activation during pain empathy for ones own group
correlated with subjective measures of
racial bias (implicit association task) i.e., Those who showed the highest levels of racial bias, showed the highest differences in brain activation between the groups
-Has been replicated in other countries and cultures
What evidence is there for Intentionality in empathy for pain (Decety et al., 2009)?
-A study in children.
-Pain images were associated
with typical activations, e.g., aMCC or AI.
-Study manipulated context as to whether the pain was caused intentionally by other person
-The temporo-parietal junction (involved in context) was preferentially activated when pain was perceived to be caused intentionally by another person (i.e., they saw it as unfair)
What evidence is there for Focus of attention modulation of empathic response (Lamm et al., 2007)?
P’s saw Numbed vs. non-numbed target hand and Sensory vs. unpleasantness focus
- Activity in the somatosensory cortex was enhanced when participants evaluated the
sensory aspects of pain. - Viewing pain in the numbed hand still activate pain brain regions suggesting some
degree of automatic activation in accordance with Preston and de Waal (2002) i.e., Even if told that they cannot feel pain because they are numbed, they still felt pain showing perception action to a degree automatic and cannot be blocked
Beyond ‘up and down’ – What are more complex models of empathy? (de Waal, 2008) (needing a model which combines both bottom-up and top-down)
The Russian-Doll model of empathy posits a tiered system with progressive levels of
empathy from basic affective (e.g. emotional contagion) to higher-order processes such as sympathetic concern and
emotional perspective taking.
- Core of the doll is P-A-M (i.e., evolutionary aspect) called emotional contagion
- White part of doll is sympathetic concern (i.e., context)
- The outside of the doll is empathetic perspective-taking (considering what they may be thinking and formulating a response).
Beyond ‘up and down’ – What are more complex models of empathy? (Lamm, 2016) (needing a model which combines both bottom-up and top-down)
Lamm (2016) suggested a need for multifaceted neuroscientific theoretical
models of empathy which necessitate shared representations between self
and other, plus the ability to distinguish between the two, as distinct and essential
building blocks for empathic experience
Beyond ‘up and down’ – What are more complex models of empathy? (de Waal, 2017) (needing a model which combines both bottom-up and top-down)
-Somewhat similar to Lamm
-The most recent iteration of the PAM describes a dynamic and graded system with flexibility for learning and experience
which is likely to recruit different brain regions for distinct components of
empathic processing (de Waal & Preston, 2017).
-Laam and de Waal both were theoretical without the data
Beyond ‘up and down’: What was found in the Meta-Analysis of fMRI: Empathy + Pain overlap (Fallon et al., 2020)
- We performed meta- analysis of fMRI
studies of empathy and compared the
activation profile against meta-analysis of
pain experience. - The conjunction (overlapping) analysis of
ALE maps representing empathy for pain
and direct pain experience pooled 219
studies with a total of 3717 participants and
3307 reported foci. - The results highlighted an overlap of
activation likelihood between empathy and pain coordinates in seven clusters encompassing - bilateral AI and ACC/aMCC (expected)
- bilateral IFG which bordered (and in
the case of the right hemisphere
extended to) middle frontal gyrus, and
bilateral supramarginal regions - The location of significant clusters from
conjunction analysis of ALE maps for empathy for pain and directly perceived pain.
What did Fallon (2020) find when contrasting empathy vs pain?
- Contrast analyses: empathy > pain (looked at separate areas when witnessing pain and experiencing pain)
- Contrast analysis pointed to significantly greater likelihood of activation during empathy for pain, relative to directly perceived pain, in 6 clusters encompassing bilateral supramarginal, IFG and occipitotemporal regions (specific to empathy but not pain)
- Contrast analyses: pain> empathy
- The reverse contrast revealed six clusters
indicative of increased activation likelihood
estimates for directly perceived pain relative to empathy for observed pain. These encompassed two large bilateral clusters over parietal opercular cortices (S2), posterior insula and S1. Right putamen and right frontal cluster encompassing right prefrontal and dorsolateral prefrontal and two clusters in aMCC (specific to experiencing pain but not witnessing pain)
What are the implications of Fallon’s (2020) study?
- Meta-analysis demonstrates a rich functional brain network of empathy
for pain, extending beyond AI and aMCC, and including activations areas that demonstrate activation to empathy but not pain. - This is important for theoretical understanding of the phenomenon which
is likely to complex and multi-faceted.
From a theoretical perspective, the patterns of ALE seen in conjunction and contrast analyses show alignment with a tiered theoretical understanding of empathic processing such as:
* Russian-Doll model (de Waal, 2008; de Waal and Preston, 2017)
- Independent components of shared representation and self-other distinction (Lamm et al., 2016).
Implications of empathy for pain: What evidence is there for the empathy response for pain in ASD?
- Fan, 2014: ASD participants exhibited
significantly reduced activation in aMCC and
anterior insula but sensory activation profile
intact. - Fan infers that ASD exhibit heightened
empathic arousal but impaired social
understanding when perceiving others’
distress (lacking in social understanding but understands the sensory aspects)
– This is still a matter for research and debate! - Alternatively Gu and colleagues (2015)
reported enhanced neural activation in AI for ASD relative to controls (although behavioral empathetic pain discriminability was reduced). Skin conductance responses were also elevated but the ratings of pain was reduced.
-ASD is a wide spectrum so this still needs to be investigated as it is likely the sample always varies.
