The role of physiological arousal for self-reported emotional empathy

Physiological Dysregulation in Children With and Without Externalizing Difficulties: Novel Insights From Intensive Longitudinal Data

Extant research on physiological dysregulation in children has focused on point-in-time measures and absolute mean levels of physiology. However, these methods do not capture dynamic fluctuations in physiology that characterize dysregulation. In the present work, we aimed to assess whether physiological dysregulation as captured by fluctuations rather than mean levels would differentiate between children with and without clinically elevated levels of externalizing behavior. As an exploratory approach, we examined fluctuations in children's physiological responses (i.e., root mean square of successive differences [RMSSD] in beat-to-beat heart rate intervals) to social transgression scenarios across 15 short-term measurement occasions (5-second bins). Controlling for mean RMSSD, as well as emotional and cognitive correlates of externalizing behavior (i.e., sympathy and inhibitory control), children with externalizing difficulties exhibited greater within-person fluctuations in RMSSD (i.e., physiological dysregulation) compared to children without externalizing difficulties. The present findings provide preliminary support for using intensive longitudinal data comprised of short-term physiological measurements and point to the centrality of within-child physiological variability as a marker of dysregulation, particularly amongst children with externalizing disorders for whom self-regulation is a core challenge.

Opening the Black Box of Family-Based Treatments: An Artificial Intelligence Framework to Examine Therapeutic Alliance and Therapist Empathy

The evidence-based treatment (EBT) movement has primarily focused on core intervention content or treatment fidelity and has largely ignored practitioner skills to manage interpersonal process issues that emerge during treatment, especially with difficult-to-treat adolescents (delinquent, substance-using, medical non-adherence) and those of color. A chief complaint of "real world" practitioners about manualized treatments is the lack of correspondence between following a manual and managing microsocial interpersonal processes (e.g. negative affect) that arise in treating "real world clients." Although family-based EBTs share core similarities (e.g. focus on family interactions, emphasis on practitioner engagement, family involvement), most of these treatments do not have an evidence base regarding common implementation and treatment process problems that practitioners experience in delivering particular models, especially in mid-treatment when demands on families to change their behavior is greatest in treatment - a lack that characterizes the field as a whole. Failure to effectively address common interpersonal processes with difficult-to-treat families likely undermines treatment fidelity and sustained use of EBTs, treatment outcome, and contributes to treatment dropout and treatment nonadherence. Recent advancements in wearables, sensing technologies, multivariate time-series analyses, and machine learning allow scientists to make significant advancements in the study of psychotherapy processes by looking "under the skin" of the provider-client interpersonal interactions that define therapeutic alliance, empathy, and empathic accuracy, along with the predictive validity of these therapy processes (therapeutic alliance, therapist empathy) to treatment outcome. Moreover, assessment of these processes can be extended to develop procedures for training providers to manage difficult interpersonal processes while maintaining a physiological profile that is consistent with astute skills in psychotherapeutic processes. This paper argues for opening the "black box" of therapy to advance the science of evidence-based psychotherapy by examining the clinical interior of evidence-based treatments to develop the next generation of audit- and feedback- (i.e., systemic review of professional performance) supervision systems.

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.

Anxiety symptoms and theory of mind in older and younger adults: curvilinearity moderated by age group

OBJECTIVES

Theory of mind (ToM), the ability to reason about mental states, declines in later life. While anxiety symptoms may predict ToM abilities, the nature of associations requires more elucidation. Further, it is unknown whether age group moderates associational patterns. We examined associations between anxiety symptoms (linear and curvilinear) and cognitive ToM (C-ToM) and affective ToM (A-ToM); and moderation by age group (older vs. younger adults).

METHODS

In a sample of healthy younger (n = 90, M_age = 20.17 years) and older adults (n = 87, M_age = 71.52), we used hierarchical regressions with polynomial and interaction terms to assess the association between anxiety symptoms and ToM in younger and older adults.

RESULTS

Anxiety symptoms were associated with C-ToM but not A-ToM. Age group interacted linearly with anxiety (β = -1.64, p = .02), and with anxiety's quadratic polynomial (β = .84, p = .04). The inverted-U shaped association in younger adults (highest C-ToM at moderate anxiety) contrasted with older adults' linear decline in C-ToM with increasing anxiety.

CONCLUSION

We highlight the importance of anxiety symptoms for predicting ToM, and clarify that associations vary by age. Elucidating associations may be critical to developing interventions that improve social wellbeing.

The Utility of Physiological Measures in Assessing the Empathic Skills of Incarcerated Violent Offenders

Since lack of empathy is an important indicator of violent behaviors, researchers need consistent and valid measures. This study evaluated the practical significance of a potential physiological correlate of empathy compared to a traditional self-report questionnaire in 18 male violent offenders and 21 general population controls. Empathy skills were assessed with the Interpersonal Reactivity Index (IRI) questionnaire. Heart-Rate Variability (HRV) was assessed with an electrocardiogram. The RMSSD (Root Mean Square of the Successive beat-to-beat Differences), an HRV index implicated in social cognition, was calculated. There were no group differences in IRI scores. However, RMSSD was lower in the offender group. Positive correlations between RMSSD and IRI subscales were found for controls only. We conclude that psychometric measures of empathy do not discriminate incarcerated violent offenders, and that the incorporation of psychophysiological measures, such as HRV, could be an avenue for forensic research on empathy to establish translatable evidence-based information.

Spanish Medical Interpreters' Management of Challenges in End of Life Discussions

OBJECTIVE

Professional medical interpreters facilitate patient understanding of illness, prognosis, and treatment options. Facilitating end of life discussions can be challenging. Our objective was to better understand the challenges professional medical interpreters face and how they affect the accuracy of provider-patient communication during discussions of end of life.

METHODS

We conducted semi-structured interviews with professional Spanish medical interpreters. We asked about their experiences interpreting end of life discussions, including questions about values, professional and emotional challenges interpreting these conversations, and how those challenges might impact accuracy. We used a grounded theory, constant comparative method to analyze the data. Participants completed a short demographic questionnaire.

RESULTS

Seventeen Spanish language interpreters participated. Participants described intensive attention to communication accuracy during end of life discussions, even when discussions caused emotional or professional distress. Professional strains such as rapid discussion tempo contributed to unintentional alterations in discussion content. Perceived non-empathic behaviors of providers contributed to rare, intentional alterations in discussion flow and content.

CONCLUSION

We found that despite challenges, Spanish language interpreters focus intensively on accurate interpretation in discussions of end of life.

PRACTICE IMPLICATIONS

Provider training on how to best work with interpreters in these important conversations could support accurate and empathetic interpretation.

The Heart in the Mind: A Systematic Review and Meta-Analysis of the Association Between Theory of Mind and Cardiac Vagal Tone

Theory of mind (ToM) is the human ability to infer the mental states of others in order to understand their behaviors and plan own actions. In the past decades, accumulating evidence has shown that heart rate variability (HRV), an index of parasympathetic control of the heart, is linked to behavioral regulation, social competence, and social cognition abilities, all implicated-to some extent-in ToM. This study aims to systematically review and meta-analyze the available studies, investigating the relation between ToM and HRV in typically developing people. Six studies were eligible for the meta-analysis, yielding a significant association between HRV and ToM of a small-to-medium effect size (g = 0.44). This result was not influenced by publication bias. Due to the small number of studies eligible for the meta-analysis, it was not possible to test for the effect of categorical moderators. The moderating role of sex and quality of the studies was examined by meta-regression analysis. Moderation analysis did not yield any significant effect; however, at a descriptive level, studies yielding the largest effect size were characterized by the use of high frequency-HRV assessment at rest and the Reading the Mind in the Eyes Test to evaluate ToM abilities. The results preliminarily suggest that tonic HRV might be used as an indicator of the ability to understand the content of mind of others.

Yohimbine-Induced Reactivity of Heart Rate Variability in Unmedicated Depressed Patients With and Without Adverse Childhood Experience

Stressful life events play a role in the pathogenesis of major depressive disorder (MDD) and many patients with MDD were exposed to developmental stress due to adverse childhood experiences (ACE). Furthermore, dysregulation of the autonomic nervous system and higher incidence of cardiovascular disease are found in MDD. In MDD, and independently in individuals with ACE, abnormalities in heart rate variability (HRV) have been reported. While these are often confounded, we systematically investigated them with a study which included MDD patients with/without ACE as well as healthy individuals with/without ACE. With this study, we investigated the influence of noradrenergic stimulation on HRV reactivity in unmedicated participants in a randomized, double-blind, repeated measures design. Our sample consisted of men and women with MDD and ACE (n = 25), MDD without ACE (n = 24), healthy participants with ACE (n = 27), and without ACE (n = 48). Participants received a 10 mg single dose of the alpha-2 antagonist yohimbine that increases noradrenergic activity or placebo on 2 separate days, with ECG recordings before and after drug administration at defined intervals. We found lower basal HRV in MDD and ACE: patients with MDD had reduced RMSSD whereas participants with ACE had lower LF-HRV. Contrary to our hypothesis, there was no effect of yohimbine. With this study, we were able to replicate previous findings on HRV differences in MDD and ACE. From the null effect of yohimbine, we conclude that the yohimbine-induced sympathetic activation is not a significant driver of HRV in MDD and ACE.

Cognitive and emotional empathy after stimulation of brain mineralocorticoid and NMDA receptors in patients with major depression and healthy controls

Mineralocorticoid receptors (MR) are predominantly expressed in the hippocampus and prefrontal cortex. Both brain areas are associated with social cognition, which includes cognitive empathy (ability to understand others' emotions) and emotional empathy (ability to empathize with another person). MR stimulation improves memory and executive functioning in patients with major depressive disorder (MDD) and healthy controls, and leads to glutamate-mediated N-methyl-D-aspartate receptor (NMDA-R) signaling. We examined whether the beneficial effects of MR stimulation can be extended to social cognition (empathy), and whether DCS would have additional beneficial effects. In this double-blind placebo-controlled single-dose study, we randomized 116 unmedicated MDD patients (mean age 34 years, 78% women) and 116 age-, sex-, and education years-matched healthy controls to four conditions: MR stimulation (fludrocortisone (0.4 mg) + placebo), NMDA-R stimulation (placebo + D-cycloserine (250 mg)), MR and NMDA-R stimulation (both drugs), or placebo. Cognitive and emotional empathy were assessed by the Multifaceted Empathy Test. The study was registered on clinicaltrials.gov (NCT03062150). MR stimulation increased cognitive empathy across groups, whereas NMDA-R stimulation decreased cognitive empathy in MDD patients only. Independent of receptor stimulation, cognitive empathy did not differ between groups. Emotional empathy was not affected by MR or NMDA-R stimulation. However, MDD patients showed decreased emotional empathy compared with controls but, according to exploratory analyses, only for positive emotions. We conclude that MR stimulation has beneficial effects on cognitive empathy in MDD patients and healthy controls, whereas NMDA-R stimulation decreased cognitive empathy in MDD patients. It appears that MR rather than NMDA-R are potential treatment targets to modulate cognitive empathy in MDD.

The influence of attachment styles on autonomic correlates of perspective-taking

This study examined the effects of attachment styles on physiological responses during a perspective-taking task. Sixty-eight participants were selected according to attachment styles. Physiological responses were assessed using skin conductance responses (SCRs) in the three attachment groups (secure, insecure-anxious and insecure-avoidant) during the presentation of attachment-based pictures (distress, comfort or neutral) in two different perspective-taking conditions: self perspective-taking (i.e. imagine how you would feel in the given situation) or other perspective-taking (i.e. imagine how that person could feel in this situation). In the self perspective-taking condition, insecure-anxious individuals displayed higher SCRs than secure individuals for distress pictures. In the other perspective-taking condition, insecure-anxious individuals showed higher SCRs than secure individuals for comfort pictures. The results also showed a strong negative association between self-reported perspective-taking tendencies and SCRs in secure individuals. The findings suggest that perspective-taking plays an important role in the modulation of physiological responses in reaction to attachment-related pictures, which varies according to attachment styles.

Stress and Depressive Symptoms Among Demographically Diverse American Pregnant Women

Pregnancy is a sensitive period of life where mental health is of utmost importance to the mother's and child's well-being peripartum and beyond. To better prevent and treat common mental health conditions such as depressive symptoms and perceived stress (defined in this study to encompass psychological and physiological (heart rate variability (HRV)) dimensions), it is crucial to examine and report differences in mental health outcomes among demographically diverse pregnant women. Therefore, the purpose of this secondary analysis (N = 79) was to determine if there are differences in mental health outcomes between pregnant women who differ across demographic factors, as well as to determine if demographic factors predict mental health outcomes when controlling for other demographic variables. Findings indicate that there were significant differences in depressive symptoms and perceived stress by all demographic factors except age. Marital status and total household income were the only significant predictors of depressive symptoms and perceived stress, respectively, when all other factors were controlled. There were no significant differences or correlations between demographic variables and HRV. Pregnant women may be predisposed to adverse mental health outcomes, illustrating the need for more refined interventions that are sensitive to pre-existing factors.