Detached empathic experience of others' pain in remitted states of depression - An fMRI study

Neural circuits and therapeutic mechanisms of empathic pain

Empathy is the capacity to understand and share the experiences of others. This ability fosters connections between individuals, enriching the fabric of our shared world. One notable example is empathy for the pain of others. Such experiences facilitate the identification of potential dangers, both for oneself and for others. Neuroimaging studies have helped to pinpoint brain regions that modulate empathic pain. Recently, there has also been a surge in studies exploring the neural mechanisms of empathic pain in rodent models. Neuropsychiatric disorders such as autism, psychosis, and schizophrenia often exhibit empathy deficits. Targeting the modulation of empathic pain holds potential for alleviating core symptoms in these patients. Interestingly, empathy research may also benefit pain management, leading to new approaches for understanding the negative emotions associated with pain. This review summarizes recent advances in neuroimaging for the study of empathic pain, outlines the underlying neurocircuit mechanisms, describes therapeutic strategies, and explores promising avenues for future research. This article is part of the Special Issue on "Empathic Pain".

The self in depression and anxiety as a transdiagnostic and differential-diagnostic neural marker: A systematic review

Accurate and early diagnosis of Depression and Anxiety is met with the challenge of comorbid presentations and the neglect of the basic disturbances of self in current diagnostic criteria. Here, we review studies employing functional magnetic resonance imaging (fMRI) with self-based tasks in major depressive disorder (MDD) and anxiety disorders (AD) to determine the transdiagnostic and differential-diagnostic applicability of neural markers related to the self. This systematic review identified three main findings: (I) Large-scale brain-wide changes related to self-dysfunction overlap significantly between MDD and AD. (II) Regional changes are unspecific to tasks and stimuli confirming their specificity to the self as distinguished from other cognitive functions. (III) MDD affects regions related to emotional-cognitive processing like the anterior cingulate cortex, while AD involves prefrontal and insular regions associated with interoceptive and emotional-cognitive regulation. Our systematic review shows the utility of the self as a transdiagnostic marker that exhibits neural topographic similarities across the diagnostic boundaries of MDD and AD. More fine-grained regional differences between MDD and AD can be found within their underlying large scale neural similarities, allowing for their differential-diagnostic specification. In conclusion, we demonstrate the relevance of the self as both a transdiagnostic and differential diagnostic neural marker in MDD and AD.

Emotional contagion and cognitive empathy regulate the effect of depressive symptoms on empathy-related brain functional connectivity in patients with chronic back pain

BACKGROUND

Chronic pain and depression share common neural mechanisms, but their impacts on empathy are different. It is unclear how comorbid depressive symptoms affect empathy-related brain function in patients with chronic pain.

METHODS

A total of 29 healthy participants and 107 patients with chronic back pain (CBP) were included in this study. All subjects underwent a functional MRI scan with concurrent empathic stimulation. Multiple linear regression, moderation analysis, and mediation analysis were used to explore the impacts of chronic pain and comorbid depression on empathy.

RESULTS

The interaction between the pain intensity and the depressive symptoms affected the functional connectivity (FC) of the insula-middle frontal gyrus (MFG), and the severity of the self-rating depression scale (SDS) scores moderated the effect of the pain on the left insula-left MFG FC. Within the CBP group, the emotional contagion (EC) scores served as a mediator in the association between the SDS scores and the FC of the left middle cingulate cortex (MCC)-inferior temporal gyrus (ITG), and the level of cognitive empathy (CE) moderated the effect of the SDS scores on the left MCC-ITG FC.

LIMITATIONS

There is a lack of research on the effects of depressive symptoms on empathy in individuals with different types of chronic pain.

CONCLUSION

Depressive symptoms were strongly associated with the emotional contagion in patients with chronic back pain. Furthermore, the emotional contagion and the cognitive empathy regulated the effect of the comorbid depressive symptoms on the MCC-ITG connectivity in patients with chronic back pain.

Downsides to the empathic brain? A review of neural correlates of empathy in major depressive disorder

Empathy as one of the basic prerequisites for successful social interactions seems to be aberrant in individuals with major depressive disorder (MDD). Although understanding empathic impairments in MDD is crucial considering the frequently reported social skill deficits in patients, the current state of research is still inconclusive, pointing to both elevated and impaired levels of empathy. In this review, we extend previous reports of MDD-related aberrations in self-reported and behavioral empathy by shedding light on the neural correlates of empathy in MDD. Study findings indicate a complex and potentially state-dependent association, comprising both elevated and lower neural activity in empathy-related brain regions such as the inferior frontal gyri, bilateral anterior insulae, and cingulate areas. Predominantly, lower activity in these areas seems to be induced by antidepressant treatment or remission, with accompanying behavioral results indicating a reduced negativity-bias in empathic processing compared to acute states of MDD. We propose a preliminary model of empathy development throughout the course of the disorder, comprising initially elevated levels of empathy and a somewhat detached and lower empathic responding during the further progression of the disorder or post-treatment. The seemingly multifaceted nature of the association between empathy and MDD requires further exploration in future multimodal and longitudinal studies. The study of neural correlates of empathy in MDD should prospectively be enlarged by including further socio-affective and -cognitive capacities in MDD and related mental disorders.

Cross-cultural adaptation and clinical application of the Perth Empathy Scale

OBJECTIVE

Alterations of empathy have been observed in patients with various mental disorders. The Perth Empathy Scale (PES) was recently developed to measure a multidimensional construct of empathy across positive and negative emotions. However, its psychometric properties and clinical applications have not been examined in the Chinese context.

METHODS

The Chinese version of the PES was developed and administered to a large Chinese sample (n = 1090). Factor structure, internal consistency, test-retest reliability, and convergent, discriminant, as well as concurrent validity were examined. Moreover, 50 patients with major depressive disorder (MDD) and 50 healthy controls were recruited to explore the clinical utility of the PES.

RESULTS

Confirmatory factor analyses supported a theoretically congruent three-factor structure of empathy, namely Cognitive Empathy, Negative Affective Empathy and Positive Affective Empathy. The PES showed good to excellent internal consistency reliability, good convergent and discriminant validity, acceptable concurrent validity, and moderate to high test-retest reliability. Patients with MDD had significantly lower PES scores compared to healthy controls. Linear discriminant function comprised of the three factors correctly differentiated 71% of participants, which further verified the clinical utility of the PES.

CONCLUSIONS

Our findings indicated that the Chinese version of the PES is a reliable and valid instrument to measure cognitive and affective empathy across negative and positive emotions, and could therefore be used in both research and clinical practice.