Decreased empathy response to other people's pain in bipolar disorder: evidence from an event-related potential study

Exploring Pain Empathy Among Doctors, Nurses and Patients: A Scoping Review

Purpose

This review aims to systematically assess the existing body of research on pain empathy among healthcare workers and patients, with the goal of enhancing both understanding and clinical application.

Methods

Studies were retrieved from seven databases: PubMed, EBSCO, The Cochrane Library, Embase, CBM, CNKI, and Wanfang, with a search date limit from database inception to September 13, 2024. Inclusion and exclusion criteria were established based on the PCCs (Population, Concept, Context, Study design) principle. The research was independently screened and summarized by two researchers. A pre-designed data extraction form was used for information extraction from the included studies.

Results

A total of 4729 studies were initially identified, with 50 studies included after screening. The participants were categorized into six groups: pain patients, nurses, patients with neurological diseases, cancer patients, patients with psychiatric disorders, doctors, and medical students. The studies employed 75 distinct research tools, including the Empathy for Pain Scale (EPS), the Interpersonal Reactivity Index (IRI), pain empathy paradigms, and the Visual Analogue Scale (VAS), along with various detection technologies, such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). Factors influencing pain empathy included psychological factors, individual traits, and social influences. Mechanistic studies explored the neural substrates of emotional empathy (anterior insula, anterior cingulate cortex, amygdala), cognitive empathy (precuneus and parietal-occipital junction), the relationship between emotional regulation and cognitive processing, and the synergistic interactions of multiple brain regions.

Conclusion

This review offers a comprehensive overview of research on pain empathy among healthcare workers and patients, emphasizing its multidisciplinary nature and complexity. It provides theoretical foundations and outlines potential directions for future research, which may include the adoption of unified research standards, interdisciplinary collaboration, the application of advanced technologies, and cross-cultural studies to further advance the field of pain empathy.

Effects of multidomain environmental and mental health factors on the development of empathetic behaviors and emotions in adolescence

Empathy is at the core of our social world, yet multidomain factors that affect its development in socially sensitive periods, such as adolescence, are incompletely understood. To address this gap, this study investigated associations between social, environmental and mental health factors, and their temporal changes, on adolescent empathetic behaviors/emotions and, for comparison, callous unemotional (CU) traits and behaviors, in the early longitudinal Adolescent Brain Cognitive Development sample (baseline: n = 11062; 2-year follow-up: n = 9832, median age = 119 and 144 months, respectively). Caregiver affection towards the youth, liking school, having a close friend, and importance of religious beliefs/spirituality in the youth's life were consistently positively correlated with empathetic behaviors/emotions across assessments (p<0.001, Cohen's f = ~0.10). Positive family dynamics and cohesion, living in a neighborhood that shared the family's values, but also parent history of substance use and (aggregated) internalizing problems were additionally positively associated with one or more empathetic behaviors at follow-up (p<0.001, f = ~0.10). In contrast, externalizing problems, anxiety, depression, fear of social situations, and being withdrawn were negatively associated with empathetic behaviors and positively associated with CU traits and behaviors (p<0.001, f = ~0.1-0.44). The latter were also correlated with being cyberbullied and/or discriminated against, anhedonia, and impulsivity, and their interactions with externalizing and internalizing issues. Significant positive temporal correlations of behaviors at the two assessments indicated positive (early) developmental empathetic behavior trajectories, and negative CU traits' trajectories. Negative changes in mental health adversely moderated positive trajectories and facilitated negative ones. These findings highlight that adolescent empathetic behaviors/emotions are positively related to multidomain protective social environmental factors, but simultaneously adversely associated with risk factors in the same domains, as well as bully victimization, discrimination, and mental health problems. Risk factors instead facilitate the development of CU traits and behaviors.

The alterations in event-related potential responses to pain empathy in breast cancer survivors treated with chemotherapy

Background

Previous findings indicated that breast cancer patients often have dysfunction in empathy and other cognitive functions during or after chemotherapy. However, the manifestations and possible neuro-electrophysiological mechanisms of pain empathy impairment in breast cancer patients after chemotherapy were still unknown.

Objective

The current study aimed to investigate the potential correlations between pain empathy impairment and event-related potentials (ERP) in breast cancer patients undergoing chemotherapy.

Methods

Twenty-two breast cancer patients were evaluated on a neuropsychological test and pain empathy paradigm before and after chemotherapy, containing the Chinese version of the Interpersonal Reactivity Index (IRI-C), while recording ERP data.

Results

The empathic concern scores were lower and personal distress scores were higher on IRI-C task compared with those before chemotherapy (t = 3.039, p < 0.01; t = −2.324, p < 0.05, respectively). Meanwhile, the accuracy rates were lower than those before chemotherapy for both pain and laterality tasks on the pain empathy paradigm (F = 5.099, P = 0.035). However, the response time was no significant differences before and after chemotherapy (F = 0.543, P = 0.469). Further, the amplitude of the N1 component was significantly increased (F = 38.091, P < 0.001), and the amplitude of the P2 component was significantly decreased (F = 15.046, P = 0.001) in the subsequent ERP study. A linear mixed effect model was used to analyze the correlation, the average amplitude of N1 and P2 were positively correlated with the accuracy rates in laterality tasks (r = 1.765, r = 1.125, respectively, P < 0.05).

Conclusion

The results indicated that pain empathy impairment was performed in chemotherapeutic breast cancer patients, which was possibly correlated to the changes of N1 and P2 components in ERP. These findings provide neuro-electrophysiological information about chemo-brain in breast cancer patients.

Decreased Empathy Response to Other's Pain in Parents of Children With Autism Spectrum Disorder

We aimed to investigate pain empathy ability and self-reported empathy among parents of children with autism spectrum disorder (ASD). Twenty-four parents of children with ASD and 26 parents of typically developing children completed the Empathy Quotient (EQ) self-report scale and responded to painful or neutral images during an empathy-for-pain paradigm test. Parents of children with ASD had lower EQ scores, lower accuracy, and longer reaction time (RT) for pain empathy task response (all p < 0.05) compared with controls. There was a negative relationship between cognitive empathy, social skills, total EQ scores, and RT of response in parents of children with ASD. Our findings indicate that self-reported empathy deficits and decreased empathy response to the sight of others' pain in parents of children with ASD are part of a broader autistic phenotype.

Visual similarity and psychological closeness are neurally dissociable in the brain response to vicarious pain

Personal and vicarious experience of pain activate partially overlapping brain networks. This brain activity is further modulated by low- and high-order factors, e.g., the perceived intensity of the model's pain and the model's similarity with the onlooker, respectively. We investigated which specific aspect of similarity modulates such empathic reactivity, focusing on the potential differentiation between visual similarity and psychological closeness between the onlooker and different types of models. To this aim, we recorded fMRI data in neurotypical participants who observed painful and tactile stimuli delivered to an adult human hand, a baby human hand, a puppy dog paw, and an anthropomorphic robotic hand. The interaction between type of vicarious experience (pain, touch) and nature of model (adult, baby, dog, robot) showed that the right supramarginal gyrus (rSMG) was selectively active for visual similarity (more active during vicarious pain for the adult and baby models), while the anterior cingulate cortex (ACC) was more sensitive to psychological closeness (specifically linked to vicarious pain for the baby model). These findings indicate that visual similarity and psychological closeness between onlooker and model differentially affect the activity of brain regions specifically implied in encoding interindividual sharing of sensorimotor and affective aspects of vicarious pain, respectively.

Meta-analysis of ERP investigations of pain empathy underlines methodological issues in ERP research

Empathy has received considerable attention from the field of cognitive and social neuroscience. A significant portion of these studies used the event-related potential (ERP) technique to study the mechanisms of empathy for pain in others in different conditions and clinical populations. These show that specific ERP components measured during the observation of pain in others are modulated by several factors and altered in clinical populations. However, issues present in this literature such as analytical flexibility and lack of type 1 error control raise doubts regarding the validity and reliability of these conclusions. The current study compiled the results and methodological characteristics of 40 studies using ERP to study empathy of pain in others. The results of the meta-analysis suggest that the centro-parietal P3 and late positive potential component are sensitive to the observation of pain in others, while the early N1 and N2 components are not reliably associated with vicarious pain observation. The review of the methodological characteristics shows that the presence of selective reporting, analytical flexibility and lack of type 1 error control compromise the interpretation of these results. The implication of these results for the study of empathy and potential solutions to improve future investigations are discussed.

Competitive Intensity Modulates the Pain Empathy Response: An Event-Related Potentials Study

Previous studies have widely reported that competition modulates an individual's ability to empathize with pain experienced by others. What remains to be clarified, however, is how modulations in the intensity of competition might affect this type of empathy. To investigate this, we first used a Eriksen Flanker task to set different competitive intensity context (high competitive intensity, HCI; medium competitive intensity, MCI; low competitive intensity, LCI). Then we used a recognition task as a competitive task, in which we recorded event-related potentials (ERP) while participants viewed static images of body parts in painful and non-painful situations. Participants were informed that both sets of images depicted an opponent that they were required to play against in the recognition task that varied in levels of competitive intensity according to condition (HCI, MCI, and LCI). We observed an early N2 differentiation between pain and no-pain stimuli over the frontal area under MCI and LCI conditions, but this was not detected under HCI condition. Moreover, we observed a pattern of pain and no-pain differentiation for the late LPP over the frontal and centro-parietal regions under HCI, MCI, and LCI condition. As the pain empathy response is indexed by pain and no-pain differentiation, these results indicate a down-regulation of pain empathy response attributable to a high level of competition. With its very early onset, this effect appears to inhibit bottom-up processing of the ability to perceive pain experienced by an opponent. Our results provide neuroscientific evidence for a deficit in early automatic arousal in response to the pain of the opponent under the influence of high competitive intensity.

Cerebral processing of facial emotions in bipolar I and II disorders: An event-related potential study

BACKGROUND

Behavioral results have shown that bipolar disorder patients have impaired recognition of facial emotions, but the detailed information processing of facial emotions in patients with bipolar I (BD I) and II (BD II) disorders remain unknown.

METHODS

We tested the cerebral event-related potentials to the static facial expressions of Neutral, Happiness, Anger and Sadness in 39 adult patients with BD I, 22 BD II, and 54 healthy volunteers. Participants' affective states were measured with the Mood Disorder Questionnaire, the Hypomania Checklist-32, and the Plutchik-van Praag Depression Inventory.

RESULTS

Over-processed right occipitotemporal cortex during N1 time window to Neutral and Happiness, and during P3b window to Sadness were found in BD I; prolonged N1 latencies to Neutral and Happiness, declined P3b amplitude to Sadness, negative correlation between P3b latency to Sadness and depression, and attenuated superior frontal activity during P3b window to Sadness were found in BD II; and the right-side dominance during facial emotion processing were found in both BD I and BD II.

LIMITATIONS

We didn't record the personality traits or medication used in patients, nor included other facial emotions such as fear and disgust.

CONCLUSIONS

When responding to facial emotions, both BD I and BD II showed a right-side processing dominance; BD I displayed enhanced processing in the right occipitotemporal cortex during structural encoding and categorical processing of facial emotions; while BD II displayed generalized impairments, less involvement of superior frontal cortex to negative emotions, and reduced ability to process negative emotions which was associated with depression.