Empathy, Pain and Attention: Cues that Predict Pain Stimulation to the Partner and the Self Capture Visual Attention

Dyadic cooperation with human and artificial agents: Event-related potentials trace dynamic role taking during an interactive game

Humans are highly co-operative and thus cognitively, affectively, and motivationally tuned to pursue shared goals. Yet, cooperative tasks typically require people to constantly take and switch individual roles. Task relevance is dictated by these roles and thereby dynamically changing. Here, we designed a dyadic game to test whether the family of P3 components can trace this dynamic allocation of task relevance. We demonstrate that late positive event-related potential (ERP) modulations not only reflect predictable asymmetries between receiving and sending information but also differentiate whether the receiver's role is related to correct decision making or action monitoring. Furthermore, similar results were observed when playing the game with a computer, suggesting that experimental games may motivate humans to similarly cooperate with an artificial agent. Overall, late positive ERP waves provide a real-time measure of how role taking dynamically shapes the meaning and relevance of stimuli within collaborative contexts. Our results, therefore, shed light on how the processes of mutual coordination unfold during dyadic cooperation.

Evaluating the relationship between pain empathy, knowledge and attitudes among nurses in North China: a cross-sectional study

BACKGROUND

Effective pain management is closely related to nurses' knowledge, attitudes and empathy regarding pain. Nursing educators and managers should understand the relationship between nurses' pain management knowledge, attitudes and empathy level, and take targeted measures accordingly. Currently, there is limited study exploring the relationship between pain empathy and pain knowledge and attitudes among nurses in North China.

OBJECTIVES

The purpose of this study was to investigate the level of nurses' pain management knowledge and attitudes and pain empathy, to analyze the factors influencing pain empathy, and to explore the relationship between these two variables.

DESIGN

This study was a quantitative, descriptive-correlation design.

SETTING AND PARTICIPANTS

The study population was registered nurses in North China, the sample included 177 registered nurses in North China.

METHODS

Data were collected with the "General data questionnaire", "Knowledge and attitudes survey regarding pain" (KASRP) and the "Empathy for pain scale" (EPS) via Wechat mini program "Questionnaire Star".

RESULTS

The 177 registered nurses completed the survey. The averege correct rate for KASRP was (51.94 ± 9.44)%, and none of the respondents achieved a percentage score of >80%. The mean score for pain empathy was (2.78 ± 0.78), the empathy reactions dimension was (2.99 ± 0.77), and the body and mind discomfort dimension was (2.71 ± 0.80). The results of multiple stepwise linear regression showed that whether they had received empathy training, whether they had greater trauma or severe pain and whether they had negative emotions were independent influencing factors for EPS scores. Pearson correlation analysis showed that KASRP scores were positively correlated with EPS scores (r = 0.242, P < 0.05).

CONCLUSIONS

The pain knowledge and attitudes of nurses in North China are far from optimal. Nurses have a relatively low accuracy rate in areas such as medication knowledge, assessment of patient pain based on case studies, and handling PRN prescriptions. Nursing educators and administrators need to design some pain management courses in a targeted manner. Nurses' empathy for pain was at a moderate level. Pain empathy was positively correlated with pain knowledge and attitudes, suggesting that empathy for pain can be developed postnatally.

Selective attention to pain and empathy: Studying frequent blood donors

INTRODUCTION

Empathy is an interpersonal experience that enables understanding of other's emotions and can lead to altruistic behavior such as blood donation. Cognitive theories of empathy refer to selective attention as one of its cognitive dimensions. The current study examined if individuals who engage in altruistic behavior are characterized by a distinct pattern of selective attention to observation of pain in others.

METHODS

We recruited 50 volunteer blood donors. Half (n = 25) of the volunteers donated for a self-declared altruistic reason, and the other half of the volunteers donated blood for a health-related reason. We assessed the individuals' self-reported empathy with the Interpersonal Reactivity Index (IRI). We then measured the individuals' selective attention toward faces expressing pain in a pictorial dot-probe task.

RESULTS

Consistent with the proposed hypothesis, participants who donated blood out of altruism reported significantly higher empathic concern on the IRI than those who donated blood for a health-related reason. The altruistic donors also showed significantly greater selective attention toward facial expressions of pain. Moreover, among all donors, self-report empathic concern on the IRI was significantly correlated with greater selective attention toward faces expressing pain.

DISCUSSION

These findings suggest that altruistic individuals not only show higher levels of empathy, but also attend more to the pain of others. Limitations, implications, and suggestions for future research are discussed.

Differences in empathy toward patients between medical and nonmedical students: an fMRI study

There is growing concern about a potential decline in empathy among medical students over time. Despite the importance of empathy toward patients in medicine, it remains unclear the nature of the changes in empathy among medical students. Thus, we systematically investigated affective and cognitive empathy for patients among medical students using neuroscientific approach. Nineteen medical students who completed their fifth-year medical curriculum and 23 age- and sex-matched nonmedical students participated in a functional magnetic resonance imaging study. Inside a brain scanner, all participants read empathy-eliciting scenarios while adopting either the patient or doctor perspective. Brain activation and self-reported ratings during the experience of empathy were obtained. Behavioral results indicated that all participants reported greater emotional negativity and empathic concern in association with the patient perspective condition than with the doctor perspective condition. Functional brain imaging results indicated that neural activity in the posterior superior temporal region implicated in goal-relevant attention reorienting was overall increased under the patient perspective than the doctor perspective condition. Relative to nonmedical students, medical students showed decreased activity in the temporoparietal region implicated in mentalizing under the patient perspective versus doctor perspective condition. Notably, this same region showed increased activity under the doctor versus patient condition in medical students relative to nonmedical students. This study is among the first to investigate the neural mechanisms of empathy among medical students and the current findings point to the cognitive empathy system as the locus of the primary brain differences associated with empathy toward patients.

The dyadic interaction model of relationship quality and the impact of attachment orientation and empathy on infertile couples in China

Aim

The study was conducted to examine the effect of attachment orientation and empathy on the relationship quality of infertile couples and assess the inter‐dependency model of these factors.

Design

A cross‐sectional survey.

Method

In this study, 168 infertile couples (336 individuals) were enrolled and asked to finish the following questionnaires: the revised Adult Attachment Scales, the Interpersonal Response Index questionnaire and the Relationship Quality sub‐scale of the Fertility Quality of Life (FertiQol). Hierarchical regression and path analysis were used to analyse the unique and combined contribution of the independent variables to relationship quality of couples.

Results

The attachment orientation of infertile couples can influence their relationship quality, and empathetic wives and husbands have actor and partner effects on the infertile couples' relationship quality. Empathetic infertile couples are conducive to the harmony of the relationship.

Case-by-case: Emotional stimulus significance and the modulation of the EPN and LPP

Stimuli encountered in the environment are continuously evaluated according to their affective stimulus significance. Numerous event-related potential studies have shown that the early posterior negativity (EPN) and the late positive potential (LPP) are larger for pictures high in emotional arousal compared to low arousing images. Here, we used a case-by-case approach to determine the emotional modulation of the EPN and LPP at the level of the individual case. We probed the effect in three studies regarding behavior systems of predator fear, disease avoidance, and sexual reproduction. In each study, high and low arousing pictures from the respective behavior system were presented and event-related brain potentials measured. At the group level, previous findings regarding an enhanced EPN and LPP for high compared to low arousing stimuli were replicated. Novel findings were observed when analyzing each case individually. The majority of participants showed significantly larger EPN and LPP amplitudes to pictures showing threatening compared to harmless animals (15 and 16 out of 16 tests, respectively), images of disease and mutilation compared to neutral people (15 and 17 out of 18 tests, respectively), and high-arousing erotic compared to romantic pictures (17 and 17 out of 17 tests, respectively). Further analyses exploring the tradeoff between specificity and sensitivity suggest reliance on picture categories of sexual reproduction and disease avoidance. Overall, the present findings demonstrate that the case-by-case approach can be useful for revealing a general principle of emotional stimulus processing common-to-all. Implications for the reproducibility of the findings and biomarker development are discussed.

Level of uncertainty about the affective nature of a pictorial stimulus influences anticipatory neural processes: An event-related potential (ERP) study

Uncertainty about the emotional impact of future events is a common part of everyday life. However, relatively little is known about whether the level of uncertainty about the affective nature of an upcoming visual image influences anticipatory neurocognitive processes. To investigate this, participants viewed a series of negative and neutral pictures, which were preceded by abstract anticipatory cues. Neural activity was measured using event-related potentials (ERPs). In the 'uncertain' cue condition, the cue could be followed by either a negative or a neutral picture with equal probability; in the 'fairly uncertain' condition the cue was followed by a negative picture on 70% of trials, and by a neutral picture on 30% of trials. In the 'certain' condition, the cue was always followed by a negative picture. For the P200 component, reflecting early stages of selective attention, there was no amplitude difference between cue conditions. At later stages of processing, the early posterior negativity (EPN) amplitude was enhanced for cues indicating a greater level of certainty, and the late positive potential (LPP) amplitude was greater for certain, compared to fairly uncertain and uncertain cues. The stimulus preceding negativity (SPN), an index of anticipatory processing, was more negative for certain cues compared to fairly uncertain and uncertain cues. For the SPN there was no difference between fairly uncertain and uncertain cues. These results provide evidence that the level of uncertainty regarding the affective nature of an upcoming picture influenced several stages of processing during the anticipation of the stimulus.

Behavioral and EEG Measures Show no Amplifying Effects of Shared Attention on Attention or Memory

Shared attention experiments examine the potential differences in function or behavior when stimuli are experienced alone or in the presence of others, and when simultaneous attention of the participants to the same stimulus or set is involved. Previous work has found enhanced reactions to emotional stimuli in social situations, yet these changes might represent enhanced communicative or motivational purposes. This study examines whether viewing emotional stimuli in the presence of another person influences attention to or memory for the stimulus. Participants passively viewed emotionally-valenced stimuli while completing another task (counting flowers). Each participant performed this task both alone and in a shared attention condition (simultaneously with another person in the same room) while EEG signals were measured. Recognition of the emotional pictures was later measured. A significant shared attention behavioral effect was found in the attention task but not in the recognition task. Compared to event-related potential responses for neutral pictures, we found higher P3b response for task relevant stimuli (flowers), and higher Late Positive Potential (LPP) responses for emotional stimuli. However, no main effect was found for shared attention between presence conditions. To conclude, shared attention may therefore have a more limited effect on cognitive processes than previously suggested.

Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review

Non-oncologic chronic pain is a common high-morbidity impairment worldwide and acknowledged as a condition with significant incidence on quality of life. Pain intensity is largely perceived as a subjective experience, what makes challenging its objective measurement. However, the physiological traces of pain make possible its correlation with vital signs, such as heart rate variability, skin conductance, electromyogram, etc., or health performance metrics derived from daily activity monitoring or facial expressions, which can be acquired with diverse sensor technologies and multisensory approaches. As the assessment and management of pain are essential issues for a wide range of clinical disorders and treatments, this paper reviews different sensor-based approaches applied to the objective evaluation of non-oncological chronic pain. The space of available technologies and resources aimed at pain assessment represent a diversified set of alternatives that can be exploited to address the multidimensional nature of pain.

Linking brain structure and activation in anterior insula cortex to explain the trait empathy for pain

The ability to perceive, understand, and react to the feelings of others' pain is referred to as empathy for pain which is composed of two components, affective‐perceptual empathy and cognitive‐evaluative empathy. Recent reviews on the neural mechanisms of empathetic pain showed the anterior insula (AI) cortex as a core circuit for empathy. However, little is known about the modulation of brain anatomy and empathic responses by trait measures of empathy (trait empathy). Thus, we investigated whether individual variation in the personality trait of empathy is associated with individual variation in the structure of specific brain regions using voxel‐based morphometry (VBM). We further investigated the relationship between the trait empathy and the activity of the same regions using state measures of empathy for pain in a trial‐by‐trial fashion in the given situation. VBM analysis indicated a small but significant negative relationship between trait empathy and gray matter volume in the bilateral AI. Functional MRI study further demonstrated that experimentally induced activity of the bilateral AI during state empathy for pain was also correlated with trait empathy. An asymmetry exists between the right and left AI between the affective and cognitive empathy. The right AI was found to be involved in the affective‐perceptual form of empathy and the left AI was active in cognitive‐evaluative forms of empathy. The interindividual differences in trait empathy may be reflected both in the state empathy and more stable brain structure difference.

Observers' impression of the person in pain influences their pain estimation and tendency to help

BACKGROUND

Estimation of a patient's pain may have a considerable impact on the level of care that patient receives. Many studies have shown that contextual factors may influence an observer's pain estimation. Here, we investigate the effect of an observer's impression of a person in pain and justification of his/her pain on the observer's pain estimation, tendency to help and perceived empathy.

METHODS

Thirty healthy individuals (half females) read scenarios aimed to manipulate the reader's impression of characters who ultimately were fired from their work (four positive characters and four negative; half females). Then they observed 1-s videos of four levels of pain expression (neutral, mild, moderate, strong) in those characters during an examination. Subsequently, they rated pain estimation, tendency to help and perceived empathy. Afterwards, they rated their likability of characters and how just they find the end of story.

RESULTS

People rated pain in positive characters higher than the pain in negative characters. They also expressed more tendency to help and a higher level of perceived empathy towards positive characters than negative characters. For the highest level of pain in positive characters, perceived injustice towards that person was the best predictor of the observer's pain estimation, tendency to help and perceived empathy. For negative characters, dislikeability was the best predictor of tendency to help and perceived empathy. Justification of their pain was a predictor of pain estimation and tendency to help.

CONCLUSION

Observers used different information to evaluate pain in positive and negative individuals.

SIGNIFICANCE

Observers' estimation of pain, perceived empathy and tendency to help biases by their understanding of the characteristics of the person in pain. In clinical settings, these biases may influence the quality of care and well-being of patients. Understanding the underlying mechanisms of these biases can help us improve the quality of care and control the effect of prejudices on pain assessment.

Physical Cue Influences Children's Empathy for Pain: The Role of Attention Allocation

Empathy for pain is evolutionally important and context-dependent. The current study explored the effect of physical cue on 4- to 5-year-old children’s empathy for pain with two experiments. Experiment 1 investigated the effect of valid and invalid physical cue as compared to baseline (without cue) in pain evaluation task (evaluating the pain intensity of a facial expression, N = 28). Experiment 2 employed eye-tracking to investigate the attentional process in valid and baseline conditions (evaluating the pain intensity of a body image with an apparently injured arm or leg, N = 65). We found the evaluation of pain intensity was the highest in the valid condition, and higher in baseline condition than invalid. As for eye-tracking results, children fixated more quickly, had more fixations and longer total fixation duration in valid-cue condition. Of attention allocation, compared with baseline condition, children fixated on arm/leg more quickly, more frequently and for longer time in valid condition. Additionally, eye-tracking results were significantly related to their evaluation of pain intensity.

Personal responsibility modulates neural representations of anticipatory and experienced pain

An individual's sense of personal responsibility is crucial for adaptive functioning in ever-changing social situations. This study investigated how the sense of personal responsibility affected the neural dynamics of anticipating one's own pain and another person's pain, using EEG. Participants played a cooperation game in which either the participant (self-context) or the confederate (other-context) received a mild electric shock whenever one of them erred. At the anticipatory stage of pain, feedback-related negativity (FRN) and P300 were sensitive to the degree of responsibility in both contexts. The FRN was more negative when the participant had full responsibility (only the participant had erred) than when the participant shared responsibility with the confederate (both had erred) or had no responsibility (only the confederate had erred), and shared responsibility elicited more negative FRN than no responsibility. Having no responsibility produced larger P300 amplitudes than having shared or full responsibility, whereas there was no significant difference in P300 amplitude between the shared responsibility and the full responsibility conditions. When the shock was delivered to the participants, the P2 was smaller when there was no responsibility than when there was shared or full responsibility. When participants observed the painful facial expressions of the confederates, the P300 was not sensitive to responsibility level. Our results suggest that responsibility level modulates FRN and P300 in anticipation of pain experienced by both self and others, reflecting the attentional and affective experiences in both pain- and empathy-related processes.

The Influence of Medical Professional Knowledge on Empathy for Pain: Evidence From fNIRS

Empathy is a mental ability that allows one person to understand the mental and emotional state of another and determines how to effectively respond to that person. When a person receives cues that another person is in pain, neural pain circuits within the brain are activated. Studies have shown that compared with non-medical staff, medical practitioners present lower empathy for pain in medical scenarios, but the mechanism of this phenomenon remains in dispute. This work investigates whether the neural correlates of empathic processes of pain are altered by professional medical knowledge. The participants were 16 medical students who were enrolled at a Chinese medical college and 16 non-medical students who were enrolled at a normal university. Participants were scanned by functional near-infrared spectroscopy while watching pictures of medical scenarios that were either painful or neutral situations. Subjects were asked to evaluate the pain intensity supposedly felt by the model in the stimulus displays, and the Interpersonal Reactivity Index-C (IRI-C) questionnaire was used to measure the empathic ability of participants. The results showed that there is no significant difference between medical professional and non-medical professional subjects in IRI-C questionnaire scores. The subjects of medical professions rated the pain degree of medical pictures significantly lower than those of non-medical professions. The activation areas in non-medical subjects were mainly located in the dorsolateral prefrontal cortex, frontal polar regions, posterior part of the inferior frontal gyrus, supramarginal gyrus, supplementary somatosensory cortex and angular gyrus, whereas there was a wide range of activation in the prefrontal lobe region in addition to the somatosensory cortex in medical professionals. These results indicate that the process of pain empathy in medical settings is influenced by medical professional knowledge.