Sex bias in pain management decisions.

In the pursuit of mental and physical health, effective pain management stands as a cornerstone. Here, we examine a potential sex bias in pain management. Leveraging insights from psychological research showing that females' pain is stereotypically judged as less intense than males' pain, we hypothesize that there may be tangible differences in pain management decisions based on patients' sex. Our investigation spans emergency department (ED) datasets from two countries, including discharge notes of patients arriving with pain complaints (N = 21,851). Across these datasets, a consistent sex disparity emerges. Female patients are less likely to be prescribed pain-relief medications compared to males, and this disparity persists even after adjusting for patients' reported pain scores and numerous patient, physician, and ED variables. This disparity extends across medical practitioners, with both male and female physicians prescribing less pain-relief medications to females than to males. Additional analyses reveal that female patients' pain scores are 10% less likely to be recorded by nurses, and female patients spend an additional 30 min in the ED compared to male patients. A controlled experiment employing clinical vignettes reinforces our hypothesis, showing that nurses (N = 109) judge pain of female patients to be less intense than that of males. We argue that the findings reflect an undertreatment of female patients' pain. We discuss the troubling societal and medical implications of females' pain being overlooked and call for policy interventions to ensure equal pain treatment.

Considering the Role of Human Empathy in AI-Driven Therapy.

Recent breakthroughs in artificial intelligence (AI) language models have elevated the vision of using conversational AI support for mental health, with a growing body of literature indicating varying degrees of efficacy. In this paper, we ask when, in therapy, it will be easier to replace humans and, conversely, in what instances, human connection will still be more valued. We suggest that empathy lies at the heart of the answer to this question. First, we define different aspects of empathy and outline the potential empathic capabilities of humans versus AI. Next, we consider what determines when these aspects are needed most in therapy, both from the perspective of therapeutic methodology and from the perspective of patient objectives. Ultimately, our goal is to prompt further investigation and dialogue, urging both practitioners and scholars engaged in AI-mediated therapy to keep these questions and considerations in mind when investigating AI implementation in mental health.

Beyond physical sensations: investigating empathy and prosocial behavior in vicarious pain responders.

Empathy, the capacity to share others' emotional experiences, has been proposed as a key motivation for altruistic behavior in both humans and animals. Sharing another's emotional experience may generate a self-embodied simulation of their emotional state, fostering understanding and promoting prosocial behavior. Vicarious pain responders report sensing physical pain when observing others in pain. Whether this ability extends to emotional experiences remains unexplored. Using both questionnaires and ecologically valid behavioral tasks, we explored whether vicarious pain responders differ from nonresponders in empathic abilities and prosocial behavior. Participants watched video clips of people describing a negative emotional life event. We operationalized several empathic abilities and responses (empathic accuracy, affective synchrony, emotional reaction, and empathic motivation) based on participants' and targets' responses during and after watching the videos. Participants were also engaged in a donation task measuring tendency for prosocial behavior. Findings reveal that compared to nonresponders, vicarious pain responders exhibit enhanced empathic accuracy, intensified emotional reactions to others' emotional pain, and a greater motivation to communicate with the target. This study marks the first behavioral evidence showcasing vicarious pain responders' empathic abilities, reactions, and motivation in response to nonphysical pain of others, expanding our knowledge of this phenomenon and its association with broader empathic abilities.

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.

The relationship between empathy and executive functions among young adolescents.

Empathy and executive functions (EFs) are multimodal constructs that enable individuals to cope with their environment. Both abilities develop throughout childhood and are known to contribute to social behavior and academic performance in young adolescents. Notably, mentalizing and EF activate shared frontotemporal brain areas, which in previous studies of adults led researchers to suggest that at least some aspects of empathy depend on intact EF mechanisms. Despite the substantial development that empathy and EF undergo during adolescence, no study to date has systematically examined the associations between components of empathy and EF in this age group. Here, we explore these associations using data from an online battery of tasks, collected as part of a longitudinal twin study (N = 593; Mage 11.09 ± 0.2; 53.46% female, Israeli adolescents from Jewish decent). Using a confirmatory factor analysis, we quantified the associations between the main components of empathy (mentalizing and interpersonal concern) and of EF (working memory [WM], inhibition and shifting [IaS]). We found that WM was related to both mentalizing and interpersonal concern, whereas IaS were related to mentalizing but not to interpersonal concern. We also discuss the genetic and environmental contributions to individual differences in each factor. Our findings show both similarities and differences from previous findings in adults, suggesting that the ongoing brain maturation processes and environmental age-dependent experiences in adolescence may affect the developing relation between cognitive and emotional development. These results have implications for better understanding and treating clinical populations demonstrating executive or emotional deficits, specifically during adolescence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intonation Units in Spontaneous Speech Evoke a Neural Response.

Spontaneous speech is produced in chunks called intonation units (IUs). IUs are defined by a set of prosodic cues and presumably occur in all human languages. Recent work has shown that across different grammatical and sociocultural conditions IUs form rhythms of ∼1 unit per second. Linguistic theory suggests that IUs pace the flow of information in the discourse. As a result, IUs provide a promising and hitherto unexplored theoretical framework for studying the neural mechanisms of communication. In this article, we identify a neural response unique to the boundary defined by the IU. We measured the EEG of human participants (of either sex), who listened to different speakers recounting an emotional life event. We analyzed the speech stimuli linguistically and modeled the EEG response at word offset using a GLM approach. We find that the EEG response to IU-final words differs from the response to IU-nonfinal words even when equating acoustic boundary strength. Finally, we relate our findings to the body of research on rhythmic brain mechanisms in speech processing. We study the unique contribution of IUs and acoustic boundary strength in predicting delta-band EEG. This analysis suggests that IU-related neural activity, which is tightly linked to the classic Closure Positive Shift (CPS), could be a time-locked component that captures the previously characterized delta-band neural speech tracking.SIGNIFICANCE STATEMENT Linguistic communication is central to human experience, and its neural underpinnings are a topic of much research in recent years. Neuroscientific research has benefited from studying human behavior in naturalistic settings, an endeavor that requires explicit models of complex behavior. Usage-based linguistic theory suggests that spoken language is prosodically structured in intonation units. We reveal that the neural system is attuned to intonation units by explicitly modeling their impact on the EEG response beyond mere acoustics. To our understanding, this is the first time this is demonstrated in spontaneous speech under naturalistic conditions and under a theoretical framework that connects the prosodic chunking of speech, on the one hand, with the flow of information during communication, on the other.

Effects of social presence on behavioral, neural, and physiological aspects of empathy for pain.

In mediated interactions (e.g. video calls), less information is available about the other. To investigate how this affects our empathy for one another, we conducted an electroencephalogram study, in which 30 human participants observed 1 of 5 targets undergoing painful electric stimulation, once in a direct interaction and once in a live, video-mediated interaction. We found that observers were as accurate in judging others' pain and showed as much affective empathy via video as in a direct encounter. While mu suppression, a common neural marker of empathy, was not sensitive to others' pain, theta responses to others' pain as well as skin conductance coupling between participants were reduced in the video-mediated condition. We conclude that physical proximity with its rich social cues is important for nuanced physiological resonance with the other's experience. More studies are warranted to confirm these results and to understand their behavioral significance for remote social interactions.

Midfrontal theta as an index of conflict strength in approach-approach vs avoidance-avoidance conflicts.

The seminal theory of motivational conflicts distinguishes between approach-approach (AP-AP) conflicts, in which a decision is made between desirable alternatives, and avoidance-avoidance (AV-AV) conflicts, in which a decision is made between undesirable alternatives. The behavioral differences between AP-AP and AV-AV conflicts are well documented: abundant research showed that AV-AV conflicts are more difficult to resolve than AP-AP ones. However, there is little to no research looking into the neural underpinnings of the differences between the two conflict types. Here, we show that midfrontal theta, an established neural marker of conflict, distinguished between the two conflict types such that midfrontal theta power was higher in AV-AV conflicts than in AP-AP conflicts. We further demonstrate that higher midfrontal theta power was associated with shorter decision times on a single-trial basis, indicating that midfrontal theta played a role in promoting successful controlled behavior. Taken together, our results show that AP-AP and AV-AV conflicts are distinguishable on the neural level. The implications of these results go beyond motivational conflicts, as they establish midfrontal theta as a measure of the continuous degree of conflict in subjective decisions.

Grasp-specific high-frequency broadband mirror neuron activity during reach-and-grasp movements in humans.

Broadly congruent mirror neurons, responding to any grasp movement, and strictly congruent mirror neurons, responding only to specific grasp movements, have been reported in single-cell studies with primates. Delineating grasp properties in humans is essential to understand the human mirror neuron system with implications for behavior and social cognition. We analyzed electrocorticography data from a natural reach-and-grasp movement observation and delayed imitation task with 3 different natural grasp types of everyday objects. We focused on the classification of grasp types from high-frequency broadband mirror activation patterns found in classic mirror system areas, including sensorimotor, supplementary motor, inferior frontal, and parietal cortices. Classification of grasp types was successful during movement observation and execution intervals but not during movement retention. Our grasp type classification from combined and single mirror electrodes provides evidence for grasp-congruent activity in the human mirror neuron system potentially arising from strictly congruent mirror neurons.

Impaired empathic accuracy following damage to the left hemisphere.

Failing to understand others accurately can be extremely costly. Unfortunately, events such as strokes can lead to a decline in emotional understanding. Such impairments have been documented in stroke patients and are widely hypothesized to be related to right-hemisphere lesions, as well as to the amygdala, and are thought to be driven in part by attentional biases, for example, less fixation on the eyes. Notably, most of the previous research relied on measurements of emotional understanding from simplified cues, such as facial expressions or prosody. We hypothesize that chronic damage to the left hemisphere could hinder empathic accuracy and emotion recognition in naturalistic social settings that require complex language comprehension, even after a patient regains core language capacities. To assess this notion, we use an empathic accuracy task and eye-tracking measurements with chronic stroke patients with either right (N = 13) or left (N = 11) hemispheric damage-together with aged-matched controls (N = 15)-to explore the patients' understanding of others' affect inferred from stimuli that separates audio and visual cues. While we find that patients with right-hemisphere lesions showed visual attention bias compared to the other two groups, we uncover a disadvantage for patients with left-hemisphere lesions in empathic accuracy, especially when only auditory cues are present. These results suggest that patients with left-hemisphere damage have long-lasting difficulties comprehending real-world complex emotional situations.

Physicians prescribe fewer analgesics during night shifts than day shifts.

Adequate pain management is one of the biggest challenges of the modern healthcare system. Physician perception of patient subjective pain, which is crucial to pain management, is susceptible to a host of potential biases. Here we explore the timing of physicians' work as a previously unrecognized source of systematic bias in pain management. We hypothesized that during night shifts, sleep deprivation, fatigue, and stress would reduce physicians' empathy for others' pain, leading to underprescription of analgesics for patient pain relief. In study 1, 67 resident physicians, either following a night shift or not, performed empathy for pain assessment tasks and simulated patient scenarios in laboratory conditions. As predicted, following a night shift, physicians showed reduced empathy for pain. In study 2, we explored this phenomenon in medical decisions in the field. We analyzed three emergency department datasets from Israel and the United States that included discharge notes of patients arriving with pain complaints during 2013 to 2020 (n = 13,482). Across all datasets, physicians were less likely to prescribe an analgesic during night shifts (compared to daytime shifts) and prescribed fewer analgesics than generally recommended by the World Health Organization. This effect remained significant after adjusting for patient, physician, type of complaint, and emergency department characteristics. Underprescription for pain during night shifts was particularly prominent for opioids. We conclude that night shift work is an important and previously unrecognized source of bias in pain management, likely stemming from impaired perception of pain. We consider the implications for hospitals and other organizations employing night shifts.

Are there positive effects of having a sibling with special needs? Empathy and prosociality of twins of children with non-typical development.

This study examined whether typically developing (TD) twins of non-TD children demonstrate enhanced empathy and prosociality. Of 778 Hebrew-speaking Israeli families who participated in a twin study, 63 were identified to have a non-TD child with a TD twin, and 404 as having both twins TD. TD twins of non-TD children (27% males) were compared to the rest of the cohort of TD children (46% males) on measures of empathy and prosociality. Participants were 11 years old. TD twins of non-TD children scored significantly higher than TD twins of TD children in a measure of cognitive empathy (d = .43). No differences were found in emotional empathy and prosociality. The specificity of the positive effect on cognitive empathy is discussed.

Mu rhythm suppression over sensorimotor regions is associated with greater empathic accuracy.

When people encounter others' emotions, they engage multiple brain systems, including parts of the sensorimotor cortex associated with motor simulation. Simulation-related brain activity is commonly described as a 'low-level' component of empathy and social cognition. It remains unclear whether and how sensorimotor simulation contributes to complex empathic judgments. Here, we combine a naturalistic social paradigm with a reliable index of sensorimotor cortex-based simulation: electroencephalography suppression of oscillatory activity in the mu frequency band. We recruited participants to watch naturalistic video clips of people ('targets') describing emotional life events. In two experiments, participants viewed these clips (i) with video and sound, (ii) with only video or (iii) with only sound and provided continuous ratings of how they believed the target felt. We operationalized 'empathic accuracy' as the correlation between participants' inferences and targets' self-report. In Experiment 1 (US sample), across all conditions, right-lateralized mu suppression tracked empathic accuracy. In Experiment 2 (Israeli sample), this replicated only when using individualized frequency-bands and only for the visual stimuli. Our results provide novel evidence that sensorimotor representations-as measured through mu suppression-play a role not only in low-level motor simulation, but also in higher-level inferences about others' emotions, especially when visual cues are crucial for accuracy.

Gender bias in academia: A lifetime problem that needs solutions.

Despite increased awareness of the lack of gender equity in academia and a growing number of initiatives to address issues of diversity, change is slow, and inequalities remain. A major source of inequity is gender bias, which has a substantial negative impact on the careers, work-life balance, and mental health of underrepresented groups in science. Here, we argue that gender bias is not a single problem but manifests as a collection of distinct issues that impact researchers' lives. We disentangle these facets and propose concrete solutions that can be adopted by individuals, academic institutions, and society.

The influence of anger on empathy and theory of mind.

Social cognition allows humans to understand and predict other people's behavior by inferring or sharing their emotions, intentions and beliefs. Few studies have investigated the impact of one's own emotional state on understanding others. Here, we tested the effect of being in an angry state on empathy and theory of mind (ToM). In a between-groups design we manipulated anger status with different paradigms in three studies (autobiographical recall (N = 45), negative feedback (N = 49), frustration (N = 46)) and checked how this manipulation affected empathic accuracy and performance in the EmpaToM. All paradigms were successful in inducing mild anger. We did not find the expected effect of anger on empathy or ToM performance but observed small behavioral changes. Together, our results validate the use of three different anger induction paradigms and speak for rather weak behavioral effects of mild state anger on empathy and ToM.

The contribution of linguistic and visual cues to physiological synchrony and empathic accuracy.

There is an ongoing debate concerning the contribution of different aspects of empathy to achieving an accurate understanding of others. In this study, we aimed to better comprehend the roles of experience sharing and mentalizing using a modified empathic-accuracy task. We analyzed the unique contribution of each of these mechanisms with an explicit cognitive report as well as an affective physiological synchrony measurement. First, we recorded the emotional autobiographical stories told by participants ("targets", N = 28). Then, the targets watched their own videos as their heart rate (HR) was measured, and they reported on both a continuous and a discrete emotion scale what they felt while relaying the story. Next, we collected HR data from new participants ("observers", N = 72) as they similarly rated the targets' valence and discrete emotional states. In order to test the contribution of sensorimotor cues and contextual cues to empathic accuracy, observers viewed some videos with audio, others without audio, and listened to a third set of only the audio. We hypothesized that empathic accuracy-a cognitive measure that is a proxy for mentalizing and is operationalized by the correlation between a target's reported emotions and an observer's inference of those emotions-would be greater when linguistic information is present. We also hypothesized that physiological synchrony, a proxy for experience sharing, would be greater in the video-only condition, which was limited to sensorimotor cues to infer the other's emotional state. Indeed, we found that empathic accuracy was greater when auditory information was present, and that HR synchrony was more prevalent when visual cues were presented alone. Having both information streams together did not enhance accuracy, yet it was the only condition in which both behavioral empathic-accuracy measures correlated with HR synchrony. This study provides evidence that separate experience sharing and mentalizing pathways are active in the same task.

Empathic Accuracy in Clinical Populations.

Empathy, broadly defined as the ability to understand the other and to share others' emotions, motivates prosocial behavior and underlies successful interpersonal relations. Dysfunctions in this ability may cause fundamental difficulties in social communication. Empathy has been measured in various ways, from self-report questionnaires to laboratory objective performance tests. Empathic accuracy (EA), i.e., the ability to accurately empathize, is measured using more complex and ecological paradigms, such as asking participants to infer filmed interactions, or having people narrate personal emotional stories then assessing the correspondence between the perceiver and the target of empathy as the criteria for empathic ability. This measure is particularly useful in the study of clinical populations, where deconstructing the multifaceted concept of empathy may contribute to a more complete understanding of specific clinical profiles. This paper presents a scoping review of the literature on EA in clinical populations, and on EA and clinical traits and states in nonclinical or high-risk populations. Following an exhaustive literature search, 34 studies were found eligible to be included in this review. The largest category was studies focused on EA in people with schizophrenia (31%; 11 papers), followed by studies focused on EA in autism spectrum disorders (ASD) and autistic traits in a nonclinical population (22%; 8 papers). Studies were also found on EA and depression tendencies, psychopathy, social anxiety, behavior disorders, and personality disorders, and a few other clinical conditions. The included studies varied on research aims, designs, sample sizes, and male:female ratios. The overall synthesized results suggest that EA is reduced in schizophrenia and ASD. In other clinical populations, the number of studies was very limited. We urge researchers to further examine EA in these less-studied populations. The review reveals a general underrepresentation of female participants in studies on EA in clinical populations. We suggest that future research address understudied clinical populations, such as those diagnosed with psychopathy. Subject, target, and situational variables should also be considered, with special attention to gender differences (and similarities), the association between EA abilities and adaptive functioning, and the study of individuals with clinical conditions as targets, not just observers, in EA tasks.

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.