Empathic Care and Distress: Predictive Brain Markers and Dissociable Brain Systems

Abstract

Encountering another's suffering can elicit both empathic distress and empathic care-the warm desire to affiliate. It remains unclear whether these two feelings can be accurately and differentially predicted from neural activity and to what extent their neural substrates can be distinguished. We developed fMRI markers predicting moment-by-moment intensity levels of care and distress intensity while participants (n = 66) listened to true biographies describing human suffering. Both markers' predictions correlated strongly with self-report in out-of-sample participants (r = 0.59 and r = 0.63, p < 0.00001), and both markers predicted later trial-by-trial charitable donation amounts (p < 0.05). Empathic care was preferentially associated with nucleus accumbens and medial orbitofrontal cortex activity, whereas distress was preferentially associated with premotor and somatosensory cortical activity. In tests of marker specificity with an independent behavioral sample (n = 200), the empathic care marker was associated with a mixed-valence feeling state, whereas the empathic distress marker was specific to negative emotion.

Keywords: altruism; biomarker; compassion; empathy; prosocial.

Figure 1

Theoretical and analytic framework. (a) The encounter with a suffering person can elicit both empathic care and empathic distress. Participants provided continuous ratings of these emotions while listening to biographies describing true stories of human suffering. We developed whole-brain patterns predicting ratings of empathic care and distress from fMRI activity, and used marker responses to predict real-money trial by trial charitable donation amounts. (b) In leave-one-out cross-validation, we tested the sensitivity and relative selectivity of both markers, applying them to held-out test data for empathic care and distress.

Figure 2

Marker weights and predictions. (a) Marker voxel weights reliably contributing to prediction across 5,000 bootstrap samples thresholded at FDR q < .05. Positive (red) and negative (blue) weights indicate that more intense emotion was predicted by increased and reduced activity, respectively. (b) Using leave-one-subject-out cross-validation, markers predictions were computed for both empathic care and distress test data across five emotion intensity levels (mean ± SEM). Both markers were strongly predictive of the emotion they were trained to track, and the empathic care marker was relatively selective in predicting empathic care. The inset violin plots show the distribution of within-subject prediction-outcome correlations. (c) Markers predicted fluctuations in emotional intensity at the resolution of single fMRI volumes. With leave-one-subject-out cross-validation, we compared marker responses to single fMRI volumes with the emotional intensity reported at that moment. Each subject is represented by a colored line, and the black line shows the group average relationship. (d) Predicted empathic care and distress tracked the temporal unfolding of emotional experience during biography presentation. Shown here is the average across all biographies; results for each biography are presented in Figure S1. (e) Marker responses during biography presentation predicted later charitable donation to that biography at the trial level.

Figure 3

Brains systems preferentially related to empathic care or distress overlap with brain systems related to value and mirroring, respectively. (a) Regions sensitive and relatively selective for empathic care and distress, in both multivariate and univariate analyses (see text for details). (b) Meta-analytic maps for the terms “mirror” and “value” (reverse inference), thresholded at FDR q = .01 (Yarkoni et al., 2011). PMC = premotor cortex, IPL = inferior parietal lobe, SI/SII = primary/secondary somatosensory cortex, PCC = posterior cingulate, PC = precuneus, VS = ventral striatum, vmPFC = ventromedial prefrontal cortex, mOFC = medial orbitofrontal cortex.

Figure 4

Regions identified in previous analyses (see Figure 3) as sensitive and specific to empathic care or distress show the expected pattern of response across emotion intensity levels. Plots depict ROI-average activity across increasing intensity levels of care (purple) and distress (orange) (1 = lowest intensity, 5 = highest intensity, mean ± 95% CIs).

Figure 5

Relation of empathic care and distress to eight other feelings. a) Group-average continuous time courses (in seconds) of feelings provided by an independent behavioral sample (N = 200), shown for three sample biographies. These time courses were mapped onto neuroimaging data from the fMRI sample (N = 66). b) To assess the specificity of the empathic care and distress brain markers, we tested to what extent each marker correlated with the group-average time course of each feeling. This approach tracks the time course of feelings but not the absolute intensity of feelings. The care marker tracked empathic care significantly more strongly than any other emotion, and it was positively correlated with a range of positively and negatively valenced emotions. c) The distress marker was positively correlated with a cluster of negative emotions, negatively correlated with the two positive emotions, and had a relatively weak relationship with care and surprise, the two emotions with ambiguous valence.