Omnivore - This Is What Happiness Looks Like

From Bookforum's Omnivore blog at the end of February, here is a jolly collection of links on the topics of happiness, work, freedom, pleasure, and contentment.

This is what happiness looks like

Feb 25 2014  

9:00AM

• Anne Brunon-Ernst (Pantheon-Assas): Jeremy Bentham's Definition of Happiness. 
• Valentine Ibeka (Copenhagen): Should Public Pursuance of Happiness Be Discredited? 
• Roisin Timmins (Edinburgh): Fear of Crime, Fear of Control: How Structuring Freedoms Can Increase Happiness. 
• Yvan I. Russell (Gottingen) and Steve Phelps (Essex): How Do You Measure Pleasure? A Discussion About Intrinsic Costs and Benefits in Primate Allogrooming. 
• Viviana Ramirez (Bath): Ranking by Happiness: A New World Order? (2011). 
• Finn Janning (TBS): The Happiness of Burnout. 
• Happiness is not the same as a sense of meaning; how do we go about finding a meaningful life, not just a happy one? Roy F. Baumeister wants to know. 
• Why is a dedication to work, no matter how physically destructive and ultimately pointless, considered a virtue? Jenny Diski urges you to down tools while you can. 
• Happiness finds its way to print: Samir Husni interviews with Live Happy magazine editor in chief Karol DeWulf Nickell. 
• Tim Adams interviews Robert Skidelsky: “Why don't more people aspire to living a good life?” 
• This is what happiness looks like: It's possible to isolate what sustained contentment is — and it's more attainable than you might think. 
• I know what will cheer you up: Emotion-detecting advertising is coming — beware. 
• Can putting your child before yourself make you a happier person? 
• Kameron St.Clare on happiness as resistance: Moral obligations of the oppressed. 
• Research suggests a happy life may not be a meaningful life: Tasks that seem mundane, or even difficult, can bring a sense of meaning over time. 
• Noise makes people unhappy, cancer may not. 
• Want a happier life? Act your age.

 

In this new study from Jean Decety (one of the preeminent scholars of empathy), he and his research team examined the ability of psychopaths (or those who score highly on the PCL-R) to experience empathy for others' pain.

When the most highly psychopathic participants imagined pain to themselves, their brains showed a typical neural response within the regions involved in empathy for pain, including the anterior insula, the anterior midcingulate cortex, somatosensory cortex, and the right amygdala. The increase in brain activity in these regions was unusually pronounced, suggesting that psychopathic people are sensitive to the thought of of their own pain.

But when participants imagined pain to others, these regions failed to become active in highly psychopathic subjects. The psychopaths - this is important - showed an increased response in the ventral striatum, an area known to be involved in pleasure, when imagining others in pain.

Interesting paper.

First up is a summary of the paper from Science Daily, followed by the whole paper from Frontiers in Human Neuroscience.

Full Citation:
Decety, J, Chen, C, Harenski, C, and Kiehl, KA. (2013, Sep 24). An fMRI study of affective perspective taking in individuals with psychopathy: Imagining another in pain does not evoke empathy. Frontiers in Human Neuroscience,  DOI: 10.3389/fnhum.2013.00489

Neurological Basis for Lack of Empathy in Psychopaths

Sep. 24, 2013 — When individuals with psychopathy imagine others in pain, brain areas necessary for feeling empathy and concern for others fail to become active and be connected to other important regions involved in affective processing and decision-making, reports a study published in the open-access journal Frontiers in Human Neuroscience.

This is response in the right amygdala across groups of low (L), medium (M) and high (H) psychopathy participants, when they adopted an imagine-self and an imagine-other affective perspective while viewing bodily injuries. Groupwise effects (bars at the bottom of the figure) are expanded to show the contribution of continuous PCL-R subscores on factor 1, which encompasses the emotional/interpersonal features of psychopathy. (Credit: Decety. J, Chenyi. C, Harenski. C, and Kiehl. K, A. Frontiers in Human Neuroscience, 2013.)

Psychopathy is a personality disorder characterized by a lack of empathy and remorse, shallow affect, glibness, manipulation and callousness. Previous research indicates that the rate of psychopathy in prisons is around 23%, greater than the average population which is around 1%.

To better understand the neurological basis of empathy dysfunction in psychopaths, neuroscientists used functional magnetic resonance imaging (fMRI) on the brains of 121 inmates of a medium-security prison in the USA.

Participants were shown visual scenarios illustrating physical pain, such as a finger caught between a door, or a toe caught under a heavy object. They were by turns invited to imagine that this accident happened to themselves, or somebody else. They were also shown control images that did not depict any painful situation, for example a hand on a doorknob.

Participants were assessed with the widely used PCL-R, a diagnostic tool to identify their degree of psychopathic tendencies. Based on this assessment, the participants were then divided in three groups of approximately 40 individuals each: highly, moderately, and weakly psychopathic.

When highly psychopathic participants imagined pain to themselves, they showed a typical neural response within the brain regions involved in empathy for pain, including the anterior insula, the anterior midcingulate cortex, somatosensory cortex, and the right amygdala. The increase in brain activity in these regions was unusually pronounced, suggesting that psychopathic people are sensitive to the thought of pain.

But when participants imagined pain to others, these regions failed to become active in high psychopaths. Moreover, psychopaths showed an increased response in the ventral striatum, an area known to be involved in pleasure, when imagining others in pain.

This atypical activation combined with a negative functional connectivity between the insula and the ventromedial prefrontal cortex may suggest that individuals with high scores on psychopathy actually enjoyed imagining pain inflicted on others and did not care for them. The ventromedial prefrontal cortex is a region that plays a critical role in empathetic decision-making, such as caring for the wellbeing of others.

Taken together, this atypical pattern of activation and effective connectivity associated with perspective taking manipulations may inform intervention programs in a domain where therapeutic pessimism is more the rule than the exception. Altered connectivity may constitute novel targets for intervention. Imagining oneself in pain or in distress may trigger a stronger affective reaction than imagining what another person would feel, and this could be used with some psychopaths in cognitive-behavior therapies as a kick-starting technique, write the authors.

* * * * *

An fMRI study of affective perspective taking in individuals with psychopathy: imagining another in pain does not evoke empathy

Jean Decety [1,2], Chenyi Chen [1], Carla Harenski [3,4] and Kent A. Kiehl [3,4]

1. Department of Psychology, University of Chicago, Chicago, IL, USA
2. Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
3. Departments of Psychology and Neuroscience, University of New Mexico, Albuquerque, NM, USA
4. Mind Research Network, Albuquerque, NM, USA

While it is well established that individuals with psychopathy have a marked deficit in affective arousal, emotional empathy, and caring for the well-being of others, the extent to which perspective taking can elicit an emotional response has not yet been studied despite its potential application in rehabilitation. In healthy individuals, affective perspective taking has proven to be an effective means to elicit empathy and concern for others. To examine neural responses in individuals who vary in psychopathy during affective perspective taking, 121 incarcerated males, classified as high (n = 37; Hare psychopathy checklist-revised, PCL-R ≥ 30), intermediate (n = 44; PCL-R between 21 and 29), and low (n = 40; PCL-R ≤ 20) psychopaths, were scanned while viewing stimuli depicting bodily injuries and adopting an imagine-self and an imagine-other perspective. During the imagine-self perspective, participants with high psychopathy showed a typical response within the network involved in empathy for pain, including the anterior insula (aINS), anterior midcingulate cortex (aMCC), supplementary motor area (SMA), inferior frontal gyrus (IFG), somatosensory cortex, and right amygdala. Conversely, during the imagine-other perspective, psychopaths exhibited an atypical pattern of brain activation and effective connectivity seeded in the anterior insula and amygdala with the orbitofrontal cortex (OFC) and ventromedial prefrontal cortex (vmPFC). The response in the amygdala and insula was inversely correlated with PCL-R Factor 1 (interpersonal/affective) during the imagine-other perspective. In high psychopaths, scores on PCL-R Factor 1 predicted the neural response in ventral striatum when imagining others in pain. These patterns of brain activation and effective connectivity associated with differential perspective-taking provide a better understanding of empathy dysfunction in psychopathy, and have the potential to inform intervention programs for this complex clinical problem.

Empathy, the social-emotional response that is induced by the perception of another person's affective state, is a fundamental component of emotional experience, and plays a vital role in social interaction (Szalavitz and Perry, 2010). It is thought to be a proxy for prosocial behavior, guiding our social preferences and providing the affective and motivational base for moral development. Empathy is a deeply fundamental component of healthy co-existence whose absence is the hallmark of serious social-cognitive dysfunctions. Among the various psychopathologies marked by such deficits, psychopaths are characterized by a general lack of empathy and attenuated responding to emotional stimuli (Blair et al., 1997; Herpertz and Sass, 2000; Hare, 2003; Mahmut et al., 2008).

Empathy includes both cognitive and affective components (Decety and Jackson, 2004; Shamay-Tsoory, 2009; Singer and Lamm, 2009; Decety, 2011a; Zaki and Ochsner, 2012). The empathic arousal component, or emotion contagion, develops earlier than the cognitive component, and seems to be hardwired in the brain with deep evolutionary roots (Decety and Svetlova, 2012). In addition developmental research has found that concern for others emerges prior to the second year of life. In these studies, young children are not only moved by others' emotional states, but they make distress and pain attribution in conjunction with their comforting behavior and recognize what the target is distressed about (Roth-Hanania et al., 2011). Empathic arousal plays a fundamental role in generating the motivation to care and help another person in distress and depends only minimally on mindreading and perspective-taking capacities. In naturalistic studies, young children with high empathy disposition are more readily aroused vicariously by other' sadness, pain or distress, but at the same time possess greater capacities for emotion regulation so that their own negative arousal motivates rather than overwhelms their desire to alleviate the other's distress (Miller and Jansen op de Haar, 1997; Nichols et al., 2009). Empathic arousal is a bottom-up process in which the amygdala, hypothalamus, anterior insula (aINS), and orbitofrontal cortex (OFC) underlie rapid and prioritized processing of emotion signals sent by others (Decety and Svetlova, 2012). The cognitive component of empathy overlaps with the construct of perspective taking (Ruby and Decety, 2003). Perspective taking describes the ability to consciously put oneself into the mind of another individual and imagine what that person is thinking or feeling. The ability to adopt the perspective of another has previously been linked to social competence and social reasoning (Underwood and Moore, 1982). A substantial body of behavioral studies has documented that affective perspective taking is a powerful way to elicit empathy and concern for others (Batson et al., 1997; Decety and Hodges, 2006; Van Lange, 2008). For instance, Oswald (1996) found that affective perspective taking is more effective that cognitive perspective taking to evoke empathy and altruistic helping. Functional neuroimaging studies have consistently identified a circumscribed neural network reliably involved in perspective taking, which links the medial prefrontal cortex (mPFC), posterior superior temporal sulcus (pSTS/TPJ), and temporal poles/amygdala (Ruby and Decety, 2003, 2004; Hynes et al., 2006; Lawrence et al., 2006; Vollm et al., 2006; Rameson et al., 2011). Lesion studies have shown that affective perspective taking depends on intact medial and ventromedial prefrontal cortex (vmPFC) as well as regions in the posterior temporo-parietal cortex (Rankin et al., 2006). Importantly, neurological patients with damage to the vmPFC are found to exhibit a specific impairment in affective theory of mind tasks, sparing their cognitive empathy ability (Shamay-Tsoory et al., 2006).

In the empathy literature, a number of behavioral studies have documented a distinction between an imagine-self perspective and an imagine-other perspective (Batson, 2011). When adopting the former perspective, the central figure is oneself and one's own thoughts and feelings, and increases the salience of self-attributes. The imagining-other perspective involves an empathic attentional set in which the individual opens himself or herself in a deeply responsive way to the other person (Barrett-Lennard, 1981; Batson, 2009; Halpern, 2012). This distinction between imagine-self and imagine-other perspectives is also supported by functional neuroimaging research. For instance, when participants are asked to imagine being in physical pain themselves, they report greater pain intensity ratings and have greater activation in the aINS, aMCC, thalamus, and somatosensory cortex compared to imagining the same pain happening to another person (Jackson et al., 2006). The reverse contrast, imagining-other in pain vs. imagining oneself in pain, was associated with increased activity in the right pSTS and mPFC. Another study reported that self-perspective compared to other-perspective, when watching videos depicting facial expression of pain, led to higher activity in brain areas involved in the affective response to threat or pain, such as the amygdala, the insula, and the aMCC, as well as higher subjective ratings of personal distress (Lamm et al., 2007).

It is well established that individuals with psychopathy have limited aversive arousal to the distress and sadness cues of others (Van Honk and Schutter, 2006; Blair, 2007; Anderson and Kiehl, 2011), but spared theory of mind and cognitive perspective taking capacities (Blair, 2005; but see Brook and Kosson, 2012). However, it is not known if, when they adopt the affective perspective taking of another person, the extent to which the active contemplation of another's affective experience modulates brain circuits involved in affective processing.

Building on past research on perspective taking and empathy with healthy participants (Jackson et al., 2006; Lamm et al., 2007; Decety and Porges, 2011) as well as a recent study of pain empathy in criminal psychopaths (Decety et al., 2013), incarcerated offenders with different levels of psychopathy on Factors 1 and 2 underwent fMRI scanning while watching visual stimuli depicting physical pain. To elicit first- or third-person perspective taking (or imagine-self and imagine-other perspectives respectively) we explicitly manipulated the task instructions given to the participants in the scanner before each block, by asking them to think of the situations as either occurring to them or to someone else. Factor 1 describes a constellation of affective and interpersonal traits considered to be fundamental to the construct of psychopathy, which includes shallow affect, callous and lack of empathy, while Factor 2 reflects an unstable and antisocial lifestyle (Hare, 2003). Based on fMRI studies that used similar instructions and stimuli with healthy participants, it was predicted that imagine-self perspective would be associated with stronger visceromotor response in the aINS, somatosensory cortex and ACC than imagine-other perspective taking in participants scoring low on the psychopathy checklist-revised (PCL-R), especially Factor 1, because these regions have been associated with activation of representations of pain and of other negative emotions (Benuzzi et al., 2008). However, due to altered responding to affective stimuli in psychopathy, the opposite effect was expected for individuals scoring high on psychopathy PCL-R Factor 1. When instructed to adopt the perspective of another individual in physical pain, we hypothesized that individuals scoring high on the PCL-R would show a pronounced deficit in aINS and vmPFC hemodynamic response. This prediction is based on the large body of evidence from lesion studies and neuroimaging studies with healthy individuals as well as with psychopaths that show the importance of these regions in affective perspective taking and empathic concern (Rankin et al., 2003; Shamay-Tsoory et al., 2003; Kiehl, 2006; Gleichgerrcht et al., 2011; Rameson et al., 2011; Decety et al., 2012; Young and Dungan, 2012). The distinction between imagine-self and imagine-other is critical, as most studies suggest that psychopaths have spared mentalizing (cognitive empathy) abilities, and that the key deficit appears to relate to their lack of concern about the impact of their behavior on potential victims, rather than the inability to adopt a victim-centered perspective (Dolan and Fullam, 2004).

Finally, analyses of functional segregation can be complemented by effective connectivity analyses. Whereas standard contrast analyses create a “snapshot” of regional brain activity in response to a task or condition, functional connectivity analyses can identify patterns of communication between regions that contrast analyses may not detect [see Decety and Porges, 2011; Zaki et al. (2007) for such methods in empathy for pain]. Given the role of the insula in mapping internal states of bodily and subjective feelings (Craig, 2002) and that of the amygdala in motivational salience (Cunningham and Brosch, 2012), these two regions were selected as seeds for the functional connectivity analyses.
 

Materials and Methods

Participants

One hundred twenty-four adult right-handed males between the ages of 18 and 50, incarcerated in a medium-security North American correctional facility, volunteered for the study and provided informed consent to the procedures described here, which were approved by the Institutional Review Boards of the University of New Mexico and the University of Chicago. Participants underwent the PCL-R assessment, including file review and interview, conducted by trained research assistants under the supervision of Dr. Kiehl. Three participants were excluded for excessive movement in the scanner. Participants scoring 30 and above on the PCL-R were assigned to the high-psychopathy group (n = 37; age 32.5 ± 7.8; IQ 103.3 ± 13). To create the medium- and low-psychopathy groups, two groups of volunteers were matched to high scorers on age, race and ethnicity, IQ (WAIS), comorbidity for DSM-IV Axis II disorders, and past drug abuse and dependence, from pools of incarcerated volunteers scoring between 21 and 29 (n = 44; age 34.1 ± 7; IQ 97.3 ± 12.7), and volunteers scoring below 20 on the PCL-R (n = 40; age 34.6 ± 6.9; IQ 99.3 ± 14), respectively. Participants were paid for their participation in the study.

Exclusion Criteria 

Additional participants who volunteered for the study but met exclusion criteria were not included. Exclusion criteria were age younger than 18 years or older than 55, non-fluency in English, reading level lower than 4th grade, IQ score lower than 80, history of seizures, prior head injury with loss of consciousness > 30 min, current Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis I diagnosis, lifetime history of a psychotic disorder or psychotic disorder in a first degree relative, or current alcohol or drug use.
 
Task Design

Participants in the MRI scanner were instructed to adopt either a self-perspective or an other-perspective while viewing visual stimuli depicting right hands and right feet of individuals in painful and non-painful situations [stimuli and procedure similar to Jackson et al. (2006)]. All stimuli showed familiar events that can happen in everyday life to people (e.g., pinching one's finger in a door, or catching one's toe under a heavy object). Various types (mechanical, thermal and pressure) of pain inflicted to the limbs were depicted. Neutral pictures showed limbs in visually similar situations without pain component (e.g., a hand on the handle of a drawer as opposed to being caught in the same drawer). Participants viewed 120 stimuli of pain and no pain. Each trial lasted 1.4 s and consisted of one of the pain scenarios, and the inter-stimuli intervals were jittered between 2.5 and 5.4 s. Timing parameters were generated using a genetic optimization algorithm (Wager and Nichols, 2003). Eye-tracking was monitored in the scanner to ensure that participants were paying attention to the stimuli.

Perspective Instructions 

A mixed block-event related fMRI design [24 blocks (12 imagine-self and 12 imagine-other) with a total 120 trials] was employed, in which instructions were given to the subjects at the beginning of each block, i.e., for the imagine-self perspective blocks (“Imagine that these situations are happening to you”), and for the imaging-other perspective blocks (“Imagine that these situations are happening to someone else”). A colored border (blue or yellow) around the stimuli was used to further cue participants about which perspective to employ. Block order was pseudo-randomized across participants. Painful and non-painful scenarios were randomized within each block. Post-scan debriefings were conducted to make sure that subjects did follow the perspective-taking instructions.

MRI Acquisition

Scanning was conducted on a 1.5 Tesla Siemens Magnetom Avanto mobile unit equipped with advanced SQ gradients and a twelve element head coil. Functional images were collected using an EPI gradient-echo pulse sequence with TR/TE = 2000/39 ms, flip angle = 90°, field of view = 240 × 240 mm, matrix = 64 × 64 cm, in-plane resolution = 3.4 × 3.4 mm, slice thickness = 5 mm, and 30 slices, full-brain coverage. Task presentation was implemented using the commercial software package E-Prime (Psychology Software Tools, Inc., Pittsburgh PA).

High-resolution T1-weighted structural MRI scans were acquired using a multiecho MPRAGE pulse sequence (repetition time = 2530 ms, echo times = 1.64 ms, 3.50 ms, 5.36 ms, 7.22 ms, inversion time = 1100 ms, flip angle = 7°, slice thickness = 1.3 mm, matrix size = 256 × 256) yielding 128 sagittal slices with an in-plane resolution of 1.0 × 1.0 mm.

Image Processing and Analysis 

Functional images were processed with SPM8 (Wellcome Department of Imaging Neuroscience, London, UK) in Matlab (Mathworks Inc., Sherborn, MA, USA). For each participant, functional data were realigned to the first image acquisition of the series and re-sampled to a voxel size of 2 × 2 × 2 mm3. Structural T1 images were co-registered to the mean functional image and segmented using the “New Segment” routine. A group-level structural template and individual flow fields were created using DARTEL, and the flow fields were in turn were used to spatially normalize functional images to standard MNI space. Data were smoothed with an 8 mm full-width at half maximum (FWHM) isotropic Gaussian kernel. Three participants were eliminated from further analysis due to issues related to movement or image quality, leaving N = 121 (n = 40, 47, 37 for low, intermediate, and high psychopathy, respectively).

Statistics were calculated at the first level using the general linear model. The design matrix included three regressors for each stimulus category (detailed above), representing the event onsets and their time and dispersion derivatives. Movement parameters from the realignment output were included as regressors of no interest. All participants were entered into a second-level pooled analysis, and full brain activations were thresholded voxelwise at p < 0.001 and with an extent threshold based on Gaussian random fields set to control the whole-brain family-wise error rate (FWE) at p < 0.05.

Second-level analyses were conducted by comparing the extremes of the sample distribution of PCL-R scores, and then as a continuous regressor using the entire sample. Participants with PCL-R total score at or above 30 were selected for the psychopathy group, while participants scoring at 20 or below comprised the incarcerated control group. For these analyses, regions of interest (ROIs) were defined using the MarsBar ROI toolbox. We focused on brain regions that were of maximal importance to the hypotheses under investigation, informed by the existing literature on empathy for pain in particular from a meta-analysis of 32 fMRI studies of empathy for pain (Lamm et al., 2011). MNI coordinates were selected from a previous fMRI study of empathy for pain in 80 male incarcerated participants (Decety et al., 2013). That study employed the same 1.5 mobile MRI scanner, and exposed the participants (from a different North American prison) to visual stimuli depicting bodily physical pain and videos of facial expressions of pain. ROI data are reported for significant contrast image peaks within 10 mm of these a priori coordinates (FWE-corrected p < 0.05). Beyond existing literature on the processing of empathy-inducing stimuli in healthy populations, there may be additional cortical or subcortical brain regions that contribute to abnormal processing of these regions in psychopathy. For instance, the ventral striatum has been found to be over-reactive in adolescents with conduct disorder as well as sexual sadists (Decety et al., 2009; Harenski et al., 2012). Therefore, coordinates for the ventral striatum were selected from a recent meta-analysis of fMRI studies (Diekhof et al., 2012).

To explore the extent to which results found in the groupwise analysis are driven by PCL-R Factor 1, Factor 2, or both, the regions reported above were tested for significant correlation with PCL-R factor scores. Corresponding t-values for sub-factor covariates within 10 mm of the ROIs above, if significant, were reported for each factor and task.

Functional Connectivity 

Effective connectivity using psychophysiological interaction (PPI, Gitelman et al., 2003) was used to examine the effective connectivity from the anterior insula during imagine-first and imagine-third perspective taking conditions. The right anterior insula was selected because of its role in affective processing and attention. This polysensory region is considered as the integral hub of a salience network, which assists target brain regions in the generation of appropriate behavioral responses to salient stimuli (Menon and Uddin, 2010). Under the hypothesis that high psychopathy may result from a systemic brain deficit which is reflected in abnormal functional-connectivity patterns while imagining pain, we compared effective connectivity in imagine-self perspective and imagine-other perspective conditions between low- and high-psychopathy groups. Because of the importance of the amygdala reactivity (or the lack thereof) in psychopathy, we also ran a similar PPI analysis seeded in the right amygdala.

The time series of the first eigenvariates of the BOLD signal were temporally filtered, mean corrected, and deconvolved to generate the time series of the neuronal signal for the source region—the insula—as the physiological variable in the PPI. The psychological variable represented the time course of the contrast between painful and non-painful trials. An additional regressor represented the interaction of the psychological and physiological factors. These regressors were convolved with the canonical HRF and entered into the regression model. The interaction term in the resulting SPM showed areas with selective connectivity to the insula across the psychological contrast of pain vs. no pain. The PPI analysis was performed for each subject, and the resulting images of contrast estimates were entered into a random-effects group analysis. Second-level analysis results are reported at a voxelwise statistical cutoff of p < 0.001 and a spatial extent threshold of k > 10 voxels.
 

Results

The entire sample of 121 participants (regardless of their psychopathy level) showed significant neuro-hemodynamic increase in the network of regions involved in the actual experience of physical pain under the imagine-self trials (k > 10, p < 0.05, FWE corrected). This network includes the anterior insula (aINS), anterior midcingulate cortex (aMCC), supplementary motor area (SMA), inferior frontal gyrus (IFG), dorsomedial prefrontal cortex (dmPFC), mPFC, and somatosensory cortex, in both hemispheres (Table 1). In addition, signal change was detected in the left striatum and right amygdala.

TABLE 1

Table 1. Imagine-self perspective.

When participants adopted the imagine-other perspective, a similar network was implicated, except for the right amygdala (Table 2). The only additional regions activated were the pSTS and mPFC in the right hemisphere. When imagine-other perspective was contrasted with imagine-self perspective, bilateral activation was detected in the superior parietal cortex (−23, −52, 60 and 27, −44, 59), superior frontal gyrus (−21, −7, 52 and 26, −8, 52), and dorsal striatum (−6, 4, 12 and 9, 4, 11). No significant signal increase was detected for the reverse contrast.

TABLE 2

Table 2. Imagine-other perspective.

Region of Interest Analyses

Results from the ROI analyses are presented in Table 3. When participants with low scores on the PCL-R were compared with individuals scoring high on the PCL-R, the mPFC (−12, 52, 8) was activated during imagine-self perspective. A cluster of significant hemodynamic increase was found in the OFC. The opposite contrast (high psychopathy > low psychopathy) showed increased signal in the aMCC, SMA, right aINS, IFG, and right pSTS/TPJ. All participants showed significant response in the right amygdala during imagine-self perspective (Figure 1).

TABLE 3  

Table 3. Groupwise results and factor sub-score covariates for imagine-self and imagine-other perspectives.

FIGURE 1

Figure 1. Response in the right amygdala across groups of low (L), medium (M), and high (H) psychopathy (on total PCL-R scores) participants, when they adopted an imagine-self and an imagine-other affective perspective while viewing bodily injuries. Groupwise effects (bars at the bottom of the figure) are expanded to show the contribution of continuous PCL-R subscores on Factor 1, which encompasses the emotional/interpersonal features of psychopathy.

During the imagine-other perspective, individuals with low scores on the PCL-R compared with individuals with high scores on the PCL-R, showed greater signal change in the SMA, right mPFC, intraparietal sulcus, precentral gyrus, and parahippocampal gyrus/amygdala, pSTS, dorsal aINS and dorsal ACC. In participants with high scores on the PCL-R, the imagine-other perspective was associated with greater activation in the dlPFC and ventral striatum (p < 0.001), when compared to low-scoring incarcerated controls.

Correlations Between PCL-R Scores and ROIs

The hemodynamic response in the aINS was significantly greater in individuals scoring high on psychopathy (total PCL-R score) during imagine-self perspective, and the reverse was found for imagine-other perspective (Figure 2). Factor 2 positively correlated with the activity in aINS during imagine-self perspective (r = 0.372, p = 0.016), whereas it negatively correlated with aINS activity during imagine-other perspective (r = −0.254, p = 0.01). Factor 1 was negatively correlated with response in aINS during third-person perspective (r = −0.272, p = 0.01). Activity in the dmPFC was negatively associated with both Factor 1 (r = −0.24, p < 0.01) and Factor 2 (r = −0.237, p = 0.01) during imagine-self perspective. The hemodynamic response in the dlPFC was positively correlated with both Factor 1 (r = 0.288, p < 0.01) and Factor 2 (r = 0.274, p < 0.01) during imagine-other perspective. The response in the ventral striatum during imagine-other perspective significantly correlated with scores on Factor 1 (r = 0.212, p < 0.02, see Figure 3). Finally, response in the right amygdala (26, 2, −18) showed a negative correlation with Factor 1 (r = −0.258, p = 0.04) during imagine-other perspective. No significant correlation was found in imagine-self perspective with either Factors 1 and 2. See Table 3 for a complete list of results.

FIGURE 2

Figure 2. Response in the right anterior insula across groups (L, low; M, medium; H, high on total PCL-R scores) during imagine-self and imagine-other perspectives in participants viewing bodily injuries. Groupwise effects seen in (bar graph) are expanded to show the contribution of Factors 1 and 2 from PCL-R subscores.

FIGURE 3

Figure 3. Response in the right ventral striatum in participants scoring high on the PCL-R (≥30) when they imagined another person in pain, and correlation with scores on Factor 1.

Effective Connectivity Analyses

Functional connectivity analyses seeded in the anterior insula revealed distinct patterns in functional coupling between the low- and high-psychopathy groups. During imagine-self perspective, individuals scoring low on the PCL-R showed a negative connectivity between the aINS and the hippocampus and the OFC (Figure 4). In the high psychopathy group, there was only significant functional connectivity between the aINS and the right pSTS. During imagine-other perspective, low-psychopathy participants had significant effective connectivity between the aINS and posterior cingulate cortex and dlPFC (Figure 5). In high-scoring participants, negative connectivity was found between aINS and the right OFC and posterior cingulate cortex.

FIGURE 4

Figure 4. Functional connectivity analyses, seeded in the anterior insula in participants with the lowest scores on the PCL-R (≤20) and participants with the highest scores on the PCL-R (≥30) during imagine-self perspective.

FIGURE 5

Figure 5. Functional connectivity analyses, seeded in the anterior insula in participants with the lowest scores on the PCL-R and participants with the highest scores on the PCL-R (>30) during imagine-other perspective.  

Functional connectivity analyses seeded in the right amygdala showed distinct patterns of co-variations depending on the perspective adopted in controls vs. psychopaths. During imagine-self perspective, controls exhibited a significant negative coupling between the amygdala and ventral and mPFC, while participants with high scores on the PCL-R showed a positive coupling with the pSTS/TPJ, ventral and mPFC, and dlPFC (Figure 6). During imagine-other perspective, the reverse pattern of functional connectivity was observed. Low psychopathy was associated with greater positive coupling with the OFC, whereas the high psychopathy showed a negative coupling with the OFC and dlPFC (Figure 7).

FIGURE 6

Figure 6. Functional connectivity analyses, seeded in the right amygdala in participants with the lowest scores on the PCL-R (≤20) and participants with the highest scores on the PCL-R (≥30) during imagine-self perspective.

FIGURE 7

Figure 7. Functional connectivity analyses, seeded in the right amygdala in participants with the lowest scores on the PCL-R and participants with the highest scores on the PCL-R (>30) during imagine-other perspective.

Discussion

Perspective taking while observing or imagining other's feelings has been described as an empathic attentional set that facilitates other-oriented emotional and motivational responses congruent with the perceived welfare of that person (Van Lange, 2008; Batson, 2012). To examine the extent to which affective reactions can be evoked or modulated by perspective taking in individuals with psychopathy, incarcerated participants with different levels on the PCL-R were scanned while viewing stimuli depicting bodily injuries and instructed to imagine these situations as either happening to themselves or to someone else.

At the group level, collapsed across the PCL-R scores (n = 121), both conditions of imagine-self and imagine-other in pain were associated with signal increase in brain regions implicated in the perception of pain and distress, when viewing body parts suffering injuries or facial expressions of pain (Jackson et al., 2006; Lamm et al., 2007, 2011; Decety and Porges, 2011; Bruneau et al., 2012). In healthy participants, activity in this network, which includes the aINS, thalamus, aMCC, IFG, and somatosensory cortex, has been interpreted as a form of somatosensory resonance, or shared neural representations with the pain of others, providing an implicit intersubjective affective knowledge (Decety and Jackson, 2004; Singer and Decety, 2011; Zaki and Ochsner, 2012). However, these vicariously instigated activations of the so-called “pain matrix” are not specific to the sensory qualities of pain, but instead are associated with more general survival mechanisms such as aversion and withdrawal when exposed to danger and threat (Benuzzi et al., 2008; Decety, 2010). In fact, based on a systematic review of electroencephalographic and functional MRI studies that examined neural response triggered by nociceptive stimuli, activity of this cortical network seems to reflect a system involved in detecting, processing, and reacting to the occurrence of salient sensory events regardless of the sensory channel through which these events are conveyed (Legrain et al., 2011).

Interestingly and quite surprisingly, the hemodynamic response in aINS and aMCC, regions considered as pivotal in the affective component of empathy, was highest in high psychopaths during imagine-self perspective, replicating the results of a recent study of pain empathy in criminal psychopaths that reported greater activation in the insula, which was positively correlated with scores on both PCL-R factors 1 and 2 (Decety et al., 2013) (Figure 2). The aINS and aMCC are the two regions that have been most reliably activated in fMRI studies of pain empathy with healthy subjects (Valentini, 2010; Lamm et al., 2011). This finding does not support the view that psychopaths do not resonate when exposed aversive stimuli such as pain, or at least they are not totally blunted when they take a first-person perspective. This finding also raises an interesting question: whether or not sensorimotor resonance (underpinned by the mirror neuron system involved in perception-action coupling) is the mechanism that facilitates emotion contagion and empathic arousal. Psychopaths are characterized by a lack of affective empathy, but there is little evidence that they show a deficit in sensorimotor resonance (Blair, 2011; Decety, 2011b). For instance, a transcranial magnetic stimulation study demonstrated increased sensorimotor resonance to painful hand-pricking videos in college students scoring high on the psychopathic personality inventory (PPI), as compared to students who score low on the PPI (Fecteau et al., 2008). Juvenile incarcerated psychopaths showed greater sensorimotor resonance as measured by EEG and suppression of the mu rhythm when they viewed visual stimuli depicting people being physically injured, despite a lack of affective arousal to the same stimuli as measured by the N120 ERP component (Cheng et al., 2012). Children with aggressive conduct disorder and psychopathic tendencies and incarcerated psychopaths exhibit typical (Marsh et al., 2013) or even stronger activation in the somatosensory cortex than control participants when they watched scenarios depicting people in pain (Decety et al., 2009, 2013), all of which does not suggest an impairment in somatosensory responses to others' pain. Our finding that participants scoring high on psychopathy activate the pain network during imagine-self perspective fits well with studies showing that individuals with psychopathy may up-regulate emotional (at least for fear) processing when attention to salient stimuli is particularly engaged (Newman and Lorenz, 2003), and this may be the case for pain.

Furthermore, and as expected, the lower the participants scored on Factors 1 and 2 of the PCL-R, the higher the activity in the aINS during imaging-other perspective. This indicates that more vicarious experience was elicited in control participants when they imagined another in pain, and the opposite pattern (low activation in the aINS) was found in participants who scored high on psychopathy. In addition, functional connectivity analyses, seeded in the right aINS during imagine-self perspective negatively co-varied with activation in the hippocampal gyrus and OFC in control participants (low on psychopathy), and was positively coupled with the right pSTS region in psychopaths. During imagine-other perspective, the aINS positively covaried with activity in the right dlPFC and PCC in controls, and negatively with the OFC and PCC in high psychopaths. Altogether, the hemodynamic response in the aINS shows distinct profiles of activation depending on whether participants adopted an imagine-self or imagine-other perspective taking. These results from the imagine-other perspective condition support two recent functional neuroimaging studies in children with conduct disorder (Lockwood et al., 2013; Marsh et al., 2013). Both studies reported a reduced response in the aINS and ACC when the children viewed pictures of others in pain. Furthermore, a negative association between callous traits and the aINS/ACC was found. The fact that individuals with high scores on the PCL-R showed a reduced response when imagining the pain of another suggests a specific deficit in affective processing in a region considered as a critical hub to integrate salient stimuli and events with visceral and autonomic information (Menon and Uddin, 2010).

Signal change in the right amygdala was detected during imagine-self perspective in all participants, and during imagine-other perspective in controls. The hemodynamic response in the amygdala was inversely correlated with individual scores on PCL-R Factor 1 during imagine-other perspective. This is in line with most neuroimaging studies of psychopathy that documented reduced amygdala response to fearful and aversive stimuli (Marsh and Blair, 2008; Harenski et al., 2009). This finding is consistent with the notion that psychopaths lack the ability to be responsive to, or aroused by distress cues, and therefore are not sensitive to signs of vulnerability. A recent fMRI study in youths with psychopathic traits also reported reduction in the amygdala and insula when they imagined physical injuries to others, but not their own pain (Marsh et al., 2013).

It is very interesting to note that imagine-self perspective was associated with activity in the amygdala in psychopaths when they focus on their own affective reaction. While most studies report a reduced response in the amygdala in psychopaths, an fMRI study conducted on a small number psychopaths and controls found increased activation in the right amygdala in the psychopath group with respect to controls when viewing negative IAPS pictures (Müller et al., 2003), indicating that the role of the amygdala in psychopathy may not be straightforward, nor its lateralization. A meta-analysis of 67 neuroimaging studies reported that the lateralization of activation in the amygdala was explained by differences in temporal dynamics and/or habituation rates, namely a short-duration response in the right amygdala and a more sustained one in the left (Sergerie et al., 2008). It is however difficult to interpret the amygdala activation during imagine-self perspective further without a more fine-grain analysis of amygdala sub-nuclei and their anatomical connectivity, which helps determine their function (Saygin et al., 2011). With this caveat in mind, it is important to note that functional connectivity analyses, seeded in the right amygdala, demonstrated very different patterns of connectivity depending on the perspective taking strategy (imagine-self vs. imagine-other) and participants (low vs. high psychopaths). The response in the right amygdala was negatively coupled with activity in the OFC in controls and positively correlated with the OFC and dlPFC and pSTS in high psychopathy during imagine-self perspective (Figure 3). The exact reverse functional connectivity was detected during imagine-other perspective (Figure 4). This finding specifically points to amygdala–OFC interactions as being an important neural mechanism that underlies the outcome of perspective taking in psychopathy. It seems to indicate that during imagine-self perspective, individuals with psychopathy elicit amygdala-OFC coupling but fail to do so during imagine-other perspective. Such a failure to recruit the OFC during third-person perspective taking supports the dysfunction of this neural pathway in response to distress cues of others in psychopaths. It has been argued that the integrated functioning of this circuit enables the basics of care-based morality, and that dysfunction within these regions in psychopathy means that reinforcement-based decision making, including moral decision making, and care base morality is impaired (Blair, 2007; Shamay-Tsoory et al., 2010; Marsh et al., 2011). One theory of the origin of empathic deficits in psychopathy is the failure during development to form stimulus-reinforcement associations connecting harmful or aggressive actions with the pain and distress of others (Kiehl, 2006; Glenn and Raine, 2009). It is worth mentioning that psychopathic traits are not exclusively associated with amygdala hyporeactivity. A study that included 200 young adults with self-reported psychopathy assessment found that amygdala reactivity to fearful facial expressions is negatively associated with the interpersonal facet of psychopathy, whereas reactivity to angry expressions is positively associated with the lifestyle facet (Carré et al., 2013).

Finally, the increase of activity in the ventral striatum during imagine-other perspective in psychopaths, which was predicted by their scores on Factor 1 of the PCL-R, is an intriguing finding. This could suggest that psychopaths not only experience blunted vicariously arousal to others' pain and reduced feelings of concern when adopting their perspective, but they may in fact find the distress of others pleasurable or positively arousing. The ventral striatum is selectively recruited during reward anticipation in healthy participants (Diekhof et al., 2012 for a meta-analysis). In adolescents with conduct disorder and psychopathic tendencies, an fMRI study found activation of the ventral striatum during the perception of pain in others (Decety et al., 2009). In healthy subjects, the ventral striatum has been associated with experiencing pleasure at others' misfortune (e.g., Dvash et al., 2010; Cikara et al., 2011). It has been suggested that neurons in the ventral striatum have access to central representations of reward and thereby participate in the processing of information underlying the motivational control of goal-directed behavior (Schultz et al., 1992). Activation of the ventral striatum while imaging another in physical pain was correlated with PCL-R Factor 1, and not Factor 2. Abnormalities in the ventral and dorsal striatum are considered to play a key role in the etiology of psychopathic traits (Buckholtz et al., 2010; Carré et al., 2013).
 

Conclusion

There is general consensus among theorists that the ability to adopt and entertain the psychological perspective of others has a number of important consequences, including empathic concern (e.g., Blair, 2007; Batson, 2009; Decety and Svetlova, 2012). Adopting the perspective of another is a powerful way to place oneself in the situation or emotional state of that person (Batson, 2011). Our results demonstrate that while individuals with psychopathy exhibited a strong response in pain-affective brain regions when taking an imagine-self perspective, they failed to recruit the neural circuits that are were activated in controls during an imagine-other perspective, and that may contribute to lack of empathic concern. Finally, this atypical pattern of activation and effective connectivity associated with perspective taking manipulations may inform intervention programs in a domain where therapeutic pessimism is more the rule than the exception (Salekin, 2002). Altered connectivity may constitute novel therapeutic targets for interventions. Both cognitive and pharmacotherapy interventions may restore connectivity patterns (Crocker et al., 2013). Imagining oneself in pain or in distress may trigger a stronger affective reaction than imagining what another person would feel, and this could be used with some psychopaths in cognitive-behavior therapies as a kick-starting technique for eliciting emotional tagging of different outcomes of interpersonal situations.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
 
Acknowledgments

This study was supported by NIMH R01 grant 1R01MH087525-01A2 (J. Decety, PI) and by NIMH R01 grant MH070539-01 and NIDA 1R01DA026505-01A1 (K. Kiehl, PI). Dr. J. Decety, Dr. C. Chen, Dr. C. Harenski, and Dr. K. Kiehl have no conflicts of interest to disclose. Dr. Decety takes full responsibility for the integrity of the data and the accuracy of the data analysis. All authors had full access to all the data in the study.

References available at the Frontiers site

The Compassionate Mind: Science Shows Why it’s Healthy and How it Spreads

From the Association for Psychological Science's Observer Magazine, this article was the cover story for the May/June issue, and it offers a great overview of the state of the science on compassion. Definitely a good resource article, as well as being a good overview in general.

The Compassionate Mind

Science shows why it’s healthy and how it spreads

By Emma Seppala

At a GlanceGathering Empirical Evidence About Compassion

• Michael Tomasello and other scientists at the Max Planck Institute have found that infants and chimpanzees spontaneously engage in helpful behavior and will even overcome obstacles to do so.

• Steve Cole at the University of California, Los Angeles, and Barbara L. Fredrickson at the University of North Carolina at Chapel Hill found in a study that people who are happy because they live a life of purpose or meaning had low levels of the cellular inflammation associated with many diseases, including cancer.

• A brain-imaging study headed by neuroscientist Jordan Grafman from the National Institutes of Health showed that the “pleasure centers” in the brain, i.e., the parts of the brain that are active when we experience pleasure (like dessert, money, and sex), are equally active when we observe someone giving money to charity as when we receive money ourselves.

Decades of clinical research has focused and shed light on the psychology of human suffering. That suffering, as unpleasant as it is, often also has a bright side to which research has paid less attention: compassion. Human suffering is often accompanied by beautiful acts of compassion by others wishing to help relieve it. What led 26.5 percent of Americans to volunteer in 2012 (according to statistics from the US Department of Labor)? What propels someone to serve food at a homeless shelter, pull over on the highway in the rain to help someone with a broken down vehicle, or feed a stray cat?

What is Compassion?

What is compassion and how is it different from empathy or altruism? The definition of compassion is often confused with that of empathy. Empathy, as defined by researchers, is the visceral or emotional experience of another person’s feelings. It is, in a sense, an automatic mirroring of another’s emotion, like tearing up at a friend’s sadness. Altruism is an action that benefits someone else. It may or may not be accompanied by empathy or compassion, for example in the case of making a donation for tax purposes. Although these terms are related to compassion, they are not identical. Compassion often does, of course, involve an empathic response and an altruistic behavior. However, compassion is defined as the emotional response when perceiving suffering and involves an authentic desire to help.

Is Compassion Natural or Learned?

Though economists have long argued the contrary, a growing body of evidence suggests that, at our core, both animals and human beings have what APS Fellow Dacher Keltner at the University of California, Berkeley, coins a “compassionate instinct.” In other words, compassion is a natural and automatic response that has ensured our survival. Research by APS Fellow Jean Decety, at the University of Chicago, showed that even rats are driven to empathize with another suffering rat and to go out of their way to help it out of its quandary. Studies with chimpanzees and human infants too young to have learned the rules of politeness, also back up these claims. Michael Tomasello and other scientists at the Max Planck Institute, in Germany, have found that infants and chimpanzees spontaneously engage in helpful behavior and will even overcome obstacles to do so. They apparently do so from intrinsic motivation without expectation of reward. A recent study they ran indicated that infants’ pupil diameters (a measure of attention) decrease both when they help and when they see someone else helping, suggesting that they are not simply helping because helping feels rewarding. It appears to be the alleviation of suffering that brings reward — whether or not they engage in the helping behavior themselves. Recent research by David Rand at Harvard University shows that adults’ and children’s first impulse is to help others. Research by APS Fellow Dale Miller at Stanford’s Graduate School of Business suggests that this is also the case of adults, however, worrying that others will think they are acting out of self-interest can stop them from this impulse to help.

It is not surprising that compassion is a natural tendency since it is essential for human survival. As has been brought to light by Keltner, the term “survival of the fittest,” often attributed to Charles Darwin, was actually coined by Herbert Spencer and Social Darwinists who wished to justify class and race superiority. A lesser known fact is that Darwin’s work is best described with the phrase “survival of the kindest.” Indeed in The Descent of Man and Selection In Relation to Sex, Darwin argued for “the greater strength of the social or maternal instincts than that of any other instinct or motive.” In another passage, he comments that “communities, which included the greatest number of the most sympathetic members, would flourish best, and rear the greatest number of offspring.” Compassion may indeed be a naturally evolved and adaptive trait. Without it, the survival and flourishing of our species would have been unlikely.

One more sign that suggests that compassion is an adaptively evolved trait is that it makes us more attractive to potential mates. A study examining the trait most highly valued in potential romantic partners suggests that both men and women agree that “kindness” is one of the most highly desirable traits.

Compassion’s Surprising Benefits for Physical and Psychological Health

Compassion may have ensured our survival because of its tremendous benefits for both physical and mental health and overall well-being. Research by APS William James Fellow Ed Diener, a leading researcher in positive psychology, and APS James McKeen Cattell Fellow Martin Seligman, a pioneer of the psychology of happiness and human flourishing, suggests that connecting with others in a meaningful way helps us enjoy better mental and physical health and speeds up recovery from disease; furthermore, research by Stephanie Brown, at Stony Brook University, and Sara Konrath, at the University of Michigan, has shown that it may even lengthen our life spans.

The reason a compassionate lifestyle leads to greater psychological well-being may be explained by the fact that the act of giving appears to be as pleasurable, if not more so, as the act of receiving. A brain-imaging study headed by neuroscientist Jordan Grafman from the National Institutes of Health showed that the “pleasure centers” in the brain, i.e., the parts of the brain that are active when we experience pleasure (like dessert, money, and sex), are equally active when we observe someone giving money to charity as when we receive money ourselves! Giving to others even increases well-being above and beyond what we experience when we spend money on ourselves. In a revealing experiment by Elizabeth Dunn, at the University of British Columbia, participants received a sum of money and half of the participants were instructed to spend the money on themselves; the other half was told to spend the money on others. At the end of the study, which was published in the academic journal Science, participants who had spent money on others felt significantly happier than those who had spent money on themselves.

This is true even for infants. A study by Lara Aknin and colleagues at the University of British Columbia shows that even in children as young as two, giving treats to others increases the givers’ happiness more than receiving treats themselves. Even more surprisingly, the fact that giving makes us happier than receiving is true across the world, regardless of whether countries are rich or poor. A new study by Aknin, now at Simon Fraser University, shows that the amount of money spent on others (rather than for personal benefit) and personal well-being were highly correlated, regardless of income, social support, perceived freedom, and perceived national corruption.

Why is Compassion Good For Us?

Why does compassion lead to health benefits in particular? A clue to this question rests in a fascinating new study by Steve Cole at the University of California, Los Angeles, and APS Fellow Barbara Fredrickson at the University of North Carolina at Chapel Hill. The results were reported at Stanford Medical School’s Center for Compassion and Altruism Research and Education’s (CCARE) inaugural Science of Compassion conference in 2012. Their study evaluated the levels of cellular inflammation in people who describe themselves as “very happy.” Inflammation is at the root of cancer and other diseases and is generally high in people who live under a lot of stress. We might expect that inflammation would be lower for people with higher levels of happiness. Cole and Fredrickson found that this was only the case for certain “very happy” people. They found that people who were happy because they lived the “good life” (sometimes also know as “hedonic happiness”) had high inflammation levels but that, on the other hand, people who were happy because they lived a life of purpose or meaning (sometimes also known as “eudaimonic happiness”) had low inflammation levels. A life of meaning and purpose is one focused less on satisfying oneself and more on others. It is a life rich in compassion, altruism, and greater meaning.

Another way in which a compassionate lifestyle may improve longevity is that it may serve as a buffer against stress. A new study conducted on a large population (more than 800 people) and spearheaded by the University at Buffalo’s Michael Poulin found that stress did not predict mortality in those who helped others, but that it did in those who did not. One of the reasons that compassion may protect against stress is the very fact that it is so pleasurable. Motivation, however, seems to play an important role in predicting whether a compassionate lifestyle exerts a beneficial impact on health. Sara Konrath, at the University of Michigan, discovered that people who engaged in volunteerism lived longer than their non-volunteering peers — but only if their reasons for volunteering were altruistic rather than self-serving.

Another reason compassion may boost our well-being is that it can help broaden our perspective beyond ourselves. Research shows that depression and anxiety are linked to a state of self-focus, a preoccupation with “me, myself, and I.” When you do something for someone else, however, that state of self-focus shifts to a state of other-focus. If you recall a time you were feeling blue and suddenly a close friend or relative calls you for urgent help with a problem, you may remember that as your attention shifts to helping them, your mood lifts. Rather than feeling blue, you may have felt energized to help; before you knew it, you may even have felt better and gained some perspective on your own situation as well.

Finally, one additional way in which compassion may boost our well-being is by increasing a sense of connection to others. One telling study showed that lack of social connection is a greater detriment to health than obesity, smoking, and high blood pressure. On the flip side, strong social connection leads to a 50 percent increased chance of longevity. Social connection strengthens our immune system (research by Cole shows that genes impacted by social connection also code for immune function and inflammation), helps us recover from disease faster, and may even lengthen our life. People who feel more connected to others have lower rates of anxiety and depression. Moreover, studies show that they also have higher self-esteem, are more empathic to others, more trusting and cooperative and, as a consequence, others are more open to trusting and cooperating with them. Social connectedness therefore generates a positive feedback loop of social, emotional, and physical well-being. Unfortunately, the opposite is also true for those who lack social connectedness. Low social connection has been generally associated with declines in physical and psychological health, as well as a higher propensity for antisocial behavior that leads to further isolation. Adopting a compassionate lifestyle or cultivating compassion may help boost social connection and improve physical and psychological health.

Why Compassion Really Does Have the Ability to Change the World

Why are the lives of people like Mother Teresa, Martin Luther King, Jr., and Desmond Tutu so inspiring? Research by APS Fellow Jonathan Haidt at the University of Virginia suggests that seeing someone helping another person creates a state of “elevation.” Have you ever been moved to tears by seeing someone’s loving and compassionate behavior? Haidt’s data suggest that elevation then inspires us to help others — and it may just be the force behind a chain reaction of giving. Haidt has shown that corporate leaders who engage in self-sacrificing behavior and elicit “elevation” in their employees, also yield greater influence among their employees — who become more committed and in turn may act with more compassion in the workplace. Indeed, compassion is contagious. Social scientists James Fowler of the University of California, San Diego, and Nicholas Christakis of Harvard demonstrated that helping is contagious: acts of generosity and kindness beget more generosity in a chain reaction of goodness. You may have seen one of the news reports about chain reactions that occur when someone pays for the coffee of the drivers behind them at a drive-through restaurant or at a highway tollbooth. People keep the generous behavior going for hours. Our acts of compassion uplift others and make them happy. We may not know it, but by uplifting others we are also helping ourselves; research by Fowler and Christakis has shown that happiness spreads and that if the people around us are happy, we, in turn become happier.

Cultivating Compassion

Although compassion appears to be a naturally evolved instinct, it sometimes helps to receive some training. A number of studies have now shown that a variety of compassion and “loving-kindness” meditation practices, mostly derived out of traditional Buddhist practices, may help cultivate compassion. Cultivating compassion does not require years of study and can be elicited quite rapidly. In a study Cendri Hutcherson, at the California Institute of Technology, and I conducted in 2008 with APS Fellow James Gross at Stanford, we found that a seven-minute intervention was enough to increase feelings of closeness and connection to the target of meditation on both explicit measures, but also on implicit measures that participants could not voluntarily control; this suggests that their sense of connection had changed on a deep-seated level. Fredrickson tested a nine-week loving-kindness meditation intervention and found that the participants who went through the intervention experienced increased daily positive emotions, reduced depressive symptoms, and increased life satisfaction. A group led by Sheethal Reddy at Emory with foster children showed that a compassion intervention increased hopefulness in the children. Overall, research on compassion interventions show improvements in psychological well-being, compassion, and social connection.

In addition to questionnaire measures, researchers are finding that compassion interventions also impact behavior. APS Fellow Tania Singer and her team at the Max Planck Institute conducted a study that looked at the effects of compassion training on prosocial behavior. These researchers developed the Zurich Prosocial Game, which has the ability to measure an individual’s prosocial behavior multiple times, unlike many other prosocial tasks that only measure prosocial behavior in individuals once. Singer found that daylong compassion training did in fact increase prosocial behavior on the game. Interestingly, the type of meditation seems to matter less than just the act of meditation itself. Condon, Miller, Desbordes, and DeSteno (in press) found that eight-week meditation trainings led participants to act more compassionately toward a person who is suffering (give up their chair to someone in crutches) — regardless of the type of meditation that they did (mindfulness or compassion).

More research is needed to understand exactly how compassion training improves well-being and promotes altruistic behavior. Research by Antoine Lutz and APS William James Fellow Richard Davidson at the University of Wisconsin-Madison found that, during meditation, participants display enhanced emotional processing in brain regions linked to empathy in response to emotion-evoking cries. A study led by Gaëlle Desbordes at Massachusetts General Hospital indicated that both compassion and a mindfulness meditation training decreased activity in the amygdala in response to emotional images; this suggests that meditation in general can help improve emotion regulation. However, compassion meditation did not reduce activity for images of human suffering, suggesting that the compassion meditation increased a person’s responsiveness to suffering.

In collaboration with Thupten Jinpa, personal translator to the Dalai Lama, as well as several Stanford psychologists, CCARE has developed a secular compassion training program known as the Compassion Cultivation Training Program. Preliminary research spearheaded by Stanford’s Philippe Goldin suggests that it is helpful in reducing ailments such as social anxiety and that it elevates different compassion measures. In addition to having taught hundreds of community members and Stanford students who have expressed interest, we have also developed a teacher-training program currently under way.

Given the importance of compassion in our world today, and a growing body of evidence about the benefits of compassion for health and well-being, this field is bound to generate more interest and hopefully impact our community at large. CCARE envisions a world in which, thanks to rigorous research studies on the benefits of compassion, the practice of compassion is understood to be as important for health as physical exercise and a healthful diet; empirically validated techniques for cultivating compassion are widely accessible; and the practice of compassion is taught and applied in schools, hospitals, prisons, the military, and other community settings.

Establishing A Compassion Center at Stanford University School of Medicine

The Center for Compassion and Altruism Research and Education (CCARE) at Stanford University School of Medicine was founded in 2008 with the explicit goal of promoting, supporting, and conducting rigorous scientific studies on compassion and altruistic behavior. In 2005, His Holiness the Dalai Lama spoke at Stanford University before 5,000 people. During his visit, he shared the stage with a number of prominent neuroscientists and psychologists in a dialogue about the brain and emotions. James Doty, clinical professor of neurosurgery at Stanford University, was so inspired by the event that he created an informal research group of scientists to pursue research on compassion. He called this group “Project Compassion.”

In 2008, following a meeting with the Dalai Lama during which an invitation was extended to again visit Stanford to speak on compassion, His Holiness made a spontaneous donation to CCARE — the largest he has ever given to a non-Tibetan cause. Following that visit and on the receipt of two other significant donations, “Project Compassion” was formally integrated into the Stanford Institute for Neuro-Innovation and Translational Neurosciences as “The Center for Compassion and Altruism Research and Education.”

Founded and directed by Doty, CCARE is established within the Stanford Institute for Neuro-Innovation and Translational Neurosciences. CCARE has collaborated with a number of prominent neuroscientists, behavioral scientists, geneticists, and biomedical researchers to closely examine the physiological and psychological correlates of compassion and altruism. The center has also developed a secular compassion education program with Thupten Jinpa, Buddhist scholar and personal translator to the Dalai Lama.

Doty has a longstanding interest in the fundamental motivations of individuals to do good. This interest stemmed out of personal experience. A neurosurgeon with a background that involved poverty, hopelessness, and neglect as the child of an invalid mother and alcoholic father, Doty is no stranger to suffering. Through a series of acts of compassion by and love from strangers, however, he found his life transformed.

Despite the emotional challenges and financial difficulties of his life as a child and young adult, Doty was able not only to attend college but to complete medical school, a long-standing dream, and to go on to become a successful neurosurgeon, entrepreneur, inventor, philanthropist, and father of three. Deeply inspired by the compassion he received as a child, Doty now devotes much of his time to promoting compassion in society through research, education, events, and writing.

“I have received the greatest gift in my life and that is seeing the power of compassion to result in transformation,” Doty says.

References and Further Reading:

Aknin, L. B., Hamlin, J., & Dunn, E. W. (2012). Giving leads to happiness in young children. PLOS ONE, 7.

Aknin, L. B., Barrington-Leigh, C. P., Dunn, E. W., Helliwell, J. F., Burns, J., Biswas-Diener, R., Kemeza, I., Nyende, P., Ashton-James, C. E., & Norton, M. I. (in press). Prosocial spending and well-being: Cross-cultural evidence for a psychological universal. Journal of Personality and Social Psychology.

Algoe, S. B., & Haidt, J. (2009). Witnessing excellence in action: The ‘other-praising’ emotions of elevation, gratitude, and admiration. The Journal of Positive Psychology, 4, 105–127.

Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497–529.

Brown, S. L., Nesse, R. M., Vinokur, A. D., & Smith, D. M. (2003). Providing social support may be more beneficial than receiving it: Results from a prospective study of mortality. Psychological Science, 14, 320–327.

Burton, N. (2011, May). Romance report: Most men and women believe in the enduring power of attraction. Retrieved from http://glo.msn.com/relationships/romance-report-1534241.story.

Cole, S. W., Hawkley, L. C., Arevalo, J. M., Sung, C. Y., Rose, R. M., & Cacioppo, J. T. (2007). Social regulation of gene expression in human leukocytes. Genome Biology, 8, R189.

Condon, P., Desbordes, G., Miller, W., & DeSteno, D. (in press). Meditation increases compassionate responses to suffering. Psychological Science.

Diener, E., & Seligman, M. E. P. (2004). Beyond money: Toward an economy of well-being. Psychological Science in the Public Interest, 5, 1–31.

Dunn, E. W., Aknin, L. B., & Norton, M. I. (2008). Spending money on others promotes happiness. Science, 319, 1687–1688.

Fowler, J. H., & Christakis, N. A. (2010). Cooperative behavior cascades in human social networks. Proceedings of The National Academy of Sciences of The United States of America, 107, 5334–5338.

Holt-Lunstad, J., Smith T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLOS Med 7, e1000316.

House, J. S., Landis, K. R., & Umberson, D. (2003). Social relationships and health. In P. Salovey, A. J. Rothman (Eds.), Social Psychology of Health (pp. 218–226). New York, NY, US: Psychology Press.

Konrath, S., Fuhrel-Forbis, A., Lou, A., & Brown, S. (2012). Motives for volunteering are associated with mortality risk in older adults. Health Psychology, 31, 87–96.

Lee, R. M., Draper, M., & Lee, S. (2001). Social connectedness, dysfunctional interpersonal behaviors, and psychological distress: Testing a mediator model. Journal of Counseling Psychology, 48, 310–318.

Leiberg, S., Klimecki, O., & Singer, T. (2011). Short-term compassion training increases prosocial behavior in a newly developed prosocial game. PLOS ONE, 6: e17798.

Lutz, A., Brefczynski-Lewis, J., Johnstone, T., Davidson, R. J. (2008). Regulation of the neural circuitry of emotion by compassion meditation: Effects of meditative expertise. PLOS ONE, 3: e1897.

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Observer Vol.26, No.5 May/June, 2013