Dissecting the Roles of Medial Cingulate Cortex and Anterior Insula in Clinician Empathy

758 

Abstract Submission 

Maryam Amini¹, Nikta Khalilkhani², Theoni Varoudaki³, Morgan Gianola⁴, ELIZABETH LOSIN²

¹Penn State University, University Park - State College, PA, ²Penn State University, State College, PA, ³Penn State Univeristy, State College, PA, ⁴University of Miami, Coral Gables, FL

Maryam Amini  
Penn State University
University Park - State College, PA

Nikta Khalilkhani  
Penn State University
State College, PA

Theoni Varoudaki  
Penn State Univeristy
State College, PA

Morgan Gianola  
University of Miami
Coral Gables, FL

ELIZABETH LOSIN, Ph.D.  
Penn State University
State College, PA

Empathy is a complex construct with significant implications for clinical decision-making. Understanding its neural basis, particularly during pain evaluation and treatment, is crucial for improving clinical practice (Decety & Jackson, 2004). Although several brain areas have been suggested to play an important role in pain empathy, this conclusion has primarily been drawn from studies outside of a clinical context. Two of these brain areas are the anterior midcingulate cortex (aMCC), thought to be more involved in cognitive aspects of empathy, and the Anterior Insula (AI), which is believed to play a role in more reactive affect sharing (Gu et al. 2010; Timmers et al., 2018). Our study's examination of the role of these regions in a simulated clinical context aims to enhance understanding of their roles in clinical pain empathy and decision making. This approach may ultimately contribute to translating the broader findings of social neuroscience into practical clinical applications, enriching our comprehension of how empathy's neural dynamics operate in different contexts.

67 medical students (34 females) participated in a series of simulated pain management appointments while undergoing fMRI. The pain management task involved virtual appointments with 36 mock patients with diverse demographics. Each session began with a medical vignette describing the patient's injury, followed by a series of brief videos depicting pain behaviors in response to evoked pain stimulation, meant to simulate a clinical examination. Medical students, acting as clinicians, were then tasked with evaluating pain levels and rating how likely they would be to prescribe an analgesic.

For the present analysis we employed a multivariate method known as Stochastic Search Variable Selection (SSVS) (Bainter et al. 2020) to examine which subset of the 28 questions from a well-validated measure of empathy, the interpersonal reactivity intex (IRI) most effectively predicted neural activity in the AI and aMCC regions of interest (ROIs) while clinicians were observing the patient pain videos. The IRI is a measure of dispositional empathy with subscales representing personal distress, empathic concern, fantasy, and perspective taking (Davis, 1983). These ROIs were identified based on their established association with empathy for pain in a landmark meta-analysis conducted by Lamm et al. (2011).

We identified specific items within the IRI that were significant predictors of activity in the aMCC and the AI among clinicians observing patients in pain. We found that IRI question 8 from the Perspective Taking sub-scale, which assessed clinicians' ability to consider diverse perspectives during conflicts, emerged as a significant positive predictor of increased activity in the aMCC. In contrast, IRI question 27 from the Personal Distress Scale, which measures the intensity of emotional distress experienced when encountering someone in an emergency situation, was found to positively predict increased neural activity in both the aMCC and the AI.

Our findings are consistent with previous studies of empathy outside of clinical contexts in suggesting that the AI is generally associated with affective responses to pain whereas the aMCC is also involved in goal specific aspects of pain evaluation. Future analyses will test to what degree these regions are involved in patient pain assessment and treatment decisions. These insights may ultimately aid in developing more effective and context-sensitive pain management strategies, which have the potential to significantly improve patient outcomes.

Non-invasive Magnetic/TMS

Emotional Perception ¹

Social Interaction

Emotion and Motivation Other

Higher Cognitive Functions Other ²

Cognition

Cortex

Emotions

fMRI CONTRAST MECHANISMS

MRI