Abstract
This chapter gives an overview of the current state of the neuroscientific basis of empathy and the experience of vicarious pain; that is, an explicit sensory experience of pain when observing another in pain. We summarise the central and autonomic mechanisms that are associated with vicarious pain experience from studies using electrophysiology, electroencephalography, transcranial magnetic stimulation and functional Magnetic Resonance Imaging. While this research has given us fantastic insight into the neural mechanisms giving rise to vicarious pain experience, the mechanisms are not well contextualised in relation to the daily lived experience. We discuss the importance of social roles and context in vicarious experiences to provide insight into the aspects of life in which vicarious sensations may arise. For instance, when a parent vicariously reacts to a painful injury in their own child, this may motivate protection and nurturing. Healthcare providers who embody the pain or emotions of their client may report that this enhances intuitive and/or compassionate care. However, distressing vicarious reactivity towards the suffering of others may also ultimately disrupt the capacity to deliver compassionate care and/or lead to burnout. While several qualitative studies have characterised the experience of secondary trauma, and to a lesser degree emotion contagion in clinicians, there has been a lack of qualitative and mixed methods research in this field. In an attempt to emphasise the significance of the social context in empathic and vicarious responses, we give an overview of lived experience of vicarious pain from the perspective of a clinician who describes her experiences both with family members and patients in pain. In concluding, we draw parallels between the phenomenological lived account of vicarious pain experience and neurophysiological mechanisms, and discuss the implications of vicarious reactivity for interpersonal relationships, especially within a clinical context. Ultimately for our understanding of both the mechanisms and consequences of vicarious pains sensations future research should take advantage of mixed methods designs to triangulate the neuroscientific mechanisms with the lived experience.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Appelhans BM, Luecken LJ (2006) Heart rate variability as an index of regulated emotional responding. Rev Gen Psychol 10(3):229–240
Avenanti A, Sirigu A, Aglioti SM (2010) Racial bias reduces empathic sensorimotor resonance with other-race pain. Curr Biol 20(11):1018–1022
Aydede M, Price D (2006) The experimental use of introspection in the scientific study of pain and its integration with third-person methodologies: the experiential-phenomenological approach. In: Aydede M (ed) Pain: new essays on its nature and the methodology of its study. MIT Press, Cambridge, pp 243–273
Azevedo RT, Macaluso E, Avenanti A, Santangelo V, Cazzato V, Aglioti SM (2012) Their pain is not our pain: Brain and autonomic correlates of empathic resonance with the pain of same and different race individuals. Hum Brain Mapp 34(12):3168–3181
Banissy MJ, Cohen Kadosh R, Maus GW, Walsh V, Ward J (2009) Prevalence, characteristics and a neurocognitive model of mirror-touch synaesthesia. Exp Brain Res 198(2–3):261–272
Bastian B, Jetten J, Ferris LJ (2014) Pain as social glue: shared pain increases cooperation. Psychol Sci 25(11):2079–2085
Bernhardt BC, Singer T (2012) The neural basis of empathy. Annu Rev Neurosci 35:1–23
Blakemore S-J, Bristow D, Bird G, Frith C, Ward J (2005) Somatosensory activations during the observation of touch and a case of vision-touch synaesthesia. Brain 128(7):1571–1583
Blatt B, LeLacheur SF, Galinsky AD, Simmens SJ, Greenberg L (2010) Does perspective-taking increase patient satisfaction in medical encounters? Acad Med 85(9):1445–1452
Bourke J (2014) The story of pain: from prayer to painkillers. Oxford University Press, New York
Bufalari I, Aprile T, Avenanti A, Di Russo F, Aglioti SM (2007) Empathy for pain and touch in the human somatosensory cortex. Cereb Cortex 17:2553–2561
Cheng Y, Lin CP, Liu HL, Hsu YY, Lim KE, Hung D, Decety J (2007) Expertise modulates the perception of pain in others. Curr Biol 17(19):1708–1713
Cheng Y, Yang C, Lin C, Lee P, Decety J (2008) The perception of pain in others suppresses somatosensory oscillations: a magnetoencephalography study. Neuroimage 40:1833–1840
Cheon BK, Im DM, Harada T, Kim JS, Mathur VA, Scimeca JM, Parrish TB, Park H, Chiao JY (2013) Cultural modulation of the neural correlates of emotional pain perception: the role of other-focusedness. Neuropsychologia 51(7):1177–1186
Cisler JM, Olatunji BO, Feldner MT, Forsyth JP (2010) Emotion regulation and the anxiety disorders: an integrative review. J Psychopathol Behav Assess 32(1):68–82
Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, Salazar WH (2001) “Let me see if I have this right…”: words that help build empathy. Ann Intern Med 135(3):221–227
Craig KD (1968) Physiological arousal as a function of imagined vicarious and direct stress experiences. J Abnorm Psychol 73(6):513–520
Cui F, Abdelgabar AR, Keysers C, Gazzola V (2015) Responsibility modulates pain-matrix activation elicited by the expressions of others in pain. Neuroimage 114:371–378
Davidov M, Zahn-Waxler C, Roth-Hanania R, Knafo A (2013) Concern for others in the first year of life: theory, evidence, and avenues for research. Child Dev Perspect 7(2):126–131
Daykin AR, Richardson D (2004) Physiotherapists’ pain beliefs and their influence on the management of patients with chronic low back pain. Spine 29(7):783–795
de Waal F (2010) The age of empathy: nature’s lessons for a kinder society. Broadway Books, New York
Decety J (2010) The neurodevelopment of empathy in humans. Dev Neurosci 32(4):257–267
Decety J, Chaminade T (2003) Neural correlates of feeling sympathy. Neuropsychologia 41(2):127–138
Decety J, Jackson PL (2006) A social-neuroscience perspective on empathy. Curr Dir Psychol Sci 15(2):54–58
Decety J, Meyer M (2008) From emotion resonance to empathic understanding: a social developmental neuroscience account. Dev Psychopathol 20(4):1053–1080
Decety J, Echols S, Correll J (2009) The blame game: the effect of responsibility and social stigma on empathy for pain. J Cogn Neurosci 22(5):985–997
Decety J, Smith K, Norman G, Halpern J (2014) A social neuroscience perspective on clinical empathy. World Psychiatry 13:233–237
Derbyshire SWG, Osborn J, Brown S (2013) Feeling the pain of others is associated with self-other confusion and prior pain experience. Front Hum Neurosci 7:Article 470
Duprat R, Desmyter S, Rudi DR, van Heeringen K, Van den Abbeele D, Tandt H, Bakic J, Pourtois G, Dedoncker J, Vervaet M, Van Autreve S, Lemmens GMD, Baeken C (2016) Accelerated intermittent theta burst stimulation treatment in medication-resistant major depression: a fast road to remission? J Affect Disord 200:6–14
Eley D, Eley R, Bertello M, Rogers-Clark C (2012) Why did I become a nurse? Personality traits and reasons for entering nursing. J Adv Nurs 68(7):1546–1555
Fan Y, Duncan NW, de Greck M, Northoff G (2011) Is there a core neural network in empathy? An fMRI based quantitative meta-analysis. Neurosci Biobehav Rev 35(3):903–911
Fitzgibbon BM, Enticott PG, Bradshaw JL, Giummarra MJ, Chou M, Georgiou-Karistianis N, Fitzgerald PB (2012a) Enhanced corticospinal response to observed pain in pain synesthetes. Cogn Affect Behav Neurosci 12(2):406–418
Fitzgibbon BM, Enticott PG, Giummarra MJ, Thomson RH, Georgiou-Karistianis N, Bradshaw JL (2012b) Atypical electrophysiological activity during pain observation in amputees who experience synaesthetic pain. Soc Cogn Affect Neurosci 7(3):357–368
Fitzgibbon BM, Enticott PG, Rich AN, Giummarra MJ, Georgiou-Karistianis N, Bradshaw JL (2012c) Mirror-sensory synaesthesia: exploring ‘shared’ sensory experiences as synaesthesia. Neurosci Biobehav Rev 36(1):645–657
Forsythe LP, Romano JM, Jensen MP, Thorn BE (2012) Attachment style is associated with perceived spouse responses and pain-related outcomes. Rehabil Psychol 57:290–300
Giummarra MJ, Fitzgibbon BM (2016) Vicarious experiences are associated with greater compassionate concern, but only via an indirect association with heightened anxious arousal traits (review)
Giummarra MJ, Fitzgibbon BM, Georgiou-Karistianis N, Beukelman M, Verdejo-Garcia A, Blumberg Z, Chou M, Gibson SJ (2015a) Affective, sensory and empathic sharing of others’ pain: the Empathy for pain scale. Eur J Pain 19: 807–816 doi: 10.1002/ejp.607
Giummarra MJ, Fitzgibbon BM, Tsao JW, Gibson S, Rich AN, Georgiou-Karistianis N, Chou M, Bradshaw JL, Alphonso AL, Tung ML, Drastal CA, Hanling S, Pasquina PF, Enticott PG (2015b) Symptoms of PTSD associated with painful and nonpainful vicarious reactivity following amputation. J Trauma Stress 28:1–9
Giummarra MJ, Poudel G, Pei-Tse AN, Nicholls MER, Fielding J, Verdejo-Garcia A, Labuschagne I (2016) Disinhibited left-lateralised neural mechanisms when processing threatening emotions in persons who respond vicariously towards others in pain (review)
Godinho F, Faillenot I, Perchet C, Frot M, Magnin M, Garcia-Larrea L (2012) How the pain of others enhances our pain: searching the cerebral correlates of ‘compassional hyperalgesia’. Eur J Pain 16(5):748–759
Halifax J (2011) The precious necessity of compassion. J Pain Symptom Manage 41(1):146–153
Halpern J (2010) From detached concern to empathy: humanizing medical practice. Oxford University Press, Oxford
Hein G, Silani G, Preuschoff K, Batson CD, Singer T (2010) Neural responses to ingroup and outgroup members’ suffering predict individual differences in costly helping. Neuron 68(1):149–160
Ho SS, Konrath S, Brown S, Swain JE (2014) Empathy and stress related neural responses in maternal decision making. Front Neurosci 8:152
Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS (2011) Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med 86(3):359–364
Huikuri HV, Stein PK (2013) Heart rate variability in risk stratification of cardiac patients. Prog Cardiovasc Dis 56(2):153–159
Jackson PL, Meltzoff AN, Decety J (2005) How do we perceive the pain of others? A window into the neural processes involved in empathy. Neuroimage 24:771–779
Kemp AH, Quintana DS, Felmingham KL, Matthews S, Jelinek HF (2012) Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk. PLoS One 7(2), Article id: e30777
Kim SS, Kaplowitz S, Johnston MV (2004) The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 27(3):237–251
Kim JW, Kim SE, Kim JJ, Jeong B, Park CH, Son AR, Song JE, Ki SW (2009) Compassionate attitude towards others’ suffering activates the mesolimbic neural system. Neuropsychologia 47(10):2073–2081
Lamm C, Decety J, Singer T (2011) Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. Neuroimage 54(3):2492–2502
Lang PJ, Bradley MM, Cuthbert BN (1997) Motivated attention: affect, activation and action. In: Lang PJ, Simons RF, Balaban M (eds) Attention and orienting: sensory and motivational processes, vol 1. Lawrence Erlbaum Associates, Mahwah, pp 97–136
Leiberg S, Eippert F, Veit R, Anders S (2012) Intentional social distance regulation alters affective responses towards victims of violence: an FMRI study. Hum Brain Mapp 33(10):2464–2476
Li Z, Yin M, Lyu XL, Zhang LL, Du XD, Hung GCL (2016) Delayed effect of repetitive transcranial magnetic stimulation (rTMS) on negative symptoms of schizophrenia: findings from a randomized controlled trial. Psychiatry Res 240:333–335
Maister L, Banissy MJ, Tsakiris M (2013) Mirror-touch synaesthesia changes representations of self-identity. Neuropsychologia 51(5):802–808
Marshall AA, Smith RC (1995) Physicians’ emotional reactions to patients: recognizing and managing countertransference. Am J Gastroenterol 90(1):4–8
McRae K, Gross JJ, Weber J, Robertson ER, Sokol-Hessner P, Ray RD, Gabrieli JDE, Ochsner KN (2012) The development of emotion regulation: an fMRI study of cognitive reappraisal in children, adolescents and young adults. Soc Cogn Affect Neurosci 7(1):11–22
Melzack R, Casey KL (1968) Sensory, motivational, and central control determinants of pain: a new conceptual model. In: Kenshalo D (ed) The skin senses. Springfield, Charles Thomas
Mercer SW, Reynolds WJ (2002) Empathy and quality of care. Br J Gen Pract 52(Suppl):S9–12
Molenberghs P (2013) The neuroscience of in-group bias. Neurosci Biobehav Rev 37:1530–1536
Mu Y, Fan Y, Mao L, Han S (2008) Event-related theta and alpha oscillations mediate empathy for pain. Brain Res 1234:128–136
Murray RJ, Debbane M, Fox PT, Bzdok D, Eickhoff SB (2015) Functional connectivity mapping of regions associated with self- and other-processing. Hum Brain Mapp 36(4):1304–1324
Nazarewicz J, Verdejo-Garcia A, Giummarra MJ (2015) Sympathetic pain? A role of poor parasympathetic nervous system engagement in vicarious pain states. Psychophysiology 52(11):1529–1537
Neumann M, Wirtz M, Bollschweiler E, Mercer SW, Warm M, Wolf J, Pfaff H (2007) Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach. Patient Educ Couns 69(1–3):63–75
Ochsner KN, Bunge SA, Gross JJ, Gabrieli JDE (2002) Rethinking feelings: an fMRI study of the cognitive regulation of emotion. J Cogn Neurosci 14(8):1215–1229
Osborn J, Derbyshire SWG (2010) Pain sensation evoked by observing injury in others. Pain 148(2):268–274
Preston SD, de Waal FBM (2002) Empathy: Its ultimate and proximate bases. Behav Brain Sci 25:1–72
Rajendra Acharya U, Paul Joseph K, Kannathal N, Lim CM, Suri JS (2006) Heart rate variability: a review. Med Biol Eng Comput 44(12):1031–1051
Rapinesi C, Del Casale A, Scatena P, Kotzalidis GD, Di Pietro S, Ferri VR, Bersani FS, Brugnoli R, Raccah RN, Zangen A, Ferracuti S, Orzi F, Girardi P, Sette G (2016) Add-on deep transcranial magnetic stimulation (dTMS) for the treatment of chronic migraine: a preliminary study. Neurosci Lett 623:7–12
Reniers RLEP, Corcoran R, Drake R, Shryane NM, Voellm BA (2011) The QCAE: a questionnaire of cognitive and affective empathy. J Pers Assess 93(1):84–95
Robins PM, Meltzer L, Zelikovsky N (2009) The experience of secondary traumatic stress upon care providers working within a children’s hospital. J Pediatr Nurs 24(4):270–279
Singer T, Seymour B, O’Doherty J, Kaube H, Dolan RJ, Frith C (2004) Empathy for pain involves the affective but not sensory components of pain. Science 303(5661):1157–1162
Squier RW (1990) A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. Soc Sci Med 30(3):325–339
Stephen L (1882) The science of ethics. Smith, Elder and Co, London
Taylor SE (2006) Tend and befriend: biobehavioral bases of affiliation under stress. Curr Dir Psychol Sci 15(6):273–277
Taylor SE, Cousino Klein L, Lewis BP, Gruenewald TL, Gurung RAR, Updegraff AJ (2000) Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychol Rev 107:411–429
Thayer JF, Ahs F, Fredrikson M, Sollers JJ III, Wager TD (2012) A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev 36(2):747–756
Tousignant-Laflamme Y, Rainville P, Marchand S (2005) Establishing a link between heart rate and pain in healthy subjects: a gender effect. J Pain 6(6):341–347
Tracy LM, Giummarra MJ (2016) Clinician empathy towards patients with pain (under prep.)
Vachon-Presseau E, Martel MO, Roy M, Caron E, Jackson PL, Rainville P (2011) The multilevel organization of vicarious pain responses: effects of pain cues and empathy traits on spinal nociception and acute pain. Pain 152(7):1525–1531
Van Diest I, Bradley MM, Guerra P, Van den Bergh O, Lang PJ (2009) Fear-conditioned respiration and its association to cardiac reactivity. Biol Psychol 80(2):212–217
Vandenbroucke S, Crombez G, Van Ryckeghem DM, Brass M, Van Damme S, Goubert L (2013) Vicarious pain while observing another in pain: an experimental approach. Front Hum Neurosci 7:265
Vandenbroucke S, Crombez G, Loeys T, Goubert L (2014) Observing another in pain facilitates vicarious experiences and modulates somatosensory experiences. Front Hum Neurosci 8:631
Vandenbroucke S, Crombez G, Loeys T, Goubert L (2015) Vicarious experiences and detection accuracy while observing pain and touch: the effect of perspective taking. Attent Percept Psychophys
von Baeyer CL (2014) Sensitization and catastrophizing: introspection confirmed experimentally. Pain Research Forum. Retrieved 12/06/2016, from http://painresearchforum.org/forums/discussion/37588-sensitization-and-catastrophizing-introspection-confirmed-experimentally
Wager TD, Atlas LY, Lindquist MA, Roy M, Woo CW, Kross E (2013) An fMRI-based neurologic signature of physical pain. N Engl J Med 368(15):1388–1397
Ward J, Banissy M (2015) Explaining mirror-touch synaesthesia. Cogn Neurosci 6(2–3):118–133
Williams F, Hasking P (2010) Emotion regulation, coping and alcohol use as moderators in the relationship between non-suicidal self-injury and psychological distress. Prev Sci 11(1):33–41
Williams A, O’Driscoll K, Moore C (2014) The influence of empathic concern on prosocial behavior in children. Front Psychol 5:425
Acknowledgments
MJG and BMF are supported by National Health and Medical Research Council (NHMRC) Early Career Fellowships (APP1036124; APP1070073).
Disclosures
The authors have no conflicts of interest to disclose. The qualitative insights and data reported in this chapter were collected from studies that had been approved by the university human research ethics committee, and all participants gave written informed consent.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing AG
About this chapter
Cite this chapter
Giummarra, M.J., Tracy, L.M., Young, K.A., Fitzgibbon, B.M. (2016). The Social Side of Pain: What Does it Mean to Feel Another’s Pain?. In: van Rysewyk, S. (eds) Meanings of Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-49022-9_21
Download citation
DOI: https://doi.org/10.1007/978-3-319-49022-9_21
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-49021-2
Online ISBN: 978-3-319-49022-9
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)