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Empathy and depression: The moral system on overdrive
Abstract
Introduction This chapter describes the intimate connection between empathy and depression, the epidemic of our modern world. While depression has been described as a ‘disorder of the self’, it may be more accurately characterized as a disorder of ‘concern for others’. People who are depressed most often have normal or elevated levels of empathy; however, their affect-directed, automatic causal interpretations of pain in others are often disturbed, leading to non-conscious assertions of blame, usually placed on themselves. Empathy, a socially organizing neural system, allows us to share others' feelings, to mimic without awareness, and forms the basis of our relationships and our social learning (Decety & Jackson, 2004). A sophisticated Theory of Mind (ToM), or the ability to know what others are thinking, is sometimes considered a prerequisite for true empathy. The capacity for empathy, present in infants from the first days of life, may be independent of cognitive maturity and a developed ToM. Healthy empathy, however, requires an understanding of causality, undeveloped in very young children and affectively distorted in depression. The empathic reaction in depressives often leads to great distress because they tend to unrealistically blame themselves for pain felt by others. Thus, in mood disorders, the empathy system may be functional; however, an overly active and automatic moral system, connected to the empathic experience, tends to misinterpret attribution, and the guilt felt at believing that you have caused pain in another leads to empathic distress, an exaggerated reaction. © Cambridge University Press 2007 and Cambridge University Press, 2009.
... To date, prior research suggested a contrary association, with reciprocal negative influences (e.g., Stotsky et al., 2020). A potential explanation for our counterintuitive finding is that higher levels of prosociality might be accompanied by excessive concerns for others (Hoffman, 2000), resulting in anxiety (Hay & Pawlby, 2003) and depression (O'Connor et al., 2007). On the other hand, anxious individuals might be more prone to employ proactive prosocial conduct to get around in their social situations (Culotta & Goldstein, 2008), and depressed individuals might act prosocially out of empathy-based guilt, which is also linked to altruism toward others (O'Connor et al., 2007). ...
... A potential explanation for our counterintuitive finding is that higher levels of prosociality might be accompanied by excessive concerns for others (Hoffman, 2000), resulting in anxiety (Hay & Pawlby, 2003) and depression (O'Connor et al., 2007). On the other hand, anxious individuals might be more prone to employ proactive prosocial conduct to get around in their social situations (Culotta & Goldstein, 2008), and depressed individuals might act prosocially out of empathy-based guilt, which is also linked to altruism toward others (O'Connor et al., 2007). This highlights how, from early to mid-to-late adolescence, prosociality contribution to adjustment is complex and prosocial individuals may not be exempt from mental health difficulties. ...
The present study investigated the longitudinal associations of self-control and parental involvement with prosociality and internalizing problems from early to mid-to-late adolescence, within a risk and resilience and a developmental cascade framework. We used a panel design (i.e., four measurement times at 2-year intervals from 2008 onwards) to examine data on 1523 Swiss adolescents when they were aged about 11, 13, 15, and 17. A cross-lagged analytical approach was used to respond to our purpose. Results showed that parental involvement promotes later levels of prosociality from early to mid-to-late adolescence. Furthermore, we observed that parental involvement predicted later improvements in self-control and that prosociality and internalizing problems mutually and positively predicted each other during the same period. Our findings suggest that interventions aimed at promoting positive parental involvement with their offspring may contribute to later adolescent prosociality and self-control and that health professionals should consider encouraging a healthy balance between self-interest and concern for others.
... Moreover, in a broader definition rumination describes a perseverative, highly selfreferential, pessimistic and abstract thinking style with little or no goal-and change-orientation (Teismann et al., 2012) and it is conceptualized as a form of repetitive negative thinking, such as worry (McEvoy et al., 2013). While the Response Styles Theory assumes that rumination is a common response to negative affect, recent theories assume the relevance of social emotions such as shame and guilt and the experience of stress (O'Connor et al., 2007) as more specific triggers of rumination. Supporting this hypothesis, rumination has been found to be associated with reduced emotional wellbeing, emotion dysregulation (Gross & John, 2003;Slavish & Graham-Engeland, 2015) and higher physiological stress parameters (Ottaviani et al., 2016). ...
... The psychotherapeutic training sessions followed a predefined script (see also Fig. 3) and were all executed by the same male psychotherapist in training (first author HL), who was supervised and in cases of illness represented by a senior CBT therapist (last author DR). The training started with a psychoeducative CBT session (50 min) on emotions, aberrant ER and how unresolved conflicts with personal goals, beliefs (schema) and needs in the long run can lead to rumination and depressive symptoms O'Connor et al., 2007). The MBERT psychoeducative rumination model was based on a cognitive behavioral stimulus-response model, incorporating personal schemata, that conceptualized rumination as a secondary cognitive reaction to an unresolved emotional conflict. ...
Repetitive negative thinking (RNT), including rumination, plays a key role in various psychopathologies. Although several psychotherapeutic treatments have been developed to reduce RNT, the neural correlates of those specific treatments and of psychotherapy in general are largely unknown. Functional near-infrared spectroscopy (fNIRS) offers the potential to investigate the neural correlates of psychotherapeutic techniques in situ. Therefore, in this study we investigated the efficacy and neural correlates of a fNIRS adapted Mindfulness-based Emotion Regulation Training (MBERT) for the treatment of depressive rumination in 42 subjects with major depressive disorder (MDD) in a cross-over designed randomized controlled trial. Using psychometric measures, subjective ratings and fNIRS, we analyzed in situ changes in depressive symptom severity, ruminative thoughts and cortical activity in the Cognitive Control Network (CCN). Our results show that MBERT is effective in treating depressive symptoms and rumination. On a neural level, we found consistently higher cortical activation during emotion regulation training compared to control trials in the bilateral inferior frontal gyrus (IFG) and dorsolateral prefrontal cortex (DLPFC). Furthermore, cortical oxygenation decreased from session to session in the bilateral DLPFC. The relevance of the results for the psychotherapeutic treatment of MDD as well as further necessary investigations are discussed.
... It was emphasized that in most cases people with depression show moderate or high levels of empathy. Depression, similar to other emotional states, has the characteristic of becoming contagious and impacting people's empathy (O'Connor et al., 2007). ...
The aim of thist study is to analyze the relationships between emotional self-regulation and the most prevalent psychological disorders at the moment, anxiety and depression. At the same time, we aim to investigate the moderating role of empathy in tjis relationship. The study was conducted on a sample of 145 participants aged between 20 and 46, M = 23.89, SD = 5.33. The instruments used were Emotion Regulation Questionnaire, Toronto Empathy Questionnaire, and Depression, Anxiety and Stress Scale (subscales for depression and anxiety). The results highlighted that ineffective emotional self-regulation is significantly and positevely associeted with anxiety. However, emotional ineffective self-regulation was not significantly associeted with depression. According to the results, empathy does not moderate the relationship between innefective emotional self-regulation and anxiety. The results of our study emphasise the necessity for giving a special attention to the factors involved in anxiety and depression, including emotional self-regulation and empathy.
... Fittingly, there is evidence that watching pain in others evokes responses in sensorimotor areas [82]. In MDD patients, empathy is associated with difficulties in distancing oneself from the pain experienced by others, making them feel responsible and guilty [83]. This view expands the found alterations by potential additional MDD-related deficits in socialemotional regulation. ...
Major depressive disorder (MDD) typically manifests itself in depressed affect, anhedonia, low energy, and additional symptoms. Despite its high global prevalence, its pathophysiology still gives rise to questions. Current research places alterations in functional connectivity among MDD’s most promising biomarkers. However, given the heterogeneity of previous findings, the use of higher-resolution imaging techniques, like ultra-high field (UHF) fMRI (≥7 Tesla, 7T), may offer greater specificity in delineating fundamental impairments. In this study, 7T UHF fMRI scans were conducted on 31 MDD patients and 27 age-gender matched healthy controls to exploratorily contrast cerebral resting-state functional connectivity patterns between both groups. The CONN toolbox was used to generate functional network connectivity (FNC) analysis based on the region of interest (ROI)-to-ROI correlations in order to enable the identification of clusters of significantly different connections. Correction for multiple comparisons was implemented at the cluster level using a false discovery rate (FDR). The analysis revealed three significant clusters differentiating MDD patients and healthy controls. In Clusters 1 and 2, MDD patients exhibited between-network hypoconnectivity in basal ganglia-cortical pathways as well as hyperconnectivity in thalamo-cortical pathways, including several individual ROI-to-ROI connections. In Cluster 3, they showed increased occipital interhemispheric within-network connectivity. These findings suggest that alterations in basal ganglia-thalamo-cortical circuits play a substantial role in the pathophysiology of MDD. Furthermore, they indicate potential MDD-related deficits relating to a combination of perception (vision, audition, and somatosensation) as well as more complex functions, especially social-emotional processing, modulation, and regulation. It is anticipated that these findings might further inform more accurate clinical procedures for addressing MDD.
... Heightened empathy was also connected to hypervigilant monitoring observed in other studies for women carers and discussed as a strategy to maintain control in unfamiliar situations (Green & King, 2009). It can be argued that this hypervigilant monitoring is associated with a form of intensive mothering driven by internalized prejudices and the "good mother" stereotype consisting of unreflected guilt and maladaptive reparation efforts that alleviate distress and depression symptoms (Liss et al., 2013;O'Connor et al., 2007). Men caregivers also experienced guilt characterized by emotional ambivalence, absence of self-disclosure, loneliness, and alienation (Bruno et al., 2009). ...
Purpose/Objective: To explore how spousal caregivers of older people undergoing rehabilitation experience gender within the Greek community. Research Method/Design: A psychological phenomenological design and analysis were used to illuminate the unique meanings 11 spousal caregivers attribute to their experience of gender by gathering qualitative data via interviews. Results: The data provided an insight into the structure of the experience of gender for the spousal caregivers as a normative diachronic identity in a succession of phases: normative constitution, alienation, and reparation. Conclusions/Implications: The findings highlight the influence of gender stereotypes on spousal caregivers’ self-concept, agency, caregiving evaluations, and practices, emphasizing the importance of adopting an intersectional perspective in future research and interventions, considering various factors such as ethnicity, gender, sexuality, age, power dynamics, and cultural norms. Spousal caregivers experience alienation on entering the caregiving journey, with gender-related vulnerabilities affecting their psychological well-being. Addressing these vulnerabilities can improve caregivers’ mental health and foster effective coping strategies. The study emphasizes the moral aspect of caregiving, highlighting the relationship between a sense of obligation, feelings of guilt, gender norms, and motivations calling for challenging self-sacrificial morals and societal norms associated with them to empower caregivers to prioritize their well-being while maintaining their caregiving motivations. This shift in perspective can lead to a more positive and fulfilling caregiving experience.
... Multiple dimensions of anxiety also adversely impact affective and/or cognitive empathy [86,87]. Depression has been positively associated with affective empathy but negatively associated with cognitive empathy, with moderations by self-esteem, feeling in control of one's life, education, guilt, and executive function [88][89][90][91][92][93]. More broadly, internalizing behaviors have been associated with increased empathy and lower CU traits, and externalizing behaviors with reduced empathy and higher CU traits [39,94,95]. ...
Empathy is at the core of our social world, yet multidomain factors that affect its development in socially sensitive periods, such as adolescence, are incompletely understood. To address this gap, this study investigated associations between social, environmental and mental health factors, and their temporal changes, on adolescent empathetic behaviors/emotions and, for comparison, callous unemotional (CU) traits and behaviors, in the early longitudinal Adolescent Brain Cognitive Development sample (baseline: n = 11062; 2-year follow-up: n = 9832, median age = 119 and 144 months, respectively). Caregiver affection towards the youth, liking school, having a close friend, and importance of religious beliefs/spirituality in the youth’s life were consistently positively correlated with empathetic behaviors/emotions across assessments (p<0.001, Cohen’s f = ~0.10). Positive family dynamics and cohesion, living in a neighborhood that shared the family’s values, but also parent history of substance use and (aggregated) internalizing problems were additionally positively associated with one or more empathetic behaviors at follow-up (p<0.001, f = ~0.10). In contrast, externalizing problems, anxiety, depression, fear of social situations, and being withdrawn were negatively associated with empathetic behaviors and positively associated with CU traits and behaviors (p<0.001, f = ~0.1–0.44). The latter were also correlated with being cyberbullied and/or discriminated against, anhedonia, and impulsivity, and their interactions with externalizing and internalizing issues. Significant positive temporal correlations of behaviors at the two assessments indicated positive (early) developmental empathetic behavior trajectories, and negative CU traits’ trajectories. Negative changes in mental health adversely moderated positive trajectories and facilitated negative ones. These findings highlight that adolescent empathetic behaviors/emotions are positively related to multidomain protective social environmental factors, but simultaneously adversely associated with risk factors in the same domains, as well as bully victimization, discrimination, and mental health problems. Risk factors instead facilitate the development of CU traits and behaviors.
... PARENTAL GUILT AND CHILDREN'S BEHAVIOR 7 (e.g., feeling overresponsible for a depressed mother) is enmeshed with guilt and anxiety from early development and, together with biological factors, can make individuals more susceptible to depression (O'Connor et al., 2007;Zahn-Waxler & Van Hulle, 2012). Surprisingly, while reparation is typically regarded as the adaptive function of guilt (Tilghman-Osborne et al., 2010), it was associated with greater parents' depressive symptoms. ...
The immense responsibility inherent in parenthood makes feeling guilty highly prevalent among parents. Such feelings are natural, yet excessive guilt is related to depression and anxiety and could burden parents. Qualitative research suggested that guilt is predominant in parents whose children suffer from behavioral and emotional difficulties, making it necessary to quantify guilt and examine possible resilience factors that could alleviate the aversive aspects of it. In this study, we examined the association between children’s externalizing and internalizing problems and different aspects of parental guilt, assessing whether parental reflective functioning (PRF) would moderate these associations. One hundred six parents of children aged 1.30–9.30 years were recruited from child daycare centers and community clinics. The Parent Development Interview was administered to measure PRF. Based on this interview, we created a new coding system, to quantify three aspects of parental guilt: intensity, reparation, and internal reaction to guilt. Children’s difficulties as well as parents’ depression and anxiety were assessed using validated self-report measures. We showed that children’s difficulties were related to parental guilt, but only when levels of PRF were not high. Specifically, internalizing problems were related to greater intensity and negative internal reaction to guilt only when PRF was low or moderate, and externalizing problems were related to greater intensity of guilt only when PRF levels were low. These findings suggest that encouraging reflective functioning could reduce the burden of guilt.
Major Depressive Disorder (MDD) is frequently associated with social dysfunction and impaired decision-making,
but its impact on social decisions remains unclear. Thus, we conducted a series of meta-analyses to examine the
effects of MDD on key social decision phenomena, including trust, altruistic punishment, and cooperation. We
searched Web of Science, PubMed, PsycINFO, and Embase up to December 2023, using Hedges’ g to compare
social decision-making between MDD patients and healthy controls (HCs). Meta-analytic results showed that
MDD patients exhibited a significant reduction in trust (Hedges’ g = − 0.347, p < 0.001), no significant difference
in altruistic punishment (Hedges’ g = 0.232, p = 0.149), and an increase in cooperative behaviors (Hedges’ g =
0.361, p = 0.002) compared to HCs. The moderation analysis revealed that age (p = 0.039) and region (p =
0.007) significantly moderated altruistic punishment, with older MDD patients and those from Asian and European regions having larger MDD-HC contrast than others. Regarding cooperation, moderation analysis indicated that age (p = 0.028), years of education (p = 0.054), and treatment coverage (p = 0.042) were significant
moderators, indicating larger MDD-HC contrast in older, less-educated and better-treated people. These findings
suggest MDD has different impacts on different social decisions, highlighting the need for fine-tuned therapeutic
interventions that address these differences. The data also underscores the importance of considering demographic and treatment-related variables in managing MDD, which could inform personalized treatment
strategies and improve social functionality and patient outcomes.
Male life history strategies are regulated by the neuroendocrine system. Testosterone (T) and cortisol regulate male behaviors including parenting and facilitate managing tradeoffs at key transitions in development such as first-time fatherhood. Both hormones demonstrate marked fluctuations in the postnatal period, and this presents an opportunity to investigate the role of T and cortisol in postpartum depressive symptoms—comparably less studied in fathers than in mothers in the evolutionary literature. Prior work on depressive symptoms has yet to integrate insights from the “dual hormone hypothesis (DHH)” which has focused on how T and cortisol interact to jointly regulate traits associated with dominance and status-seeking (i.e., mating effort) but has yet to be included in models of parenting effort. In this research, we use secondary data to investigate the relationship between DHH and traits ostensibly opposed to status seeking (i.e., depressive symptoms). First-time fathers (n = 193) provided morning saliva samples 10 months following parturition and reported on the presence of depressive symptoms (BDI-II). Responses were decomposed into three factors: cognitive, affective, and somatic. Using hybrid latent variable structural equation modeling, we did not find evidence that T predicted variability in cognitive, affective, or somatic depressive symptom factors. We found a null effect for cortisol as well. Finally, we could not find evidence that the DHH variable (T × cortisol interaction) predicted any variability in cognitive, affective, or somatic depressive symptoms. While we did not find evidence to support our hypotheses using a secondary data set, this study contributes to research on the neuroendocrinology of depression in fathers. Discussion focuses on the limitations of sample demographics, timing of saliva and self-report collection, and the lack of extant theory specific to paternal postpartum depression.
Previous regional cerebral blood flow (rCBF) studies on patients with unipolar major depressive disorder (MDD) have analysed clusters of voxels or single regions and yielded conflicting results, showing either higher or lower rCBF in MDD as compared to normal controls (CTR). The aim of this study was to assess rCBF distribution changes in 68 MDD patients, investigating the data set with both volume of interest (VOI) analysis and principal component analysis (PCA). The rCBF distribution in 68 MDD and 66 CTR, at rest, was compared. Technetium-99m d, l-hexamethylpropylene amine oxime single-photon emission tomography was performed and the uptake in 27 VOIs, bilaterally, was assessed using a standardising brain atlas. Data were then grouped into factors by means of PCA performed on rCBF of all 134 subjects and based on all 54 VOIs. VOI analysis showed a significant group x VOI x hemisphere interaction ( P<0.001). rCBF in eight VOIs (in the prefrontal, temporal, occipital and central structures) differed significantly between groups at the P<0.05 level. PCA identified 11 anatomo-functional regions that interacted with groups ( P<0.001). As compared to CTR, MDD rCBF was relatively higher in right associative temporo-parietal-occipital cortex ( P<0.01) and bilaterally in prefrontal ( P<0.005) and frontal cortex ( P<0.025), anterior temporal cortex and central structures ( P<0.05 and P<0.001 respectively). Higher rCBF in a selected group of MDD as compared to CTR at rest was found using PCA in five clusters of regions sharing close anatomical and functional relationships. At the single VOI level, all eight regions showing group differences were included in such clusters. PCA is a data-driven method for recasting VOIs to be used for group evaluation and comparison. The appearance of significant differences absent at the VOI level emphasises the value of analysing the relationships among brain regions for the investigation of psychiatric disease.
Is self-reported empathy associated with depressive symptoms? Drawing on stress process theory and social psychological research on empathy, we hypothesize that empathy is more strongly associated with depressive symptoms when personal and social resources are deficient. Using data from a 1985-1986 community sample of adults in southwestern Ontario, we examine the impact of empathy on depressive symptoms and the potential moderating effects of mastery, self-esteem, social support, and education. Results show that the relationship between empathy and depressive symptoms is more strongly positive among individuals who report less education, lower self-esteem, and lower mastery. We discuss implications of these findings.
The purpose of this study was to examine differences in empathy between offender and nonoffender youth. Seventy-six male and 33 female juvenile offenders between the ages of 12 and 18 years and 33 male and 33 female nonoffenders between the ages of 15 and 19 years comprised the samples for this study. Measures of empathy, altruism, and social support were administered to all participants and then the participants were analyzed for status group differences. Only 1 dimension of empathy, emotional tone, was found to be significantly different based on group status. Gender differences were found for both status groups for another dimension of empathy, personal distress. Among offender and nonoffender youth, females yielded higher scores in personal distress than did males. Emotional tone and family structure were found to be the most predictive variables of offender status. Findings were discussed based on previous research and implications for interventions were addressed.
Although millions of Americans take psychoactive medicines (e.g. Prozac and Ritalin), few social scientists believe biological theories and findings should be integrated with research on human behavior. Four topics illustrate current studies linking politics and the life sciences: (a) Developments in genetics and medicine indicate that governmental policies have greatly underrated the dangers posed by radiation and the social transformations that will result from DNA sequencing, (b) Research on brain structures and neurochemistry shows how toxic chemicals undermine normal emotions and behavior. Heavy metal burdens are higher in violent criminals, and exposure to these toxins is significantly correlated with rates of violence (controlling for socioeconomic, ethnic, and demographic factors), (c) An untested chemical used to treat water supplied to 140 million Americans significantly increases both odds of dangerous lead uptake and behavioral dysfunctions in children and adults, (d) The complexity of gene-environment interactions challenges accepted theories of gender, sociopolitical inequalities, ethnocentrism, and history. Such research in biopolitics can illuminate policy controversies in education, substance abuse, and crime.
This study examined the strategies adolescents use to cope with their mothers' depressive symptoms and/or episodes. An open-ended semistructured interview and a closed-ended coping scale, the Maternal Affectivity Coping Scale derived from the Self-Report Coping Scale (D. L. Causey and E. F. Dubow [1992] Development of a Self-Report Measure for Elementary School Children, Journal of Clinical Child Psychology, Vol. 21, pp. 47–59), was administered to pairs of adolescent siblings (N = 179) from families (N = 94) in which the mother was either depressed or well. With a few important exceptions, the results reveal similar coping styles in the offspring of depressed and well mothers. One difference was that mothers' current psychological distress was weakly related to young adolescents' coping patterns (e.g., problem solving, externalizing). Also, adolescents' coping styles (e.g., provide support) were related to the type of depressive symptoms the mother exhibited (e.g., anger, irritability). Second, greater sibling differences were found for emotion-focused coping strategies (e.g., distancing) in children of depressed mothers than in children of well mothers. Third, the results suggest that the sex of the adolescent may be important in attempting to understand individual differences in coping. Females were more likely than males to engage in interpersonally focused coping strategies (e.g., provide support to their mother, seek support from others). The feelings of responsibility for contributing to their mother's depression that were more evident in females than males may offer some insight into gender differences and may also have implications for placing females at higher risk for internalizing disorders.
Utilizing a behavioral-biological perspective, this article examines the functions, causes, and costs of ostracism in nonhuman primates. Among nonhuman primates, ostracism may serve many functions other than promoting the cohesiveness of the group from which an individual is excluded. These functions include range extension, population regulation, outbreeding, and the diffusion of learned traditions. A variety of behavioral and biological processes contribute to the genesis and expression of ostracism. Behaviorally, female choice and the ability to form effective alliances seem to be critical for an adult male monkey to avoid being ostracized. Biologically, the integrity of the frontal lobes and adequate functioning of serotonergic neurotransmitter systems are essential to escape forced exile from the group. There is evidence that indicates that ostracism exacts a substancial physiological cost, including altered immune function, decrements in information processing, and changes in the metabolism of drugs. Moreover, recent studies suggest that several biological indices, including low concentrations of whole blood serotonin, may be markers that can be used to identify individual at risk for ostracism.