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fpsyg-09-00229 February 26, 2018 Time: 16:47 # 1
ORIGINAL RESEARCH
published: 27 February 2018
doi: 10.3389/fpsyg.2018.00229
Edited by:
Katharina Sophia Goerlich,
RWTH Aachen University, Germany
Reviewed by:
Volker Max Perlitz,
Simplana GmbH, Germany
Georgia Panayiotou,
University of Cyprus, Cyprus
*Correspondence:
Alexander Lischke
alexander.lischke@uni-greifswald.de
Matthias Weippert
matthias.weippert@uni-rostock.de
Specialty section:
This article was submitted to
Clinical and Health Psychology,
a section of the journal
Frontiers in Psychology
Received: 26 October 2017
Accepted: 12 February 2018
Published: 27 February 2018
Citation:
Lischke A, Pahnke R,
Mau-Moeller A, Behrens M,
Grabe HJ, Freyberger HJ, Hamm AO
and Weippert M (2018)
Inter-individual Differences in Heart
Rate Variability Are Associated with
Inter-individual Differences in Empathy
and Alexithymia.
Front. Psychol. 9:229.
doi: 10.3389/fpsyg.2018.00229
Inter-individual Differences in Heart
Rate Variability Are Associated with
Inter-individual Differences in
Empathy and Alexithymia
Alexander Lischke1*, Rike Pahnke2, Anett Mau-Moeller3, Martin Behrens2,
Hans J. Grabe4, Harald J. Freyberger4,5 , Alfons O. Hamm1and Matthias Weippert2*
1Department of Psychology, University of Greifswald, Greifswald, Germany, 2Institute of Sport Science, University of
Rostock, Rostock, Germany, 3Department of Orthopaedics, University Medicine Rostock, Rostock, Germany, 4Department
of Psychiatry and Psychotherapy, University of Greifswald, Greifswald, Germany, 5HELIOS Klinikum Stralsund, Stralsund,
Germany
In the present study, we investigated whether inter-individual differences in vagally
mediated heart rate variability (vmHRV) would be associated with inter-individual
differences in empathy and alexithymia. To this end, we determined resting state
HF-HRV in 90 individuals that also completed questionnaires assessing inter-individual
differences in empathy and alexithymia. Our categorical and dimensional analyses
revealed that inter-individual differences in HF-HRV were differently associated with
inter-individual differences in empathy and alexithymia. We found that individuals with
high HF-HRV reported more empathy and less alexithymia than individuals with low
HF-HRV. Moreover, we even found that an increase in HF-HRV was associated with
an increase in empathy and a decrease in alexithymia across all participants. Taken
together, these findings indicate that individuals with high HF-HRV are more empathetic
and less alexithymic than individuals with low HF-HRV. These differences in empathy
and alexithymia may explain why individuals with high HF-HRV are more successful in
sharing and understanding the mental and emotional states of others than individuals
with low HF-HRV.
Keywords: social cognition, social interaction, empathy, alexithymia, vagus nerve, high-frequency heart rate
variability
INTRODUCTION
Social relationships have always been of utmost importance for humans. Although the number
and type of relationships may have changed over the course of evolution, the challenges and
opportunities associated with social relationships may have remained the same (Dunbar, 1998).
Evolutionary pressures may, thus, have selected a suite of skills that may have helped us to initiate
or maintain positive relationships and to avoid or terminate negative relationships (De Waal, 2008).
Of these skills, the ability to share and understand others’ emotional and mental states, which
entails a simulation of these states while making a self-other distinction, appears to be of particular
relevance (Preston and De Waal, 2002). Infants are already capable of sharing others’ emotional and
mental states, but a full understanding of these states on basis of a self-other distinction emerges
during late childhood (Frith and Frith, 2003), implying that the ability to share and understand
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Lischke et al. HRV Is Associated with Empathy and Alexithymia
emotional and mental states comprise various processes that
become more and more complex throughout our development. It
is important to note that these processes involve a simulation of
others’ emotional and mental states on the neural and autonomic
level, an interpretation of the simulated states on basis of the
corresponding neural and autonomic changes, and a distinction
between the simulated and observed states (Preston and De Waal,
2002;De Waal, 2008). These processes have been linked to inter-
individual differences in empathy, a personality trait describing
an individual’s awareness of other’s emotional and mental states
(Deutsch and Madle, 1975), and alexithymia, a personality trait
describing an individual’s awareness of one’s own emotional and
mental states (Nemiah et al., 1976). Individuals with low levels of
empathy and/or high levels of alexithymia are severely impaired
in their ability to share and understand emotional and mental
states of others and the self (e.g., Baron-Cohen et al., 1999;
Parker et al., 2001;Dolan and Fullam, 2004;Moriguchi et al.,
2007;Silani et al., 2008;Decety et al., 2013), which may explain
why these individuals frequently have difficulties to establish and
maintain positive relationships (e.g., Rilling et al., 2007;Chiu
et al., 2008;Mokros et al., 2008;Feldmanhall et al., 2013). It is,
thus, not surprising that the interest for biomarkers indicating
such impairments has steadily been growing over the last decade.
It should be noted, however, that the search for these biomarkers
is more complex than initially thought (Kapur et al., 2012;Davis
et al., 2015).
Vagally mediated heart rate variability (vmHRV), an index
of parasympathetically induced changes in consecutive heart
beats (Berntson et al., 1997), has been suggested to be a
promising biomarker for inter-individual differences in social
behavior and social cognition (Porges, 2007;Thayer and Lane,
2009). Inter-individual differences in vmHRV reflect inter-
individual differences regarding the engagement of prefrontal
and (para-)limbic brain regions during the regulation of
emotional and cognitive processes (Porges, 2007;Thayer and
Lane, 2009;Thayer et al., 2012), indicating that inter-individual
differences in vmHRV may work as biomarker for inter-
individual differences in the social domain. Individuals with
high vmHRV are more efficient in establishing and maintaining
positive relationships than individuals with low vmHRV (e.g.,
Kogan et al., 2014;Beffara et al., 2016;Lischke et al.,
2018), implying that the relationships of individuals with high
vmHRV are more characterized by mutual understanding than
the relationships of individuals with low vmHRV (Kok and
Fredrickson, 2010). Inter-individual differences regarding the
ability to share and understand emotional and mental states
may explain why individuals with high vmHRV are more likely
to achieve a mutual understanding in social relationships than
individuals with low vmHRV. Individuals with high vmHRV
may be more efficient in regulating emotional and cognitive
processes during the simulation of the respective states (e.g.,
Geisler et al., 2010, 2013;Williams et al., 2015) and may be more
efficient in regulating cognitive processes that are necessary for
the interpretation of the respective states (e.g., Hansen et al., 2003;
Segerstrom and Nes, 2007;Luft et al., 2009) than individuals with
low vmHRV, which may result in a more efficient sharing and
understanding of the respective states in individuals with high
as compared to low vmHRV (e.g., Cote et al., 2011;Quintana
et al., 2012a;Lischke et al., 2017). However, individuals with
high and low vmHRV do not only differ from one another
with respect to processes that are relevant for the sharing and
understanding of emotional and mental states, but also with
respect to personality traits that are relevant for the sharing
and understanding of these states. Empathy related personality
traits, like, for example, compassion for other’s emotional and
mental states, are more pronounced in individuals with high
than low vmHRV (e.g., Oveis et al., 2009;Kogan et al., 2014;
Stellar et al., 2015), whereas alexithymia related personality
traits, like, for example, difficulties in identifying or describing
one’s own emotional and mental states, appear to be more
pronounced in individuals with low than high vmHRV (e.g.,
Fukunishi et al., 1999;Panayiotou and Constantinou, 2017). It
should be noted, however, that the association between inter-
individualdifferences in vmHRV and inter-individual differences
in alexithymia related personality traits is less clear than the
association between inter-individual differences in vmHRV and
inter-individual differences in empathy related personality traits
(e.g., Virtanen et al., 2003;Zohar et al., 2013), indicating a
need for further studies investigating this association. Similarly,
there is a need to further study the association between inter-
individual differences in vmHRV and inter-individual differences
in empathy related personality traits because this association has
only been investigated in a few studies (e.g., Oveis et al., 2009;
Kogan et al., 2014;Stellar et al., 2015).
In the present study, we addressed these issues in a relatively
large and homogenous sample of healthy participants by
measuring inter-individual differences in vmHRV as well as
inter-individual differences in empathy and alexithymia related
personality traits. On basis of previous studies (e.g., Fukunishi
et al., 1999;Oveis et al., 2009;Kogan et al., 2014;Stellar
et al., 2015;Panayiotou and Constantinou, 2017), we expected
participants with high vmHRV to report more empathy and
less alexithymia than participants with low vmHRV. We also
expected inter-individual differences in vmHRV to be differently
associated with inter-individual differences in empathy and
alexithymia across all participants.
MATERIALS AND METHODS
Participants
According to an a priori power analysis with G∗Power3 (Faul
et al., 2007), we had to recruit 90 participants to be able to detect
medium effect sizes in our categorical (f= 0.30, 1-β= 80, α= 0.05)
and dimensional (f2= 0.15, 1-β= 80, α= 0.05) analyses regarding
the association between inter-individual differences in vmHRV
and inter-individual differences in empathy or alexithymia. In
order to be considered for recruitment, participants had to
pass a screening concerning the presence of current mental
disorders and the use of current psychotropic medication. Female
participants were not considered for recruitment to control sex-
differences in empathy (Christov-Moore et al., 2014), alexithymia
(Levant et al., 2009) and vmHRV (Koenig and Thayer, 2016).
We, thus, recruited 90 male participants at the Institute of Sport
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Lischke et al. HRV Is Associated with Empathy and Alexithymia
TABLE 1 | Participant characteristics.
M SEM
Age (years) 26.20 0.43
Body mass index (kg/m2) 24.05 0.27
Physical activity (h/w) 7.05 3.70
Respiratory activity
(Log-pHF-HRV, Hz)
−0.72 0.01
Heart rate variability
(Log HF-HRV, ms2)
2.69 0.05
Empathy (EQ-15)a16.42 0.01
Alexithymia (TAS-20)b44.13 1.15
Log-pHF-HRV = log-transformed peak of high frequency heart rate variability,
Log-HF-HRV = log-transformed high frequency heart rate variability,
EQ-15 = Empathy Quotient 15 (Allison et al., 2011), TAS-20 = Toronto
Alexithymia Scale 20 (Bagby et al., 1994a,b).
aData was available for 79 participants.
bData was available for 89 participants.
Science of the University of Rostock (see Table 1). All participants
provided written-informed consent to the study protocol that was
approved by the ethics committee of the University of Rostock
and carried out in accordance with the Declaration of Helsinki.
Procedure
After arriving at the laboratory, participants were asked to
use the bathroom to control for the effects of bladder filling
and gastric distension on vmHRV (Quintana and Heathers,
2014). Participants were then seated in a comfortable chair
and prepared for a 5 min heart rate (HR) recording. As
recently recommended (Quintana et al., 2016), participants were
instructed to breathe spontaneously and to keep their eyes open
during the recording. After the recording, participants completed
questionnaires assessing inter-individual differences in empathy
(Allison et al., 2011) and alexithymia (Bagby et al., 1994a,b).
Heart Rate Variability
HR was recorded continuously with a chest belt system, the
RS800 HR monitor (Polar Electro Oy, Kempele, Finland),
providing a sampling rate of 1000 Hz. HR monitors like the
RS800 have been shown to record changes in consecutive heart
beats as accurate as conventional electrocardiograms (Weippert
et al., 2010;Quintana et al., 2012b), indicating that the recorded
data were valid and reliable measures of instantaneous HR.
Device specific software (Polar ProTrainer 5; Polar Electro
Oy, Kempele, Finland) was used to transfer the recorded data
to a computer for further data processing with Kubios HRV
2.2 (Tarvainen et al., 2014). Following established guidelines
(Task Force of the European Society of Cardiology, 1996),
the recorded data was visually inspected, detrended (smoothn
priors: λ= 500) and, whenever necessary, corrected using
adaptive filtering. Thereafter, the recorded data was subjected to
a spectral analysis to determine HF-HRV, a measure of vagally
mediated cardiac activity (Berntson et al., 1997), and the peak of
HF-HRV (pHF-HRV), a measure of respiratory activity (Berntson
et al., 1997). Besides these measures, no further measures were
determined to avoid interpretational issues arising from the use
of measures that do not clearly reflect vagally mediated cardiac
activity (Berntson et al., 1997).
Questionnaires
The Empathy Quotient (EQ-15; Allison et al., 2011) is a 15
item self-report questionnaire for the assessment of empathy.
The EQ-15 comprises a main scale for the assessment of
global empathy and several subscales for the assessment of
specific aspects of empathy (e.g., emotional reactivity or social
skills). However, the subscales are highly inter-correlated with
one another (Muncer and Ling, 2006;Allison et al., 2011),
implying that the EQ-15 measures empathy as an unidimensional
rather than multidimensional construct. Following previous
recommendations (Muncer and Ling, 2006;Allison et al., 2011),
we only considered the main scale in our analyses. The main
scale had good psychometric properties [α= 0.75], which were
comparable to those that have previously been reported (Muncer
and Ling, 2006;Allison et al., 2011)
The Toronto Alexithymia Scale 20 (TAS-20; Bagby et al.,
1994a,b) is a 20 item self-report questionnaire for the assessment
of alexithymia. The TAS-20 consists of a main scale assessing
global differences in alexithymia and of several subscales
assessing specific differences in alexithymia (e.g., difficulties in
identifying or describing feelings). However, the high correlations
between the different subscales and the low reliabilities of some
subscales complicate the interpretation of the respective subscales
(Kooiman et al., 2002;Muller et al., 2003). Accordingly, it has
been suggested that the TAS-20 may be better suited to measure
alexithymia as an unidimensional rather than multidimensional
construct (Vorst and Bermond, 2001). We, therefore, considered
the main scale but not the subscales in our analyses. The
main scale had excellent psychometric properties [α= 0.86],
which were similar to those that have previously been reported
(Bagby et al., 1994a,b).
Statistical Analysis
All statistical analyses were conducted with SPSS 22 (SPSS
Inc., Chicago, IL, United States). To investigate whether
inter-individual differences in vmHRV would be associated
with inter-individual differences in empathy and alexithymia,
dimensional and categorical analyses were performed. In all
analyses, pre-cautions were taken to control for inter-individual
differences in age (years), body mass index (BMI, kg/m2),
physical activity (h/w) and respiratory activity (pHF-HRV, Hz)
that may contribute to inter-individual differences in vmHRV
(Quintana et al., 2016). Inter-individual differences in physical
and respiratory activity were of particular concern because
participants were recruited at a Sport Science facility, where the
prevalence of athletes that differ from non-athletes in vmHRV
due to inter-individual differences in physical and respiratory
activity is higher than in the general population (Aubert et al.,
2003). For the categorical analyses, analyses of covariance
(ANCOVAs) were computed to determine whether participants
with high and low HF-HRV would show inter-individual
differences in empathy and alexithymia. Assignment of
participants to the high and low HF-HRV group was based on a
median split. For the dimensional analyses, multiple hierarchical
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Lischke et al. HRV Is Associated with Empathy and Alexithymia
regression analyses were computed to determine whether
inter-individual differences in HF-HRV would be differentially
associated with inter-individual differences in empathy and
alexithymia across all participants. Prior to all analyses, HF-HRV
and pHF-HRV were log transformed (log 10) to account for
deviations from normality distribution. The significance level for
the analyses was set at p≤0.05 (two-tailed). In addition to the
significance level (p), effect sizes (η2
pand R2) were determined to
facilitate the interpretation of significant findings (Cohen, 1988).
RESULTS
Inter-individual Differences in Heart Rate
Variability and Inter-individual
Differences in Empathy
A one-way ANCOVA showed that participants with high
HF-HRV reported more empathy than participants with low
HF-HRV [F(1,73) = 6.51, p= 0.013, η2
p= 0.08; see Figure 1],
independent of inter-individual differences in age, BMI, physical
or respiratory activity. Across all participants, inter-individual
differences in HF-HRV were positively associated with inter-
individual differences in empathy as indicated by a multiple
regression analysis [t(73) = 2.17, p= 0.033; see Table 2].
The multiple regression analysis also indicated that there was
no association of inter-individual differences in age, BMI,
physical or respiratory activity with inter-individual differences
in empathy [all p>0.339; see Table 2]. Most of the
variance regarding inter-individual differences in empathy was,
thus, explained by inter-individual differences in HF-HRV
[F(1,73) = 4.71, p= 0.033; see Table 2], not by inter-
individual differences in age, BMI, physical or respiratory
activity [F(4,74) = 0.19, p= 0.944; see Table 2]. More
precisely, inter-individual differences in HF-HRV explained 6%
of variance regarding inter-individual differences in empathy in
FIGURE 1 | Barplots demonstrating differences in empathy between
participants with high (white bars) and low (gray bars) high-frequency heart
rate variability (HF-HRV). Bars represent M ±SEM. ∗p≤0.05.
TABLE 2 | Association between inter-individual differences in heart rate variability
and inter-individual differences in empathy across all participants.
Empathy (EQ-15a)
Predictors R21R2β
Step 1 0.01 0.01
Age (years) −0.08
Body mass index (kg/m2) 0.67
Physical activity (h/w) 0.00
Respiratory activity (Log-pHF-HRV, Hz) 0.01
Step 2 0.07 0.06∗
Age (years) −0.09
Body mass index (kg/m2) 0.11
Physical activity (h/w) −0.06
Respiratory activity (Log-pHF-HRV, Hz) −0.05
Heart rate variability (Log-HF-HRV, ms2) 0.26∗
Log-pHF-HRV = log-transformed peak of high frequency heart rate variability,
Log-HF-HRV = log transformed high frequency heart rate variability,
EQ-15 = Empathy Quotient 15 (Allison et al., 2011).
aData was available for 79 participants.
∗p≤0.05.
addition to the 2% of variance that tended to be explained by
inter-individual differences in age, BMI, physical or respiratory
activity.
Inter-individual Differences in Heart Rate
Variability and Inter-individual
Differences in Alexithymia
A one-way ANCOVA revealed that participants with high
HF-HRV reported less alexithymia than participants with
low HF-HRV [F(1,83) = 3.99, p= 0.049, η2
p= 0.05, see
Figure 2], irrespective of inter-individual differences in age, BMI,
physical or respiratory activity. Across all participants, inter-
individual differences in HF-HRV were negatively associated
FIGURE 2 | Barplots demonstrating differences in alexithymia between
participants with high (white bars) and low (gray bars) high-frequency heart
rate variability (HF-HRV). Bars represent M ±SEM. ∗p≤0.05.
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Lischke et al. HRV Is Associated with Empathy and Alexithymia
with inter-individual differences in alexithymia as indicated by
a multiple regression analysis [t(83) = −2.02, p= 0.047; see
Table 3]. The multiple regression analysis further indicated that
inter-individual differences in age were also negatively associated
with inter-individual differences in alexithymia [t(83) = −2.81,
p= 0.006; see Table 3] and that inter-individual differences in
BMI, physical or respiratory activity were not associated with
inter-individual differences in alexithymia [all p>0.416; see
Table 3]. However, inter-individual differences in alexithymia
were more relevant for explaining inter-individual differences
in HF-HRV [F(1,83) = 4.07, p= 0.047; see Table 3] than
inter-individual differences in age, BMI, physical or respiratory
activity [F(4,84) = 1.98, p= 0.106; see Table 3]. Inter-
individual differences in HF-HRV explained 4% of variance
regarding inter-individual differences in alexithymia in addition
to the 9% of variance that tended to be explained by inter-
individual differences in age, BMI, physical or respiratory
activity.
DISCUSSION
In the present study, we investigated the association of
inter-individual differences in vmHRV with inter-individual
differences in empathy and alexithymia related personality traits.
Inter-individual differences in vmHRV were determined on
basis of inter-individual differences in resting state HF-HRV
and inter-individual differences in empathy and alexithymia
were determined on basis of inter-individual differences in
questionnaire scores. In line with our expectations, we found
a positive association between inter-individual differences in
vmHRV and inter-individual differences in empathy. Our
categorical analyses revealed that participants with high vmHRV
were more empathetic than participants with low vmHRV
TABLE 3 | Association between inter-individual differences in heart rate variability
and inter-individual differences in alexithymia across all participants.
Alexithymia (TAS-20a)
Predictors R21R2β
Step 1 0.09 0.09
Age (years) −0.29
Body mass index (kg/m2) 0.08
Physical activity (h/w) 0.04
Respiratory activity (Log-pHF-HRV, Hz) 0.10
Step 2 0.13 0.04∗
Age (years) −0.29∗∗
Body mass index (kg/m2) 0.04
Physical activity (h/w) 0.09
Respiratory activity (Log-pHF-HRV, Hz) 0.60
Heart rate variability (Log-HF-HRV, ms2)−0.22∗
Log-pHF-HRV = log-transformed peak of high frequency heart rate variability,
Log-HF-HRV = log transformed high frequency heart rate variability,
TAS-20 = Toronto Alexithymia Scale 20 (Bagby et al., 1994a,b).
aData was available for 89 participants.
∗p≤0.05, ∗∗p<0.01.
and our dimensional analyses indicated that an increase in
vmHRV was associated with an increase in empathy across
all participants. Also as expected, we found a negative
association between inter-individual differences in vmHRV
and inter-individual differences in alexithymia. Our categorical
analyses showed that participants with high vmHRV were
less alexithymic than participants with low vmHRV and our
dimensional analyses indicated that an increase in vmHRV
was associated with a decrease in alexithymia across all
participants.
Previous studies revealed a similar association of
inter-individual differences in vmHRV with inter-individual
differences in empathy and alexithymia related personality
traits (e.g., Fukunishi et al., 1999;Oveis et al., 2009;Kogan
et al., 2014;Stellar et al., 2015;Panayiotou and Constantinou,
2017). With respect to empathy it is noteworthy that individuals
with high vmHRV show more agreeableness with others
and more compassion for others’ emotional or mental states
than individuals with low vmHRV (e.g., Oveis et al., 2009;
Kogan et al., 2014;Stellar et al., 2015). Agreeableness is a
personality trait that is closely related to compassion and
compassion is a personality trait that is closely related to
empathetic concern (Goetz et al., 2010), a distinct dimension
of empathy that has been regarded as an important precursor
of prosocial behavior (Batson and Shaw, 1991). Inter-individual
differences in vmHRV may, thus, be differentially associated
with distinct empathy dimensions, implying the possibility of
positive associations with empathy dimensions that facilitate
prosocial behavior, such as empathetic concern (e.g., Toi and
Batson, 1982;Batson et al., 1983), and negative associations
with empathy dimensions that impair prosocial behavior, such
as empathetic distress (e.g., Toi and Batson, 1982;Batson
et al., 1983). In the present study, we were unable to test this
possibility because the psychometric properties of our empathy
questionnaire argued against the use of the questionnaire’s
subscales in the respective analyses. Future studies should,
thus, employ empathy questionnaires with psychometrically
sound subscales to further elucidate the association between
inter-individual differences in vmHRV and inter-individual
differences in empathy. With respect to alexithymia it is
noteworthy that individuals with high vmHRV report fewer
difficulties in identifying or describing their own emotional
and mental states than individuals with low vmHRV (e.g.,
Fukunishi et al., 1999;Panayiotou and Constantinou, 2017).
However, the association between inter-individual differences
in vmHRV and inter-individual differences in alexithymia
seem to be more pronounced among younger (e.g., Fukunishi
et al., 1999;Panayiotou and Constantinou, 2017) than older
(e.g., Virtanen et al., 2003;Zohar et al., 2013) individuals.
Future studies should, therefore, investigate this association
among individuals showing a wider age range than those
individuals that have been included in the present study. These
studies should also employ alexithymia questionnaires with
psychometrically sound subscales to explore whether inter-
individual differences in vmHRV are differentially associated
with distinct dimensions of alexithymia as suggested by
previous studies (e.g., Fukunishi et al., 1999;Panayiotou and
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Lischke et al. HRV Is Associated with Empathy and Alexithymia
Constantinou, 2017). In the present study, we were unable to
perform the respective analyses because of the problematic
subscale structure of our alexithymia questionnaire. Taken
together, the findings of the present and previous studies suggest
that inter-individual differences in vmHRV are associated
with inter-individual differences regarding the ability to share
and understand emotional and mental states of others and
the self.
Assuming an association of inter-individual differences
in vmHRV with inter-individual differences in empathy
and alexithymia may help to explain why individuals
with high vmHRV are more successful in establishing and
maintaining positive relationships than individuals with
low vmHRV (e.g., Kok and Fredrickson, 2010;Beffara
et al., 2016;Lischke et al., 2018). Individuals with high
vmHRV may be more efficient in simulating and interpreting
emotional and mental states under a self-other awareness
than individuals with low vmHRV, which may increase the
likelihood of mutual understanding that is necessary for the
establishment and maintenance of positive relationships.
Inter-individual differences regarding the regulation of cognitive
and emotional processes that are relevant for the simulation
and interpretation of emotional and mental states, like, for
example, the control of emotions (e.g., Geisler et al., 2010,
2013;Williams et al., 2015) or the allocation of attention
(e.g., Hansen et al., 2003;Segerstrom and Nes, 2007;Luft
et al., 2009), may contribute to these differences. In this
respect it is noteworthy that individuals with high vmHRV
outperform individuals with low vmHRV on tasks that require
the inference of others’ states on basis of facial and/or vocal
cues (e.g., Cote et al., 2011;Quintana et al., 2012a;Lischke
et al., 2017), indicating the plausibility of the aforementioned
assumptions.
With respect to the neurobiological mechanisms mediating
the association of inter-individual differences in vmHRV with
inter-individual differences in empathy and alexithymia, it
is important to note that a similar set of prefrontal and
(para-)limbic brain regions is engaged during the simulation
and interpretation of emotional and mental states as during
the regulation of cardiac activity (Bernhardt and Singer, 2012;
Thayer et al., 2012;Wingbermuhle et al., 2012). Of these
brain regions, the anterior cingulate cortex, the insula and
amygdala are of particular relevance because functional and
structural changes in these brain regions are associated with
changes in empathy and alexithymia (e.g., Singer et al., 2004;
Moriguchi et al., 2007;Reker et al., 2010;Banissy et al., 2012;
Klimecki et al., 2012;Bernhardt et al., 2014;Grabe et al.,
2014;Goerlich-Dobre et al., 2015) as well as with changes in
vmHRV (e.g., Gianaros et al., 2004;Lane et al., 2009;Sakaki
et al., 2016;Winkelmann et al., 2017). Following previous
suggestions that changes in vmHRV serve as a proxy for changes
in prefrontal activity and prefrontal-(para-)limbic connectivity
(Porges, 2007;Thayer and Lane, 2009;Thayer et al., 2012),
we assume that inter-individual differences in vmHRV reflect
inter-individual differences in empathy and alexithymia that are
due to inter-individual differences in prefrontal activity and
prefrontal-(para-)limbic connectivity. More precisely, we assume
that individuals with high vmHRV are more empathetic and less
alexithymic than individual with low vmHRV because individuals
with high vmHRV are more efficient in recruiting prefrontal
and (para-)limbic brain regions implicated in the simulation and
interpretation of emotional and mental states than individuals
with low vmHRV. In this respect it is noteworthy that individuals
with autism, a disorder that is characterized by alterations in
empathy and alexithymia (Hill et al., 2004;Dziobek et al.,
2008), show alterations in a prefrontal and (para-)limbic brain
regions (e.g., Baron-Cohen et al., 1999;Dziobek et al., 2006;
Silani et al., 2008;Wicker et al., 2008;Ecker et al., 2012) as
well as alterations in vmHRV (e.g., Mathewson et al., 2011;
Kuiper et al., 2017). Inter-individual differences in vmHRV
may, thus, indicate inter-individual differences regarding the
recruitment of prefrontal and (para-)limbic brain regions during
the simulation and interpretation of emotional and mental states
in healthy as well as in mentally disordered individuals, implying
that inter-individual differences in vmHRV may indeed serve
as biomarker for inter-individual differences in empathy and
alexithymia.
The findings of the present study suggest that inter-individual
differences in vmHRV are associated with inter-individual
differences in empathy and alexithymia, presumably because
of inter-individual differences in prefrontal activity and
prefrontal-(para-)limbic connectivity during the simulation
and interpretation of emotional and mental states. The present
findings are not only consistent with findings of previous
studies revealing an association between inter-individual
differences in vmHRV and inter-individual differences in
the regulation of emotional and cognitive processes that are
necessary for the simulation and interpretation of emotional
and mental states (e.g., Hansen et al., 2003;Segerstrom and
Nes, 2007;Luft et al., 2009;Geisler et al., 2010;Geisler et al.,
2013;Williams et al., 2015), but also with findings of previous
studies suggesting an association between inter-individual
differences in vmHRV and inter-individual differences in
prefrontal activity and prefrontal-(para-)limbic connectivity
during the regulation of emotional and cognitive processes
that are necessary for the simulation and interpretation of
emotional and mental states (e.g., Gianaros et al., 2004;
Lane et al., 2009;Sakaki et al., 2016). Taken together, these
findings corroborate our assumption that inter-individual
differences in vmHRV are associated with inter-individual
differences regarding the ability to share and understand
emotional and mental states of others and the self. However,
whether inter-individual differences in vmHRV really have
the potential to work as a biomarker for inter-individual
differences in empathy and alexithymia remains to be
determined in future studies that are explicitly designed
for these types of investigations (Kapur et al., 2012;Davis
et al., 2015). These studies should employ correlational
and experimental study designs in a cross-sectional
or longitudinal way to investigate the aforementioned
associations on the behavioral and neural level in healthy
and mentally disordered individuals with performance and
questionnaire based measures of empathy, alexithymia and social
behavior. Otherwise it will be difficult to determine whether
Frontiers in Psychology | www.frontiersin.org 6February 2018 | Volume 9 | Article 229
fpsyg-09-00229 February 26, 2018 Time: 16:47 # 7
Lischke et al. HRV Is Associated with Empathy and Alexithymia
inter-individual differences in vmHRV qualify as a biomarker for
inter-individual differences in empathy and alexithymia.
AUTHOR CONTRIBUTIONS
AL, AM-M, and RP designed the study. AM-M and MW collected
the data. AL and RP analyzed the data. AL wrote the manuscript.
AH, AM-M, HF, HG, MB, MW, and RP contributed to writing,
reviewing and editing of the manuscript. All authors approved
the final version of the manuscript.
FUNDING
AL was supported by a grant from the German Research
Foundation (DFG; LI 2517/2-1).
ACKNOWLEDGMENTS
The authors would like to thank Thomas Dreyer, Robert Jacksteit,
Valentin Propp, Michel Rickler, and Nils Seitz for research
assistance.
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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.
Copyright © 2018 Lischke, Pahnke, Mau-Moeller, Behrens, Grabe, Freyberger,
Hamm and Weippert. This is an open-access article distributed under the terms
of the Creative Commons Attribution License (CC BY). The use, distribution or
reproduction in other forums is permitted, provided the original author(s) and the
copyright owner are credited and that the original publication in this journal is cited,
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Frontiers in Psychology | www.frontiersin.org 9February 2018 | Volume 9 | Article 229
