Shisei Tei

Can we predict burnout severity from empathy-related brain activity?

Empathy cultivates deeper interpersonal relationships and is important for socialization. However, frequent exposure to emotionally-demanding situations may put people at risk for burnout. Burnout has become a pervasive problem among medical professionals because occupational burnout may be highly sensitive to empathy levels. To better understand empathy-induced burnout among medical professionals, exploring the relationship between burnout severity and strength of empathy-related brain activity may be key. However, to our knowledge, this relationship has not yet been explored. We studied the relationship between self-reported burnout severity scores and psychological measures of empathic disposition, emotional dissonance and alexithymia in medical professionals to test two contradictory hypotheses: Burnout is explained by (1) ‘compassion fatigue’; that is, individuals become emotionally over involved; and (2) ‘emotional dissonance’; that is, a gap between felt and expressed emotion, together with reduced emotional regulation. Then, we tested whether increased or decreased empathy-related brain activity measured by fMRI was associated with burnout severity scores and psychological measures. The results showed that burnout severity of medical professionals is explained by ‘reduced’ empathy-related brain activity. Moreover, this reduced brain activity is correlated with stronger emotional dissonance and alexithymia scores and also greater empathic disposition. We speculate that reduced emotion recognition (that is, alexithymia) might potentially link with stronger emotional dissonance and greater burnout severity alongside empathy-related brain activity. In this view, greater empathic disposition in individuals with higher burnout levels might be due to greater difficulty identifying their own emotional reactions. Our study sheds new light on the ability to predict empathy-induced burnout.

Altered brain response to others׳ pain in major depressive disorder

BACKGROUND Empathy has a central role in successful interpersonal engagement. Several studies have reported altered empathy in major depressive disorder (MDD), which could lead to interpersonal difficulties. However, the neural basis of altered empathy in the disorder is still largely unknown. To address this, we performed functional magnetic resonance imaging that tested empathy for others׳ pain in MDD patients. METHODS Eleven patients with MDD and 11 age-, gender-, handedness-, and education level-matched healthy control subjects were studied. We compared MDD patients and healthy controls for their regional hemodynamic responses to visual perception of videos showing human hands in painful situations. We also assessed subjective pain ratings of the videos in each group. RESULTS The MDD patients showed lower pain ratings for the painful videos compared with the healthy controls. In addition, the MDD patients showed reduced cerebral activation in the left middle cingulate cortex, and the right somatosensory-related cortices, whereas they showed greater cerebral activation in the left inferior frontal gyrus. LIMITATIONS We relied on a relatively small sample size and could not exclude effects of medications. CONCLUSIONS These results suggest that in MDD patients the altered neural activations in these regions may be associated with a deficit in the identification of pain in others. This study adds to our understanding of the neural mechanism involved in empathy in MDD.

Anterior cingulate volume predicts response to cognitive behavioral therapy in major depressive disorder

BACKGROUND Cognitive behavioral therapy (CBT) is widely used to treat major depressive disorder (MDD). Although improved response prediction could facilitate the development of individualized treatment plans, few studies have investigated whether underlying brain structure is related to CBT response in MDD. METHODS Ten MDD patients who received individual CBT were studied in this study. We investigated the relationship between the regional gray matter (GM) volume and subsequent responses to CBT using voxel-based morphometry. RESULTS The degree of improvement in depressive symptoms was positively correlated with GM volume in the caudal portion of the anterior cingulate cortex. LIMITATIONS The sample size was small, and the effects of medication on the results could not be excluded. CONCLUSIONS Our results, although preliminary, suggest that the anterior cingulate cortex is a key structure whose volume can be used to predict responses to CBT and is thus a potential prognostic marker in MDD.

Attitudes toward risk and ambiguity in patients with autism spectrum disorder

Although the ability to make optimal decisions under uncertainty is an integral part of everyday life, individuals with autism spectrum disorder (ASD) frequently report that they experience difficulties with this skill. In behavioral economics, researchers distinguish two types of uncertainty to understand decision-making in this setting: risk (known probabilities) and ambiguity (unknown probabilities). However, it remains unclear how individuals with ASD behave under risk and ambiguity, despite growing evidence of their altered decision-making under uncertainty. We therefore extended previous research by studying the attitudes of those with ASD toward risk and ambiguity in both positive and negative contexts (i.e., gain and loss). In gain contexts, no significant difference was observed between the groups in risk attitudes, but ambiguity aversion was attenuated in ASD. In loss contexts, ambiguity attitudes did not significantly differ between the groups, but the ASD participants were less risk-seeking compared with the controls. In addition, insensitivity to the context change under risk and ambiguity in ASD was both significantly associated with poor social skills. These results improve our understanding of altered decision-making under uncertainty by disentangling the attitudes toward risk and ambiguity in ASD individuals. Applying behavioral economic tools may provide insights into the mechanisms underlying behavioral disturbances in ASD.

Neural mechanisms and personality correlates of the sunk cost effect

The sunk cost effect, an interesting and well-known maladaptive behavior, is pervasive in real life, and thus has been studied in various disciplines, including economics, psychology, organizational behavior, politics, and biology. However, the neural mechanisms underlying the sunk cost effect have not been clearly established, nor have their association with differences in individual susceptibility to the effect. Using functional magnetic resonance imaging, we investigated neural responses induced by sunk costs along with measures of core human personality. We found that individuals who tend to adhere to social rules and regulations (who are high in measured agreeableness and conscientiousness) are more susceptible to the sunk cost effect. Furthermore, this behavioral observation was strongly mediated by insula activity during sunk cost decision-making. Tight coupling between the insula and lateral prefrontal cortex was also observed during decision-making under sunk costs. Our findings reveal how individual differences can affect decision-making under sunk costs, thereby contributing to a better understanding of the psychological and neural mechanisms of the sunk cost effect.

Inflexible daily behaviour is associated with the ability to control an automatic reaction in autism spectrum disorder

Inflexible behaviours in people with autism spectrum disorder (ASD) broadly obstruct social communication. Meanwhile, flexibility implicates cognitive control to resolve socially conflicting situations; however, it remains unclear how people with ASD behave in the face of these conflicts in this respect. We used the ultimatum game (UG) and the implicit-association test (IAT) to examine goal-directed/economic flexibility, both of which involve conflict and cognitive control. In addition, we used the Detail and Flexibility Questionnaire (DFlex) to measure inflexible everyday behaviour with diminished cognitive control and attention shifting. We observed the decreased flexibility in participants with ASD (DFlex and IAT); further, their IAT scores positively correlated with DFlex. However, in the UG, contrary to our prediction, participants with ASD accepted unfair offers more frequently than TD. These results suggest that assessing the automatic/attention processing level with the IAT could be a useful approach to study behavioural flexibility among ASD compared with the UG, which might comprise multiple response strategies besides economic rationality. Overall, the severity of inflexible daily behaviours in people with ASD may be associated with a reduced flexible attitude at an automatic level, altered attention processing and decreased cognitive control.

Sense of meaning in work and risk of burnout among medical professionals.

tic and visual stimulation, and a CRS-Score of 11. Thus, we decided to increase Zp dosage up to 30 mg (administered for around 3 weeks), with a further improvement of CRS-R score (i.e. 13) and EEG (presence of theta-beta rhythm over both the temporal areas), and without relevant side-effects. Our case further supports the hypothesis of a positive effect of Zp, although at higher dosage, in improving consciousness in VS. After brain injury or cerebral anoxic damage there is a change either in the levels of glutamate (resulting in neurotoxicity) or GABA neurotransmission, with reduced cell metabolism and blood flow in brain areas adjacent to the damaged area. By binding to modified GABAA receptors of the ‘neurodormant cells’, Zp may cause reversal of the abnormal state and associated metabolic inhibition, with a consequent arousal. For the first time, we used a higher dose of Zp (30 mg) to evaluate whether the drug’s response could be dose-dependent. Indeed, our patient’s improvement was strictly related to the increase in Zp dosage, with a relatively good response at 30 mg. We are not able to explain this interesting finding, although a more effective action of high-dose Zp on the centrothalamic activity (by potentiating the ‘mesocircuit’), could be taken into account. Zp may be a valuable treatment in improving consciousness, although further studies should be fostered to confirm its efficacy, the proper dosage, and long-term safety.

Sunk Cost Effect in Individuals with Autism Spectrum Disorder

The sunk cost effect, an interesting and well-known decision bias, is pervasive in real life and has been studied in various disciplines. In this study, we modified a task exemplifying the sunk cost effect and used it to evaluate this behavior in individuals with autism spectrum disorder (ASD). The control group exhibited a typical sunk cost effect in our task. We found that the sunk cost effect was lower in the ASD group than in the control group. The results agree with previous evidence of reduced sensitivity to context stimuli in individuals with ASD and extend this finding to the context of the sunk cost effect. Our findings are useful in addressing the practical implications on their socioeconomic behavior.

An fMRI study of decision-making under sunk costs in gambling disorder

The sunk cost effect is the tendency to continue an investment, or take an action, even though it has higher future costs than benefits, if costs of time, money, or effort were previously incurred. This type of decision bias is pervasive in real life and has been studied in various disciplines. Previous studies and clinical observations suggest that decision-making under sunk costs is altered in gambling disorder (GD). However, the neural mechanisms of decision-making under sunk costs in GD remain largely unknown, and so is their association with the clinical characteristics of this patient group. Here, by combining functional magnetic resonance imaging and the task that demonstrated a clear example of the sunk cost effect, we investigated the neural correlates during decision-making under sunk costs in GD. We found no significant differences in the strength of the sunk cost effect between the GD and healthy control (HC) groups. However, the strength of the sunk cost effect in patients with GD showed a significant negative correlation with abstinence period and a marginally significant positive correlation with the duration of illness. We also found a reduction in the neural activation in the dorsal medial prefrontal cortex during decision-making under sunk costs for the GD group compared with the HC group. Furthermore, in patients with GD, the levels of activation in this area negatively correlated with the duration of illness. These findings have important clinical implications. This study will contribute to a better understanding of the mechanisms underlying altered decision-making abilities in GD.