Empathy gaps for social pain: why people underestimate the pain of social suffering

In 5 studies, the authors examined the hypothesis that people have systematically distorted beliefs about the pain of social suffering. By integrating research on empathy gaps for physical pain (Loewenstein, 1996) with social pain theory (MacDonald & Leary, 2005), the authors generated the hypothesis that people generally underestimate the severity of social pain (ostracism, shame, etc.)--a biased judgment that is only corrected when people actively experience social pain for themselves. Using a social exclusion manipulation, Studies 1-4 found that nonexcluded participants consistently underestimated the severity of social pain compared with excluded participants, who had a heightened appreciation for social pain. This empathy gap for social pain occurred when participants evaluated both the pain of others (interpersonal empathy gap) as well as the pain participants themselves experienced in the past (intrapersonal empathy gap). The authors argue that beliefs about social pain are important because they govern how people react to socially distressing events. In Study 5, middle school teachers were asked to evaluate policies regarding emotional bullying at school. This revealed that actively experiencing social pain heightened the estimated pain of emotional bullying, which in turn led teachers to recommend both more comprehensive treatment for bullied students and greater punishment for students who bully.     

Shifts in attention biases in response to acute pain induction: examination of a model of "conversion" among repressors

Unlike most people, those who are characterized by a repressive coping style report high levels of physical (sensory) pain but low levels of emotional distress (affective pain), which is a discrepancy that may suggest a "conversion" process. In two studies, we tested an attention allocation model, proposing that repressors direct attention away from threatening negative affective information and toward nonthreatening physical pain information during emotionally arousing (painful) situations. In Study 1, 84 participants underwent a cold pressor and then recovered. Repressors reported greater pain during recovery than low- and high-anxious participants, but they reported lower distress than high-anxious participants. Repressors reported significant and large discrepancies between high pain and low distress, whereas these differences were less pronounced for other groups. In Study 2, 77 participants underwent an ischemic pain task while performing a modified dot-probe task with sensory and negative affective pain words as stimuli. Repressors showed increasing biases away from affective pain words and toward sensory pain words as the pain task continued, whereas low- and high-anxious participants did not show these shifts in attention. The results support the notion that conversion among repressors may involve a process by which attention is directed away from emotional distress during noxious stimulation and is focused instead on sensory information from pain.     

Bimodal classification of aggression: affective defense and predatory attack

The development of a refined classification scheme for the categorization of human aggression is a key to improved diagnosis and treatment. The principal thesis of this review is that much of animal and human aggression contains affective or predatory characteristics. Affective defense, as defined in both the human and animal literatures, is an aggressive response based on the presence of elements of either fear and/or threat, which may be real or perceived. Predatory attack has been understudied relative to affective defense, and consists of a purposeful and goal-directed attack with absence of sympathetic arousal. In this review, we argue that a variety of classification schemes reported in both the animal and human literature could be relabeled as affective defense and predatory attack. The significance of this approach is that it: (1) links animal and human research; (2) can lead to new lines of investigation in humans; and (3) may provide the impetus for new treatment studies.     

Shame and aggression: Theoretical considerations

Within the shame literature, anger and aggression are widely recognized as responses to shame. Recent findings on the affective neuroscience of social pain suggest multiple models by which social pain (e.g., shame) and anger/aggression may be linked. These models describe the mechanisms underlying the prominent role of shame in interpersonal aggression, a role revealed by many dozens of studies. Anger and aggression in response to shame may be viewed as emotion regulation, coping strategies, and evolutionary adaptations. Unfortunately, these attempts at coping with shame may be adaptive or maladaptive. Indeed, aggression may be an adaptive defensive response to physical pain and many physical threats that, through evolutionary processes, came to be linked to shame once social pain co-opted the affective response to physical pain. In a related article (Velotti, Elison, & Garofalo, 2014), we review the many contexts and populations in which aggression manifests, providing further evidence for the models proposed here. Thus, a more complete understanding of anger and violent behavior requires consideration of social pain, shame, and shame-regulation, for which physical pain serves as a useful model.     

Neural basis of affective touch and pain: A novel model suggests possible targets for pain amelioration

Pain is one of the most common health problems and has a severe impact on quality of life. Yet, a suitable and efficient treatment is still not available for all patient populations suffering from pain. Interestingly, recent research shows that low threshold mechanosensory C-tactile (CT) fibres have a modulatory influence on pain. CT-fibres are activated by slow gentle stroking of the hairy skin, providing a pleasant sensation. Consequently, slow gentle stroking is known as affective touch. Currently, a clear overview of the way affective touch modulates pain, at a neural level, is missing. This review aims to present such an overview. To explain the interaction between affective touch and pain, first the neural basis of the affective touch system and the neural processing of pain will be described. To clarify these systems, a schematic illustration will be provided in every section. Hereafter, a novel model of interactions between affective touch and pain systems will be introduced. Finally, since affective touch might be suitable as a new treatment for chronic pain, possible clinical implications will be discussed.     

Affective deficits and pain insensitivity in schizophrenia

Affective deficits have long been considered a prominent feature of schizophrenia and play a central role in recent theory and research on the pathophysiology of this disorder. However, it has recently been argued that current approaches to the conceptualization and assessment of affective flattening in schizophrenia are confounded by the social and neuromotor deficits that are also prevalent in this disorder. Insensitivity to pain in individuals with schizophrenia — a phenomenon that has been reported frequently but never systematically investigated — provides one approach to examining affective flattening unconfounded by social and neuromotor deficits. Two studies are described in which signal detection theory measures of thermal pain sensitivity were examined in patients with schizophrenia, mood disorder, and normal controls; in addition, in the patients with schizophrenia, the relationships between these measures and measures of affective deficits were examined. Patients with schizophrenia had significantly poorer sensory discrimination of painful thermal stimuli than control subjects, but did not differ from controls with respect to their response criterion for reports of pain; patients with mood disorder had a significantly higher (i.e., more stoical) criterion for reports of pain than controls. As predicted, among the patients with schizophrenia, higher response criterion was significantly correlated with greater affective flattening and less intense affective experience (as well as with fewer positive symptoms and poorer premorbid adjustment). The results of these studies suggest that pain insensitivity in schizophrenia may reflect affective as well as sensory abnormalities, and that pain insensitivity in schizophrenia may provide a method for studying affective flattening in this disorder that is relatively independent of the social and neuromotor deficits that confound existing measures of this symptom. Continued examination of the relationship between pain insensitivity and affective deficits in schizophrenia is also important because numerous clinical reports have suggested that pain insensitivity is detrimental to health and can have life-threatening consequences in individuals with this disorder.This research was supported, in part, by research grants from the National Institute of Neurological Disorders and Stroke to Robert H. Dworkin (NS-30714) and W. Crawford Clark (NS-09263, NS-20248).     

Independent effects of emotion and attention on sensory and affective pain perception

The present study investigated whether attention and emotion independently influence sensory and affective pain ratings. Fifty-four (27 female) participants rated sensory and affective pain in response to painful mechanic pressure stimulation while exposed to positive, neutral and negative slides from the International Affective Picture System. In doing so, participants were assigned to one of three groups, which focused attention either on the pictures or on the sensory or on the affective aspects of the pressure stimulation. Consistent with the motivational priming hypothesis, sensory and affective pain ratings were generally lower during exposure to positive compared to negative and neutral slides. In line with our assumptions, attention modulated sensory pain ratings with lowest ratings in the picture focusing group and highest in the affective pain focusing group. No attention effect for affective pain ratings and no interactions between emotional and attentional effects on pain perception were found.     

Alone but feeling no pain: Effects of social exclusion on physical pain tolerance and pain threshold, affective forecasting, and interpersonal empathy

Prior findings of emotional numbness (rather than distress) among socially excluded persons led the authors to investigate whether exclusion causes a far-reaching insensitivity to both physical and emotional pain. Experiments 1-4 showed that receiving an ostensibly diagnostic forecast of a lonesome future life reduced sensitivity to physical pain, as indicated by both (higher) thresholds and tolerance. Exclusion also caused emotional insensitivity, as indicated by reductions in affective forecasting of joy or woe over a future football outcome (Experiment 3), as well as lesser empathizing with another person's suffering from either romantic breakup (Experiment 4) or a broken leg (Experiment 5). The insensitivities to pain and emotion were highly intercorrelated.     

Healthy and Maladaptive Dependency and Its Relationship to Pain Management and Perceptions in Physical Therapy Patients

This study examined the association among healthy and maladaptive aspects of interpersonal dependency and the management of pain in physical therapy outpatients. Ninety-eight patients were administered the Relationship Profile Test, West Haven-Yale Multidimensional Pain Inventory, and Pain Catastrophizing Scale. Results indicated that Destructive Overdependence was positively associated with an increased number of office visits, pain interference in one’s daily life, pain severity, affective distress, and receiving positive partner responses. Dysfunctional Detachment was associated with affective distress, pain interference in one’s daily life, and rumination about pain. Healthy Dependency was only associated with receiving distracting responses from others. Believing that a spouse/partner is supportive and caring about one’s pain partially mediated the relationship between overdependency and pain interfering in one’s life. These results support the clinical utility of assessing interpersonal dependency for its relationship to managing one’s pain and health care utilization.     

The language of pain intensity and complexity: new methods of scoring the McGill Pain Questionnaire

In Part I the McGill Pain Questionnaire was administered to 25 cancer patients, scored and analyzed in the traditional manner. Results indicated that patients with cancer pain appear to be similar in terms of intensity of the pain and the kind of pain which they experience with respect to sensory, affective, and evaluative qualities. Part II presents a new method of administering, scoring, and analyzing responses to the questionnaire, which allows for a more comprehensive interpretation of pain. In Part III the data from Part I are reanalyzed using the new scoring system. As hypothesized, the intensity of cancer pain is higher along the affective dimension than along the sensory. With regard to complexity of the experience of cancer pain, neither the sensory nor the affective dimension is more salient. The new system of scoring and analysis may enable future investigators to specify a unique pain intensity-complexity relationship for each clinical pain syndrome.     

Psychosocial Subgroups, Coping, and Chronic Low-Back Pain

The purpose of this study was to compare psychosocial subgroups in terms of pain coping strategies, pain severity, physical impairment, pain behavior, affective distress, and response to pain management treatment. The Multidimensional Pain Inventory (MPI) was used to classify 67 chronic low-back pain (CLBP) patients into the following psychosocial subgroups: Dysfunctional, Interpersonally Distressed, Adaptive Coping, and Anomalous. These MPI subgroups were compared on the Pain Behavior Checklist, Behavioral Observation Measure of Pain Behavior, Revised Coping Strategies Questionnaire, and Chronic Disease Index. The Dysfunctional subgroup reported significantly more pain behavior, disability, affective distress, and catastrophizing than either the Interpersonally Distressed subgroup or Adaptive Copers, but were not significantly different on measures of adaptive coping strategies. The percentage of dropouts from treatment was significantly less among Adaptive Copers (11%) than among the Dysfunctional (33%) or Interpersonally Distressed (47%) subgroups. Differences in affective distress found among the MPI subgroups at baseline were not evident at the posttreatment assessment. The present findings support the use of MPI psychosocial subgroup analysis to enhance our understanding of differential response to chronic pain and pain management intervention.     

Are the interpersonal and identity disturbances in the borderline personality disorder criteria linked to the traits of affective instability and impulsivity?

This study examines the degree to which two putative biologically influenced personality traits, affective instability and impulsive aggression, are associated with some of the interpersonal and intrapsychic disturbances of borderline personality disorder (BPD) and with choice of defense mechanism. In a sample of 152 personality disorder patients, affective instability and impulsive aggression were measured. Defense mechanisms were assessed in 140 of these patients using the Defensive Style Questionnaire (DSQ). The correlations between the traits of affective instability and impulsive aggression and the eight DSM-III-R criteria for borderline personality disorder and 20 DSQ defenses were examined. Affective instability was significantly correlated with the DSM-III-R criteria of identity disturbance, chronic emptiness or boredom, inappropriate anger, suicidality, and the affective instability criteria. It also was associated with the defenses of splitting, projection, acting out, passive aggression, undoing, and autistic fantasy. Impulsive aggression was related to unstable interpersonal relationships, inappropriate anger and impulsiveness and with the defense of acting out. It was negatively correlated with the defenses of suppression and reaction formation. A number of the interpersonal and experiential disturbances and defense mechanisms that are features of BPD are associated with the traits of affective instability and impulsive aggression among patients with personality disorders.     

Does physical pain impair abstract thinking?

The ability to think abstractly constitutes a fundamental dimension of human cognition. Although abstraction has been extensively studied, its emotional and affective antecedents have been largely overlooked. One experiment was conducted to examine whether physical pain affects abstraction. Drawing on Construal Level Theory [Trope, Y., &; Liberman, N. (2010). Construal-level theory of psychological distance. Psychological Review, 117, 440–463] and Loewenstein’s [(1996). Out of control: Visceral influences on behavior. Organizational Behavior and Human Decision Processes, 65, 272–292] visceral factors theory, we hypothesised that pain impairs abstraction because pain constricts people’s mental horizons and lead to a concrete, inward-focus toward oneself in the here and now. Physical pain was manipulated between subjects (N?=?150). The participants either kept their left hand immersed in cold (painful) water or neutral (painless) water while we measured abstract versus concrete behaviour identification, categorisation, and perceptual processing. Bayesian statistical analyses indicate substantial evidence against the hypothesis that pain impairs abstraction. In contrast to many other previously studied cognitive outcomes (e.g. attention), abstraction appears to be largely immune to acute, experimentally induced pain.     

Getting Personal: Thoughts on Therapeutic Action Through the Interplay of Intimacy,Affect, and Consciousness

How do patients internalize new good object experience and how do these previously closed systems open up? What happens within and between analyst and patient that leads to the opening up of affective channels between them and allows consciousness to become transpersonal? The ways in which self-state experience becomes more fluid and cohesive, or less dissociated, is an affective process. This process occurs intersubjectively, as well as between self-states within each individual. When particular self-states come together between analyst and patient, especially those associated with pain and shame, disruption and instability may result within the mind-system (intrapsychic organization) of either or both partners. Managing the affective strain and psychic destabilization are vital tasks for the analyst and patient, in order for relationships between parts of the self (within one individual) to move from pain and hiddenness to compassionate recognition, thereby allowing and facilitating for parts of the self within the other individual to, in turn, move from pain and hiddenness to compassionate recognition. This is a core process of internal life, leading to the development of intimacy between self-states as well as between individuals.     

Do MacDonald and MacDonald Solve the Problem of Mental Causal Relevance?

Ever since Davidson first articulated and defended anomalous monism, nonreductive physicalists have struggled with the problem of mental causation. Considerations about the causal closure of the physical domain and related principles about exclusion make it very difficult to maintain the distinctness of mental and physical properties while securing a causal role for the former. Recently, philosophers have turned their attention to the underlying metaphysics and ontology of the mental causation debate to gain traction on this issue. Cynthia MacDonald and Graham MacDonald have followed suit and argue that the solution to the nonreductivist’s troubles lies in a particular metaphysical view of events. They claim that an appropriately formulated property exemplification account of events resolves the problem and secures the causal relevance of mental properties. I argue that while this approach might get us the causal efficacy of mental events, it does not provide the sought-after causal relevance of mental properties. I show that the reason MacDonald and MacDonald stumble on the problem of causal relevance is—ironically—due to features of their view of events.     

Effects of trait and situational self-handicapping on competitive anxiety among athletes

Initial evidence suggests that the employment of self-handicapping strategies has a beneficial effect on negative affective states associated with the perceived threat of evaluative contexts (Harris & Snyder, 1986; Leary, 1986). The present study sought to describe the type of self-handicapping behaviors demonstrated by youth athletes (N=238) as well as to assess the stress-buffering role of athlete self-handicapping on indices of competitive state anxiety. Specifically, it was hypothesized that among high trait-handicapping athletes, those who report a greater degree of performance-debilitating obstacles prior to competition would demonstrate lowered cognitive and somatic state anxiety as well as greater state self-confidence than nonhandicapping athletes. However, MANOVA results indicated that both high trait and situational self-handicappers demonstrate elevated state anxiety immediately prior to competition. Results are discussed in relation to the possible role of state anxiety as a salient self-handicapping strategy within competitive sport.     

Emotional flexibility and recovery from pain

This study aimed to investigate the relationship between two aspects of emotional flexibility (EF, i.e. flexible emotional responsiveness and affective flexibility) and tolerance for, and recovery from, experimentally-induced pain. Fifty-two adults completed a flexible emotional responsiveness task in which emotional responses on multiple dimensions were registered while watching positive and negative pictures. Affective flexibility was measured using a switching task with positive and negative pictures. Pain tolerance was assessed as the time participants endured an ischemic pain task and total time until recovery in terms of pain intensity and pain unpleasantness was registered. Flexible emotional responsiveness—reflected in divergent corrugator responses to positive and negative stimuli—was associated with faster recovery from pain unpleasantness. Affective flexibility was associated with recovery in terms of pain intensity, with faster switches from neutral towards affective aspects of positive stimuli being predictive of faster recovery. Results did not provide evidence for an association between EF and pain tolerance. The findings suggest that EF may protect against pain persistence.

     

Chronic pain, stress, and the dynamics of affective differentiation

We describe a program of research examining how the relationship between positive and negative affect varies both between individuals and within individuals over time. This Dynamic Model of Affect (DMA) proposes that under conditions that promote maximal information processing, positive and negative affective systems function relatively independently. In contrast, under conditions characterized by uncertainty, including pain and stress, the affects become strongly inversely related. Included in our consideration are potential individual differences in the ability to sustain affective differentiation during pain and other stressors and the implications of this model for perceptions of social relations and for interventions to improve well-being among the chronically ill.     

Effects of trait and situational self-handicapping on competitive anxiety among athletes

Initial evidence suggests that the employment of self-handicapping strategies has a beneficial effect on negative affective states associated with the perceived threat of evaluative contexts (Harris & Snyder, 1986; Leary, 1986). The present study sought to describe the type of self-handicapping behaviors demonstrated by youth athletes (N=238) as well as to assess the stress-buffering role of athlete self-handicapping on indices of competitive state anxiety. Specifically, it was hypothesized that among high trait-handicapping athletes, those who report a greater degree of performance-debilitating obstacles prior to competition would demonstrate lowered cognitive and somatic state anxiety as well as greater state self-confidence than nonhandicapping athletes. However, MANOVA results indicated that both high trait and situational self-handicappers demonstrate elevated state anxiety immediately prior to competition. Results are discussed in relation to the possible role of state anxiety as a salient self-handicapping strategy within competitive sport.