INTRODUCTION Section: Choose Top of page Abstract INTRODUCTION << METHODS BEHAVIORAL RESULTS fMRI RESULTS DISCUSSION Acknowledgments Notes REFERENCES CITING ARTICLES

When we witness another individual in pain, do we wince automatically? Or are we more likely to wait to respond until we determine the cause of the pain, the context of the situation, or the background of the individual?

The psychological construct of empathy refers to an intersubjective induction process through which the cognitive and affective experiences of another come to be shared, without losing sight of the original source of the experience (Decety & Jackson, 2004). In light of multiple levels of analysis from social and developmental psychology, cognitive neuroscience, and clinical neuropsychology, it has been proposed that empathy involves both bottom–up and top–down information processing components (Goubert, Craig, & Buysse, 2009; Decety & Moriguchi, 2007). The former refers to the automatic and covert mimicry component, which drives emotional contagion during interpersonal interactions, and the latter to self-regulation and meta-cognition, which modulates both this automatic resonance system and subsequent prosocial behaviors.

As the first-hand experience of pain is ubiquitous across individuals and cultures and there is extensive knowledge about the physiological mechanisms underlying the processing of nociceptive information, studying the perception of pain in others constitutes a valuable and ecologically valid paradigm for investigating the underpinning of human empathy.

In recent years, an accumulating number of fMRI studies have demonstrated striking similarities in the neural circuits involved in the processing of both the first-hand experience of pain and the second-hand experience of observing other individuals in pain (for a meta-analysis, see Jackson, Rainville, & Decety, 2006). These studies have consistently shown that the perception of pain in others elicits activation of the neural circuit subserving the processing of the affective and motivational dimension of pain (Cheng et al., 2007; Gu & Han, 2007; Lamm, Batson, & Decety, 2007; Moriguchi et al., 2007; Ogino et al., 2007; Saarela et al., 2007; Zaki, Ochsner, Hanelin, Wager, & Mackey, 2007; Jackson, Brunet, Meltzoff, & Decety, 2006; Botvinick et al., 2005; Jackson, Meltzoff, & Decety, 2005; Morrison, Lloyd, di Pellegrino, & Roberts, 2004; Singer et al., 2004). This neural circuit includes the dorsal ACC (dACC), the anterior midcingulate cortex (aMCC), and the anterior insula (AI; Derbyshire, 2000).

The findings from these recent cognitive neuroscience investigations provide empirical support for observer–target congruence in pain processing similar to that which social psychologists have reported for the past 30 years. For instance, Hygge (1976) found that when an observer witnessed a target's distress, they experienced an increase in skin conductance similar to the arousal response elicited by the aversive stimulation itself, demonstrating that observers are autonomically aroused by a target's distress. Further, Vaughan and Lanzetta (1980) demonstrated that observers respond to a target's pain display with similar expressive behavior. Using EMG recordings from three facial muscle sites, these authors found that the pattern and timing of activation of the observer's facial muscles paralleled those of the target expressing pain.

With the abovementioned neuroimaging and physiological findings, there is strong evidence to suggest that perceiving the pain of others triggers an automatic somatic sensory-motor resonance mechanism between other and self, resulting in pain processing in the observer. This sharing of neural circuits between self (observer) and other (target) provides the foundation for analogical reasoning and offers a possible, yet partial, route to understanding others (Decety & Grèzes, 2006).

Although the neuroscience research in somatic sensory mimicry provides evidence for a universal neurological mechanism underlying empathy, it does not address the effect of a host of social factors that might influence such an empathic response. For instance, recent work in social cognition has shown that both bottom–up and top–down mechanisms of empathy can be modulated by how the target is perceived, including how similar the target is to the observer (i.e., Ames, 2004; Batson et al., 1997), how likable the target is (i.e., Kozak, Marsh, & Wegner, 2006; Singer et al., 2006), and the group membership of the target (i.e., Stürmer, Snyder, Kropp, & Siem, 2006; Yabar, Johnston, Miles, & Peace, 2006). Understanding how such factors impact the ability to perceive and to respond with care to the cognitive, affective, and motivational internal states of another is crucial to understanding the conditions in which empathy will be expressed (Decety & Batson, 2007).

One way to more fully elucidate how a priori attitudes may moderate empathy for pain is to explore the effect of social stigma on the empathic response. Stigmatization of an individual occurs when that individual is (1) labeled, (2) negatively stereotyped, (3) discriminated against, and (4) experiences status loss as a result of their stigma (Link & Phelan, 2001). Stigmatized individuals possess or are believed to possess some attribute or characteristic that conveys a social identity that is devalued in a particular context (Crocker, Major, & Steele, 1998). As a result of such a devalued and dehumanized out-group status, it can be predicted that someone would experience less empathy for an individual who is stigmatized.

A particularly illustrative example of a group of people who are stigmatized by society is those infected with HIV or who currently have AIDS. A number of empirical investigations have documented both explicit and implicit negative attitudes toward people with HIV/AIDS (for a review, see Herek, 1999). For instance, Neumann, Hulsenbeck, and Seibt (2004) measured participant's implicit attitudes toward people with AIDS (PWA) using both an implicit association test (IAT) and an automatic approach/avoidance task. Participants demonstrated a significant and negative implicit association for PWA and were significantly faster at making avoidance movements than approach movements in response to pictures of PWA.

Furthermore, attributions of responsibility can modulate an observer's emotional response toward such stigmatized targets. If targets are deemed responsible for their condition, they are judged with anger and blame and are stigmatized and socially rejected. Alternately, if targets are not considered responsible for their condition, they are judged with relative sympathy and social acceptance (Crandall & Martinez, 1996). In particular, attributions of responsibility have been shown to moderate attitudes toward individuals infected with AIDS: Participants are less likely to show compassion for individuals who contracted HIV through stigmatized behavior (i.e., drug use) than for people who were infected through other means, such as a blood transfusion (Capitanio & Herek, 1999; Weiner, Perry, & Magnusson, 1988).

The abovementioned research demonstrates not only that people infected with HIV/AIDS are negatively viewed and stigmatized in society but also that attributions of responsibility for how PWA contracted the disease influences how they are perceived. Applying this research on stigmatized out-groups (such as PWA) to the literature on the somatic sensory mimicry components of empathy, it is hypothesized that resonance to stigmatized targets will be moderated by attributions of responsibility.

To investigate this hypothesis, the current study examined whether the hemodynamic response in the neural circuits underlying pain processing was modulated by the stigma of the target and whether the target bore responsibility for his or her stigmatized status. During fMRI scanning, white participants were exposed to a series of short video clips featuring age-matched white individuals experiencing pain who were (a) similar to the participant (healthy), (b) stigmatized but not responsible for their stigmatized condition (infected with AIDS as a result of an infected blood transfusion from a recent hospital stay), or (c) stigmatized and held responsible for their stigmatized condition (infected with AIDS as a result of intravenous drug use). We predicted that although participants should show resonance to the pain of all targets (regardless of group membership), resonance should depend on the target's stigma and his or her responsibility for acquiring that stigma. As such, we predicted reduced hemodynamic activation in pain processing areas when viewing stigmatized targets in general as compared with control targets similar to the participants. However, we predicted that attributions of responsibility would moderate this effect, such that significantly greater hemodynamic activation in pain processing areas would be observed when viewing not-responsible stigmatized targets and significantly less activity would be observed for responsible stigmatized targets. The results of this investigation have important societal significance and will yield a better understanding of the mechanisms involved in interpersonal sensitivity and the factors that influence this ability.