Empathy is a critical component necessary for the development and maintenance of successful interpersonal relationships. Given that severe Traumatic Brain Injury (TBI) is known to produce marked changes to social functioning, and although the existence of empathy deficits in a significant proportion of people with TBI is generally well accepted, it is surprising that few studies have directly examined empathy in this population. The present series of research attempted to close this gap in the literature by providing a comprehensive investigation into the deficits in emotional and cognitive empathic abilities following severe TBI. Each of the three studies represents the first to implement psychophysiological indices of emotional responding, including facial electromyography (EMG) and skin conductance, to assess emotional (Studies 1-3) and cognitive (Study 2) empathy impairments after severe TBI, using different methods to evoke emotion responses, including facial expressions (Study 1), emotionally evocative pictures (Study 2), and film clips (Study 3). The assessment of empathy post-injury is especially pertinent given the rapid increase in incidence of TBIs, and the potential negative repercussions of empathy deficits to social functioning and quality of life.Study 1 examined self-rated emotional empathy, in addition to facial mimicry and skin conductance responses during exposure to happy and angry facial expressions in 21 adults with severe TBI and 22 control participants. In comparison to control participants, those in the TBI group displayed a reduction in the ability to empathize emotionally, and showed reduced physiological responding to the emotional expression of anger. By contrast, the control group spontaneously mimicked the emotional expressions they were exposed to, regardless of affective valence, and also demonstrated higher skin conductance responsivity to angry faces. The data provided further important evidence which suggested that reduced emotional empathy plays a role in the emotional response deficits to angry facial expressions following severe TBI.Study 2 examined the relationship between self-reported emotional and cognitive empathy and psychophysiological responding to emotionally evocative pictures in 20 adults with severe TBI and 22 control participants. Pictures with alternating pleasant, unpleasant and neutral content selected from the International Affective Picture System (IAPS) were presented whilst facial muscle responses, skin conductance, and valence and arousal ratings were measured. Self-reported emotional and cognitive empathy questionnaires were also administered. In comparison to control participants, those in the TBI group displayed a reduction in the ability to empathize both emotionally and cognitively, and evidence that these two aspects of empathy may be interconnected was established. Further, similar to the findings of Study 1, TBI participants showed reduced facial responding to unpleasant pictures, while also rating them as less unpleasant and arousing than controls. In addition, they exhibited lowered autonomic arousal to all pictures, regardless of affective valence. Interestingly, hypoarousal to pleasant pictures in particular was found to be related to the absence of empathy observed after TBI, and is consistent with the view that impaired emotional responsivity is associated with impairment to the empathy network. Study 3 addressed the relationship between affective empathy, emotional responsivity, and social behaviour in a sample of 21 adults with severe TBI and 25 control participants. Film clips containing pleasant, unpleasant and neutral content were presented whilst facial muscle responses, skin conductance, and valence and arousal ratings were measured. Self-reported emotional empathy questionnaires were also administered in addition to a range of neuropsychological tests. A close relative of each TBI participant completed the Current Behaviour Scale (CBS) to assess for changes in social behaviour (i.e. emotional control and drive) occurring as a consequence of the injury. In accordance with Studies 1 and 2, compared to control participants, those in the TBI group displayed a reduction in the ability to empathize emotionally. Further, TBI participants showed an impaired pattern of facial responding to both pleasant and unpleasant films. They also exhibited lowered autonomic arousal, as well as abnormal ratings of valence and arousal, particularly to unpleasant films. Despite failing to find a relationship between emotional empathy and physiological responding in the TBI sample, interestingly, relative reported loss of drive was significantly related to poor empathy, whereas by contrast, relative reported loss of emotional control was associated with heightened empathy levels in this population. The results of Study 3 represent the first to suggest that level of emotional empathy post injury is associated with disorders of social functioning (i.e. drive or control). Taken together, the results of these studies are the first to reveal that reduced emotional responsiveness and social functioning observed after TBI is linked to changes in empathy in this population. This has important implications for understanding the impaired social functioning and poor quality of interpersonal relationships commonly seen as a consequence of TBI, and may be key to comprehending and treating empathy deficits post-injury.
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