Motivation and emotion/Book/2016/MDMA and emotional empathy

Definition


Empathy is one’s ability to perceive and understand another’s emotional experience. Commonly expressed as the capacity to put yourself in someone else’s shoes, the ability to empathise with another person involves being able to view a situation from their perspective and thus relate to how they would be feeling in that situation. Not to be confused with sympathy, which can be defined as one’s ability to experience feelings of sadness or disappointment in regards to another’s misfortune, empathy extends further as it is the ability to not simply feel for another but rather to feel what they would be feeling. Empathy is an integral aspect of developing social cognition, essential for motivating prosocial behaviour (McDonald & Messinger, 2011).

Neurology
Although empathy has long been recognized as a construct of human emotion, it is not until recently due to the emergence of social cognitive neuroscience and technological advances that researchers have begun to investigate the neural mechanisms of empathy (Walter, 2012).

Mirror neurons
The first pivotal discovery occurred one day in 1992, when Italian researchers chose to eat their lunch inside the laboratory. As they ate, they noticed when the laboratory monkeys watched them eat, they displayed the same neural activity as if they were eating as well (Gerdes, Segal & Lietz, 2010). This observation lead to the imperative discovery of mirror neurons; a distinctive class of neurons found in the ventral premotor and posterior parietal cortices which fire not only as an individual is performing an action but when said individual observes the same action as well. Thus the same motor neuron which is fired when a monkey reaches for a peanut is fired when a monkey observers another reaching for a peanut. The discovery of these neurons provided an explanation as to why observed behaviour, which theoretically should be void of meaning to the observer, can be translated into something which the observer is not only able to understand but also elicits a measurable response (Gallese, 2009). Though the existence of mirror neurons in humans is less clear, neuroimaging studies have indicated the neural pathways involved with action implementation correspond to those involved when an action is observed. Similar to the regions observed in monkeys, these shared neural networks have been observed in the premotor cortex, the inferior frontal gyrus, the parietal lobule, the supplementary motor area, and the cerebellum. Furthermore, studies have shown brain areas pertaining to the same networks are activated during the imagining of an action performed by either oneself or another as well as during the imitation of another’s actions. Akin to those found in the monkeys, these shared neural networks reflect a neural conversion of another’s behaviour into one’s own, thus epitomising at a neurological level, the emotional contagion of the empathetic construct (Decety & Meltzoff, 2011).

Neural networks


The discovery of mirror neurons paved the way for future breakthroughs to occur which would improve our understanding of the brain and its orchestration of emotions and social interactions. One of these prominent discoveries was made by empathy theorist Jean Decety in 2004. Decety et al. (2004) correlated the verbal articulations of empathy with observable neurological patterns recorded using neuroimaging techniques, to discover empathy can be understood as four neural networks which comprise of both affective and cognitive processes, acting in an interconnected manner (Gerdes, Segal & Lietz, 2010). These four neural networks are:
 * 1)  Affective sharing: Which refers to an individual’s reflection on an experience which they have observed (e.g., feeling amusement one may get when observing another laugh). Based upon the automatic perception-action coupling of neural pathways as observed in mirror neurons, resulting in shared representations of an emotion, such as facial expressions, or physical reactions.
 * 2) Self-awareness: Observer’s ability to be able to clearly differentiate between their vicarious experience and the real experience of the person they are observing.
 * 3) Mental flexibility: Cognitive ability to accurately conceive an experience from another’s person’s perspective.
 * 4) Emotion regulation: One’s ability to regulate the mirrored emotions felt subsequent to observation.

This finding was the first to suggest empathy is the result of varying neural networks which interact interconnectedly to create the complete experience of empathy. Thus suggesting a deficit in one component will result in an incomplete empathic reaction (e.g., observing another laughing and cognitively being able to understand the emotion they are feeling but being unable to relate to that emotion, thus experiencing no sense off amusement or joy oneself (Decety & Jackson, 2004; Decety & Moriguchi, 2007). This finding has not only furthered our understanding of the neural orchestration of empathy but also aided in providing a possible explanation for some mental disorders such as Autism or schizophrenia, which are characterised by atypical displays of empathy.

Furthermore, more recently a meta-analysis of 40 fMRI studies found a correlation of neural activity recorded in the insula during displays of affective empathy and activity within the mid cingulate cortex and adjacent dorsomedial prefrontal cortex during displays of cognitive empathy (Eres, Decety, Louis & Molenberghs, 2015).

Empathy theories
There are a few psychological theories which explore how people come to understand each other by way of empathetic response. The two most significant of these theories in explaining empathy are Simulation Theory and Theory of Mind (otherwise T.o.M).

Simulation theory
Stemming from the discovery of mirror neurons, simulation theory pertains action observation facilitates the transition from facial perception to emotional perception, which results in the display of empathy. Suggesting that we make sense of others behaviours by activating mental process which if acted upon mimic the behaviour of that we have observed. This can be thought of or understood as a mental projection of one’s own emotion onto another, as we use our previous knowledge of our own emotion and emotions at a time of an event to predict the behaviours of others. Hence observing individual in pain, we can project our understanding of what the pain would feel like and therefore anticipate their emotional response of hurt, resulting in empathy as we to would understand that feeling of hurt they are currently feeling.

Largely based on biological evidence, the simulation theory suggests the epistemological role of empathy to derive from a survival need to process and understand our surroundings efficiently in order to act upon them. Thus the mental mirroring of others behaviours enables us to quickly relate to and make sense of our current environment Decety & Grèzes, 2006).

Theory of mind
Theory of Mind suggests, as one is only aware of and able to assess their own mind through introspection, we presume based on our knowledge of the existence of our own mind, that others would similarly have a mind of their own. This understanding is believed to only be fully developed by the time a child reaches five years of age, as the child is then both cognitively and emotionally developed enough to be able to both conceptualise another’s emotions and understand the feeling of that emotion within themselves, whilst remaining aware it is not a feeling which they are experiencing. Thus, based on this greater level of cognitive and emotional understanding, a child is now able to see the world through another’s perspective and is able to understand that others have perceptions, beliefs, desires and intent different from one’s own.

A renowned study which validates the existence of theory of mind is known as the false belief task. Although this study has now been replicated numerous times with altering methodology, typically the study consists of children being told a story of two characters, commonly known as Sally and Anne. Sally and Anne have both a box and a basket between them, Sally also has a marble and places the marble in the basket before she leaves the room. In Sally’s absence, Anne takes the marble out of the basket and hides it in the box. The researcher then asks the child where they believe Sally will look for the marble once she returns. Generally the findings suggest, children between the ages of 4-5 years old, will answer that Sally will look in the basket, despite knowing themselves that the marble is no longer in the basket, they are able to differentiate between their beliefs and what Sally’s beliefs would be having not been in the room to witness the marble being moved. A child younger than that however will typically respond that Sally will look in the box, as they are unable to differentiate between their knowledge of having seen the marble being moved and what Sally’s knowledge of the marbles whereabouts would be (Wellman, Cross & Watson, 2001)

FACT A deficit in Theory of Mind is commonly known as a hallmark of Autism Spectrum Disorder. As individuals with Autism often have difficulty in taking on the perspective of others and understanding how their behaviour is affecting others. Resulting in an inability to determine the behaviours of others and to display social reciprocity as they aren’t able to interpret the emotions of others. When participating in the false belief study, autistic children comparably older than the control age of 4 – 5 years of age were still not able to distinguish between the divergent perceptions of belief between Sally and Anne (Baron-Cohen,2000).

Development of empathy


Originally thought to be an emotion too sophisticated and complex for young children to be capable of, empathy is now understood to be present from infancy. From as young as just a mere few hours old, infants display "contagious crying"; when a newborn hears another infant crying they become markedly distressed and often begin to cry themselves. This is display of concern for another’s distress is an early observation of empathic concern. By the age of two nearly all toddlers are capable of engaging in a helping behaviour when confronted with another’s distress. Continuously developing, young infants typically display primarily physical responses (e.g., hugging, patting on the back), possibly responses which they have observed, however by the age of three toddlers are capable of a variety of empathic behaviours, able to display empathy both physically and verbally. By the age of five years old children begin to develop the ability to cognitively empathise as well as emotionally as they begin to develop the ability to understand another’s perspective, thus enabling them to be able to relate to and understand how someone else would be feeling in a given situation. This ability to relate to another by seeing the world from their perspective, is otherwise known as having a Theory of mind (McDonald & Messinger, 2011).

 Individual differences 

Prosocial helping behaviours continue to develop through infancy to early adulthood (0-20 years). Originally thought to be an aspect of an individual’s typical development, researchers have begun to question whether or not empathy is more similar to that of a trait, meaning that some people may be more empathetic than others. In a longitudinal study conducted by Knafo, Zahn-Waxler, Van Hulle, Robinson & Rhee, (2008) they investigated the development of both affective and cognitive empathy spanning over 3 to 14 years of age. They found that individual differences in prosocial behaviours remained stable throughout the years, suggesting some people may be more prosaically disposed than others. Though more longitudinal research is needed to confirm their findings (McDonald & Messinger, 2011).

Types of empathy
Empathy is generally thought to be comprised of two major components: affective empathy (otherwise known as emotional empathy) and cognitive empathy. Although there is yet to be an agreed upon definition, the general consensus suggests:
 * Affective Empathy (AE): One’s ability to share another’s emotional experience at a visceral level. Often described as the vicarious sharing of emotions, it is a largely an unconscious automated response which is brought on by observing another’s emotional state. An example of affective empathy could be thought of as if someone close to you was upset and started to cry and by observing this you felt their sadness/pain and started to cry as well. That sharing of another’s emotional state is affective empathy.
 * Cognitive Empathy (CE): One’s ability to consciously interpret and understand another’s emotional state. That is to conceptualise and understand why someone is feeling a certain way. Thought to be predominately conscious, cognitive empathy requires an individual to be able to make sense of their situation by drawing upon various schemas and prior knowledge of similar experiences, thus enabling the individual to respond appropriately.

What is MDMA?
3, 4-Methylenedioxymethamphetamine MDMA, otherwise more commonly known as Ecstasy or Molly is a psychoactive drug that alters mood and perception used most prevalently as a recreational drug. The amphetamine derivative is a popular recreational drug which produces an acute, rapid enhancement in the release of both serotonin (5-HT) and dopamine. Ecstasy most commonly comes in both a tablet form, which can vary in shape, size, colour and logo, or in the form of a capsule. Doses and purity vary but generally range between 80mg – 100mg a capsule / tablet. After being consumed, MDMA typically takes between 30 and 60 minutes to start affecting the individual. After 70 to 120 minutes, the effects peak, including a raised level of empathy, emotional openness, euphoria, increased sociability, mild hallucinations and an altered sense of time. Ecstasy can be ingested orally, by smoking it or inhaling it, orally being the most common method (Green, Mechan, Elliott, O'Shea & Colado, 2003).

History of MDMA
The historical underpinnings of the drug MDMA are unclear. Surrounded by misconception and hearsay it is difficult to derive the truth. Believed to have first been patented on December 24th 1912 in Germany by E. Merck, whilst attempting to create a therapeutic compound to aid in reducing blood loss, Merck unintentionally produced MDMA. Subsequent to Merck’s discovery the drug is thought to have gone unnoticed for the next 40 years until 1953 when the drug was rumoured to have been investigated by the US army as a means of a chemical war time code. It is also believed to have been given to German troops during world war one as a substance to suppress appetite and to enhance as stimulation for those on the front line (Pentney, 2001).

The first therapeutic use of the drug is believed to have occurred in 1976, used adjacently with psychiatric treatment. The use of MDMA became widely popular among psychotherapists, as it facilitated communication between the therapist and patient (Green, Mechan, Elliott, O'Shea & Colado,2003). It was during this period the drug began to form its recreational roots, as it is believed that patients wanted to share their therapeutic experience with friends and slowly through word of mouth the drug began to gain popularity. In 1981 the drug became commercialised in the black market as Ecstasy, reaching mass production level by 1983 (Pentney, 2001).

MDMA and empathy
MDMA is often classified as an empathogen due to its release of serotonin and norepinephrine. Known to produce prosocial feelings, the drug is often taken both recreationally and therapeutically for its enhancement of empathy and sociability. In a study by Hysek et al.,(2013), MDMA enhanced affective but not cognitive empathy, and impaired ability to read and interpret negative facial expressions and emotions. Similar results have been reported by various other researchers (Wardle & de Wit, 2014; Hysek, Domes & Liechti, 2012; Hoshi, Bisla & Curran, 2004), suggesting a confirmation as to the positive short term effects of MDMA on empathy.

It is due to these positive short-term side effects that empathy has been trailed and used as a therapeutic drug to aid in therapy of various mental disorders. As the ability to empathise has been postulated to be a prerequisite for social interaction, it enable's one's understanding of another’s intentions and motivations. The absence of this ability impairs an individual’s ability to behave in a prosocial way, inhibiting empathy and moral judgement (Decety & Moriguchi, 2007). Peole with Autism Spectrum Disorder, for example, display atypical presentations of empathy as studies have found individuals on the autism spectrum report lower than average levels of empathic concern and comforting responses to those in distress. Believed to have causational roots at neurological level, those on the autism spectrum display a reduction in their mirror neural activity (Minio-Paluello, Lombardo, Chakrabarti, Wheelwright & Baron-Cohen, 2009). Thus the use of MDMA has been suggested to aid in socially adapting autistic individuals. To date, 1133 autistic individuals have been administered MDMA, in a trial to attempt to prove the benefits of MDMA assisted therapy which could enable autistic adults to become more empathetic and socially aware (Danforth, Struble, Yazar-Klosinski & Grob, 2016).

Similarly, MDMA has been previously used as a treatment for post-traumatic stress disorder (PTSD) is a disorder that arises after a person experiences a traumatic event (e.g., a car accident, war or sexual assault). The symptoms of (PTSD) include distress being either mental and in some cases physical, worrying thoughts, anxiety and sleep apnoea due to reoccurring distressing or disturbing dreams. In the MDMA assisted psychotherapy group, patients with PTSD were administered a controlled dose of MDMA. Lasting up to eight hours the therapist remained present to aid the patient at any time if needed but typically they would only converse when needed to give support otherwise the session was silent, thus inducing the MDMA psychological process. Whilst the sessions were aimed not to be verbal there was physical reassurance given if needed. The two assisted sessions were then followed closely with non-assisted sessions to examine any lasting effects which may have been present after the assisted sessions as well as to aid the patient with any emotional debriefing needed. Through this method it may be possible for MDMA to be administered as a treatment in a safe manner. Although there was no significant reduction in symptoms, the study did provide useful insight into the administration of MDMA in a therapeutic setting (Oehen, Traber, Widmer & Schnyder, (2013).

Limitations
Despite the seemingly positive effect of MDMA assisted psychotherapy further study is warranted, especially as little research which has been done in the way of the long-term side effects of MDMA use in humans. One study conducted found prolonged use of MDMA has been known to change the axon terminals of doperminergic pathways which are used to carry dopamine throughout the brain. MDMA interrupts the release of the GH hormone also known as (HGH) responsible for cell regeneration (Curran, Rees, Hoare,Hoshi & Bond, 2004). However, majority of the research conducted has been found to be inconclusive (Green, Mechan, Elliott, O'Shea & Colado, 2003). Furthermore, most of the existing research has been conducted on users of the drug or on individuals who do not suffer from any pre-existing mental illnesses such as anxiety or depression. Thus, MDMA assisted therapy as a means of treating those with illnesses hallmarked by a lack of empathy is still in the trial stage, as longitudinal studies as to the effect of the already known adverse long-term effects (increased anxiety, depression) is needed on individuals already suffering from similar pre-existing illnesses to avoid exacerbating the issue.

Quiz
Test your knowledge!

{The neurons which were discovered to play a large role in the development of empathy are called?} + Mirror Neurons - Mimic Neurons - Mirror Imaging Neurons - Matching Neurons

{ Individuals with Autism Spectrum Syndrome are hallmarked by a deficit in?} - Their ability to visualise others - Their lack of emotion towards others + Their inability to determine the behaviour of others - Their inability to like others

{ Affective empathy refers to?} - One's ability to cognitively understand another's emotions - One's ability to act on another's emotions + One's ability to share another's emotions - One's ability to empathise

{ Infants first display the ability to empathise with others by?} - Laughing when other people laugh - Watching and being inquisitive about their environment - Smiling when they see their mother + Crying when they hear another baby cry