Many studies have shown that traumatic brain injury can result in difficulties with recognising emotions (39%), particularly fear and sadness and also in reduced empathy (60%). As therapists we are aware of the impact of these changes on relationships: when loved ones need comforting the most i.e. when they are frightened or upset, they are unlikely to get it from their injured partner who can appear detached and uncaring - often very different from how they used to be.
In treatment, a relational approach to this difficulty is essential (Neumann et al 2017) (Kreutzer (2015) so that those around the client as well as clients themselves are assisted to understand, adjust and adapt to such profound changes.
After all, empathy’s social role is to serve as the origin of the motivation for cooperative and pro-social behaviour as well as effective social communication.
Empathy as a concept links loosely to both Tom and Lauren’s earlier blogs…..
Empathy seems to be associated with activity in the ventro-medial pre-frontal cortex (the VMPFC), the area that may hold the key to the so-called executive paradox (Lauren’s topic). The executive paradox complicates assessment of capacity in many highly intelligent people. The VMPFC seems to contribute importantly to decision making where multiple factors apply and when situations are uncertain, ambiguous or specifically financial. These ingredients are often present in the decision making scenarios that prompt the need for capacity assessments. In a 2018 study (Beadle et al), people with VMPFC injuries behaved with little empathy in a financial context towards a man who was in a state of suffering compared to matched uninjured controls. The choices made by people with VMPFC injuries were also more likely to contribute to negative social impacts and evaluations. Andrew Worthington argues in the April edition of The Neuropsychologist that attention should be directed a bit less when assessing capacity at dorso-lateral pre-frontal cortex (DLPFC) related skills and more at ventro-medial function i.e. everyday tasks, social function and pre-injury behaviour as Lauren has pointed out. The overlap with empathy deficits may be relevant.
Moving to Tom’s musical theme……A study reported in Nature last month by Novembre et al suggests that there may be some mileage in musically based tasks to promote cooperation in those who have difficulty with empathic perspective taking (EPT). When asked to be the leader of a pair engaged in synchronising musical output using e-music boxes, low EPT as well as higher EPT individuals were able to modify their movements and speed to make it easier for their musical partner to synchronise with them. Does this finding support the idea of a relational approach to treating reduced empathy?
It is not clear whether treatment approaches alter only the cognitive aspect of empathy (the capacity to understand another's perspective or mental state). The emotional aspect (the capacity to respond with an appropriate emotion to another's mental state) may be more elusive. Is it the same missing ingredient that applies in the executive paradox where decision making needs the additional input of more emotional, “gut instinct” reasoning?
Louise Russell
Senior Consultant Clinical Neuropsychologist
Halliday Quinn Limited, Sep 13 2019