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Theory of Mind and Empathy As Multidimensional Constructs Neurological Foundations Top Lang Disorders Vol. 34, No. 4, pp. 282–295 Copyright c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Theory of Mind and Empathy as Multidimensional Constructs Neurological Foundations Jonathan Dvash and Simone G. Shamay-Tsoory Empathy describes an individual’s ability to understand and feel the other. In this article, we review recent theoretical approaches to the study of empathy. Recent evidence supports 2 possible empathy systems: an emotional system and a cognitive system. These processes are served by separate, albeit interacting, brain networks. When a cognitive empathic response is generated, the theory of mind (ToM) network (i.e., medial prefrontal cortex, superior temporal sulcus, temporal poles) and the affective ToM network (mainly involving the ventromedial prefrontal cortex) are typically involved. In contrast, the emotional empathic response is driven mainly by simulation and involves regions that mediate emotional experiences (i.e., amygdala, insula). A decreased empathic response may be due to deficits in mentalizing (cognitive ToM, affective ToM) or in simulation processing (emotional empathy), with these deficits mediated by different neural systems. It is proposed that a balanced activation of these 2 networks is required for appropriate social behavior. Key words: emotion, empathy, inferior frontal gyrus, mirror neurons, simulation, theory of mind, ventromedial prefrontal cortex NE of the core functions of individu- have provided evidence of the multidimen- O als living within a society is the attribu- sional nature of ToM. In this article, we review tion of mental states to others. This function, main approaches to the study of the neural ba- known as theory of mind (ToM) or “mental- sis of ToM and empathy (including tasks used izing” (Frith, 1999), enables an individual to to elicit them), describe the neurological un- understand or predict another person’s be- derpinnings for the multidimensional nature havior and to react accordingly. Much of the of ToM and empathy, and discuss these find- research on ToM has viewed it as a unitary ings in relation to clinical interventions. construct, focusing on cognitive mentalizing about others—thinking about the thoughts, ToM AND EMPATHY intentions, and beliefs of others. Technologi- cal advances in neuroscience enabling the in- The ability to infer the thoughts and feel- vestigation of neurophysiological functioning ings of others is critical for appropriate and ef- fective social interactions and discourse com- prehension, but it is not sufficient. Belief un- Author Affiliations: Department of Special derstanding does not guarantee emotion un- Education, Bar Ilan University, Ramat Gan, Israel (Dr Dvash); and Department of Psychology, derstanding; emotion understanding does not University of Haifa, Haifa, Israel (Dr guarantee empathy; and empathy does not Shamay-Tsoory). guarantee sympathy as manifested by kind- Drs. Dvash and Shamay-Tsoory have indicated that ness to people (Davis & Stone, 2003). Hence, they have no financial and no nonfinancial relation- empathy is the link between knowing the ships to disclose. thoughts and feelings of others, experiencing Corresponding Author: Jonathan Dvash, PhD, De- partment of Special Education, School of Education, them, and responding to others in caring, sup- Bar Ilan University, Max ve-Anna Webb St, Ramat Gan portive ways. 52900, Israel ([email protected]). Theory of mind is part of a person’s DOI: 10.1097/TLD.0000000000000040 empathic ability, a broader term that also 282 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Theory of Mind and Empathy as Multidimensional Constructs 283 encompasses the emotional aspect of infer- Broadly speaking, empathy refers to the ring and sharing the emotional experiences reactions of one individual to the observed of another. Empathy is a central theme in the experiences of another (Davis, 1994). Some psychological sciences, as well as in neuro- scholars view empathy as a cognitive process, science, and has become a prominent field of stressing the ability to engage in the cognitive research in recent years. Empathy describes process of adopting another individual’s psy- an individual’s ability to understand and feel chological perspective. This process, which the other. Because empathy links one’s feel- can be termed cognitive empathy (and when ings about the self to feelings about the other, including an inference on affective aspects it is a fundamental part of the social fabric can also be known as affective ToM or af- of emotion. In examining empathy and ToM, fective cognitive ToM), may be defined as an the natural focus of cognitive and psychody- active attempt by one person to get “inside” namic psychologists is on psychological pro- another’s mind or to approach someone men- cesses rather than on brain mechanisms. Yet, tally through a deliberate intellectual effort. recent experimental studies have shown that In other words, cognitive empathy describes impaired empathy is observed in both neuro- a situation in which the subject is an active logical and psychiatric populations, suggest- agent deliberately attempting to step outside ing that empathy may be mediated by dedi- the self and “into” the other’s experiences; it cated neural networks (Brothers, 1990). involves a cognitive recognition of the emo- Researchers and clinical personnel are ex- tions of others. This process may involve pressing increased concerns regarding “loss perspective taking (Eslinger, 1998) and ToM of empathy.” In Great Britain, Baron-Cohen (Shamay-Tsoory, Tomer, Goldsher, Berger, & (2011) published the book, Zero Degrees of Aharon-Peretz, 2004). It is thought to be de- Empathy, in which he describes patterns of pendent on several cognitive capacities, such ToM skills and empathy deficits in persons as cognitive flexibility and memory (Davis, with autism, Asperger’s syndrome, and a vari- 1994; Eslinger, 1998; Grattan, Bloomer, Ar- ety of psychiatric conditions.1 In the book, chambault, & Eslinger, 1994). Born for Love: Why Empathy Is Essential Other studies in the field have used a def- and Endangered, Perry and Szalavitz (2010) inition of empathy that showcases its affec- explain how empathy develops or is threat- tive aspects. Such studies refer to the ability ened as a result of genetics and social inter- to experience affective reactions to the ob- actions. The most recent version of the Diag- served experiences of others as “affective em- nostic and Statistical Manual of Mental Dis- pathy” (Davis, 1994). According to this view, orders, Fifth Edition (American Psychiatric empathy may be regarded as an emotional re- Association, 2013), added specifiers regard- action of the observer when perceiving that ing “callous-unemotional” behaviors to the di- another is experiencing or is about to expe- agnostic criteria for disruptive behavior dis- rience an emotion. There is, however, a criti- orders in children. These specifiers describe cal difference between cognitive empathy (af- behaviors associated with deficits in empa- fective cognitive ToM) and emotional or af- thy (e.g., callous disregard of the feelings of fective empathy. Whereas cognitive empathy others) and affective interpersonal ToM (e.g., involves cognitive understanding of another lack of remorse or guilt; shallow or deficient person’s perspective, emotional empathy in- affect). cludes appropriating these feelings, at least on a gross level (pleasant-unpleasant; Mehrabian & Epstein, 1972). Previously, it was argued that the various aspects of empathy are inter- 1In the United States, this book was published under the related and interact throughout development title, The Science of Evil: On Empathy and the Origins (Hoffman, 1978). Recent theories of empathy, of Guilt. however, have introduced multidimensional Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 284 TOPICS IN LANGUAGE DISORDERS/OCTOBER–DECEMBER 2014 (Davis, 1994) and integrative (Decety & Jack- eye gaze, Yoni’s facial expression, or the eye son, 2004; Preston & de Waal, 2002) mod- gaze and facial expression of the face to which els that bind several aspects of empathy and Yoni is referring. In the cognitive conditions, empathy-related behaviors. Considering this both Yoni’s facial expression and the verbal definition of empathy, it appears that affective cue are emotionally neutral, whereas in the empathy is the basis for cognitive empathic affective conditions, both cues provide af- ability. Furthermore, it appears that cognitive fective information (i.e., Yoni is thinking of empathy, as opposed to affective empathy, in- [cognitive condition] vs. Yoni loves [affec- volves creating a cognitive ToM regarding the tive condition]). That is, the cognitive condi- other’s mental and emotional states. tion requires understanding beliefs about the other’s beliefs and desires (Yoni is thinking INVESTIGATING ToM AND EMPATHY of the toy that ___ wants) whereas the affec- CONSTRUCTS tive condition involves understanding of one’s emotions with regard to the other’s emotions Evidence for the neural bases of multi- (Yoni loves the toy that ___ loves). The “Yoni” ple dimensions of ToM has come from sev- task has been used in studies of neurologi- eral sources: functional neuroimaging stud- cal (Shamay-Tsoory et al., 2007) and psychi- ies of neurotypical participants, patients atric populations (Shamay-Tsoory et al., 2007, with brain injuries or psychopathologies, 2010),
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