Changes in emotional empathy, affective responsivity, and behavior following severe traumatic brain injury

Abstract

This study was designed to examine the relationship between deficits in empathy, emotional responsivity, and social behavior in adults with severe traumatic brain injury (TBI). A total of 21 patients with severe TBI and 25 control participants viewed six film clips containing pleasant, unpleasant, and neutral content whilst facial muscle responses, skin conductance, and valence and arousal ratings were measured. Emotional empathy (the Balanced Emotional Empathy Scale, BEES: self-report) and changes in drive and control in social situations (The Current Behaviour Scale, CBS: relative report) were also assessed. In comparison to control participants, those in the TBI group reported less ability to empathize emotionally and had reduced 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. Relative reported loss of emotional control was significantly associated with heightened empathy, while there was a trend to suggest that impaired drive (or motivation) may be related to lower levels of emotional empathy. The results represent the first to suggest that level of emotional empathy post traumatic brain injury may be associated with behavioral manifestations of disorders of drive and control.

Keywords:

• Emotional empathy
• Emotional contagion
• Emotional responsivity
• Loss of emotional control
• Loss of drive

Acknowledgments

This study is a component of the primary author's doctoral dissertation conducted under the supervision of the second author. The authors wish to thank all who participated in the study, including the people with traumatic brain injuries, their families, and community controls who gave willingly of their time. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

¹Zygomaticus data for 4 participants with TBI, corrugator data for 4 participants with TBI, and skin conductance data for 12 participants (7 controls, 5 TBIs) could not be used because of equipment problems.

²The one participant with PTA of 1 day (Participant 15), is classified as severe according to Russell and Smith (1961) and Jennett (1976; i.e., PTA of 1 day or more) but mild using the Mississippi classification scales (Nakase-Richardson et al., 2011), although in both classification systems, the presence of documented radiological abnormalities, as was seen in this participant, suggests a complicated brain injury. In addition, this participant reported experiencing social difficulties following the injury and had undergone inpatient rehabilitation. For two participants (5 and 8), injuries were many years ago, and no estimate of PTA was available. Participant 5 suffered a fall at work 14 years earlier, resulting in damage localized to his left posterior cerebral hemisphere. He spent 4 months in intensive care and a further 24 months in brain injury rehabilitation. He was a builder premorbidly but has remained unemployed since. Participant 8 was hit by a golf club 27 years earlier with trauma to his left frontal lobe. He was hospitalized for one month before commencing extensive inpatient rehabilitation.