Research Programs

Investigating Racially-Modulated Neuromarkers of Pain Empathy with Electrophysiology

PI: Alessandro D'Amico, Ph.D. Student

Team: Dr. Virginia de Sa (PI), Alessandro D’Amico (Co-PI), Dr. Sarah Fabi (Co-PI)

Project Description: Racial biases manifest in various forms from a disproportionately Black prison population in the U.S., to Black patients’ pain being consistently underestimated and symptoms inadequately treated. While education and training may be effective at reducing biases, ameliorating biases by increasing empathy and compassion is another worthy goal. In order to accurately measure changes in empathy, we must first better understand the neural correlates of empathy and how those neural correlates are modulated by racial biases. To do this, we will investigate EEG correlates of perceived pain in others versus self. We hypothesize we’ll be able to isolate the neural correlates of empathic pain by comparing the differences between a participant’s response to their own versus other faces and we further expect to see a racial bias such that White participants’ neural responses to their own face look more like those to White faces than to Black faces. Our research is an important first step toward better understanding the neural correlates of racially-modulated empathy and our findings will allow us to design novel interventions in order to ameliorate racial bias in individuals.

 

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Pilot study to assess the usability and utility of a text-based system to deliver ecological momentary stress assessments to attending and resident physicians.

PI: Byron Fergerson, M.D.

Team: Byron Fergerson, M.D. (PI), Matthew Herbert Ph.D., Minh Hai Tran MBBS

Project Description: Physician stress is at epidemic proportions and is affecting patient care. To combat this, we must continuously assess stress levels using validated measures. Currently, such measures are administered irregularly with minimal coordination. Stress fluctuates making infrequent assessments ineffective. We are developing a system to deliver a single-item stress question via text to evaluate the real-time stress of attending physicians. We believe this system will minimize recall bias and maximize in-the-moment validity. We will enhance engagement with wellness education, anonymous feedback options, and personalized stress metrics. We envision the future of this system as a means to continuously monitor physician stress.

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2nd Year Renewal- An established paradigm for defining the physiological roots of empathy and compassion -- what can rodents teach us?

PI: Laleh Quinn PhD

Team: Laleh Quinn PhD (PI), Andrea Chiba PhD, Nicole La Grange

Project Description: Empathy is often considered to have a dual nature, one side holding an affective component, the other cognitive.  Phylogenetically more ancient, affective empathy may be considered to exist in “lower” animals that are capable of sharing the emotional state of others.  Our studies utilize a rodent model to shed light on the roots of both affective empathy and compassion. We will determine whether rats share in the distress of another, and whether such shared affect enhances or hinders helping behavior, a proxy for compassion. Our findings could also have the benefit of resulting in a better understanding, and thus treatment of “lower” animals.

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Two heads are better than one: the coordination of cooperative risk assessment in prosocial rat groups

PI: Lara Rangel, Ph.D.

Team: Lara Rangel Ph.D. (PI), Teryn Johnson

Project Description: Social groups can provide critical cooperative protection from danger. When groups work together to assess and combat threats, key roles can be divided among members, requiring mechanisms for communicating and coordinating decisions across the group. When encountering new visual stimuli, albino rats freeze and exhibit horizontal side-to-side head swaying gestures. Notably, jointly housed rats coordinate the number, onset, speed, duration, and instantaneous phase of these gestures among group members. This project investigates whether coordinated head swaying constitutes a shared affective state (a form of empathy) and embodied communication in prosocial rats that facilitates group decisions in response to mutual threats.

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Molecular and neuronal basis of social empathy in mice

PI: Scott Sternson, Ph.D.

Team: Scott M Sternson, Ph.D. (mentor), Zhenggang Zhu (postdoc)

Project Description: Motivation elicited by observation of the actions of a conspecific is prominent in mammals and is an evolutionarily conserved proxy for human empathy and compassion. However, the relationship between how the brain encodes self-motivated behaviors versus social motivation is unclear. For example, are there distinct cell types in the brain for self-motivation and observation-evoked empathy, or is there a shared circuitry encoding motivated-behavioral-states that reflect convergence points between self-motivated and social behaviors? This question can be investigated in the mouse hypothalamus, which has diverse cell types and is a key integratory site for self-motivation (e.g., feeding and drinking), social interaction, and encoding other's motivation. Our hypothesis is that molecularly defined hypothalamic 'empathy neurons' act as a bridge for integrating social information and interact with the self-motivation neurons to trigger social empathy. Our project will test the hypothesis by modeling empathy behaviors, functionally identifying empathy neurons via volumetric two-photon calcium imaging, and delineating their molecular identity.

A Networked Improvement Community to Improve Physician/Trainee Peer Support During the Covid-19 Pandemic

PI: Alan Card, PhD, MPH

Team: Alan Card, PhD, MPH (PI), Byron Fergerson, MD, Sidney Zisook, MD 

Project Description: This project will test a new model for improving physician peer support. The UC San Diego Networked improvement Community for Excellence in Wellbeing (NICE Wellbeing) will provide Physician Wellness Directors in each department with improvement science tools and training to facilitate shared learning while helping address the hyper-local drivers of burnout and wellbeing. It will also serve as a platform for research and dissemination about the impacts of physician peer support efforts. 

 

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Stay-at-home Wellness Ecological Momentary Assessment in Late Life (StayWELL) Study

PI: Lisa Eyler, PhD

Team: Lisa Eyler, PhD (PI), Federica Klaus, MD, PhD, Raeanne C. Moore, PhD, Colin Depp, PhD

Project Description: StayWELL investigates the relationship of social restrictions during the coronavirus pandemic to psychological health in a well-characterized sample of older adults (>65 years). The virtual study, which began in June 2020 and is ongoing, collects self-report data, including on compassion and empathy (CE), using online questionnaires and ecological momentary assessment via mobile surveys, as well as passive assessment of keyboard use and geolocation throughout the pandemic. Prior to StayWell, participants had been randomized to one of four conditions in a 6-month intervention – two that included mindfulness meditation and two that did not; mood, cognitive performance, and positive psychological traits were assessed at baseline, 6, and 18 months. Thus, we can now examine the trajectory of changes in psychological health, including momentary measures of CE, from before to during and after the period of extended pandemic-related restrictions and understand how CE and previously-learned meditation skills might buffer negative changes due to social isolation.

 

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LIGHT Therapy for Reducing Burnout and Increasing Compassion in Physicians

PI: Paul Mills, PhD

Team: Paul Mills, PhD (PI), Ying Choon Wu, PhD, Rusty Kallenberg, MD, Nicole Wells, Sydney Kessler, Paula Jackson, Thomas George Thudiyanplackal

Project Description: Light-Induced Guided Healing Therapy (LIGHT) is a novel meditation program that employs light hypnosis and guided imagery to stimulate the creative imagination for advancing specific intentions. This study examines the effects of an 8-week LIGHT program for physicians to increase relaxation, decrease symptoms of burnout and increase resilience and compassion. Electroencephalographic (EEG) and electrocardiographic (ECG) data will be recorded using unobtrusive wearable sensors to examine right versus left hemisphere dominance and magnitude of frontal low alpha power along with non-linear dynamics to provide insight into changes in arousal and brain activity during LIGHT therapy that may support reductions in mental stress.

 

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Parent-Child Dual Digital Meditation & Compassion Training in Families with Child Mental Illness

PI: Jyoti Mishra, PhD

Team: Jyoti Mishra, PhD (PI), Susan Tapert, PhD, Desiree Shapiro, MD

Project Description: The most commonly diagnosed child mental illnesses (ADHD, anxiety and depression) are prevalent in nearly 10% of US children. Building upon our prior success with digital meditation strategies in children and adults, this project will test a parent-child Cooperative meditation and Compassion (COCO) training approach as a scalable intervention for these families. We hypothesize that COCO training will sustainably ameliorate behavioral symptoms of child mental illness and will drive neuro-cognitive improvements in children. The project includes a nation-wide remote study as well as a local cohort in which measures of parent-child co-neural synchrony during co-operative meditation will be examined.

 

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Helping physicians calibrate empathetic statements during chronic pain visits

PI: Federico Rossano, PhD

Team: Federico Rossano, PhD (PI), Anne White, PhD, Stephen Henry, MD, MSc, Ming Tai-Seale, PhD, MPH

Project Description: Chronic pain is one of the most commonly discussed topics in primary care, yet both physicians and patients describe visits about chronic pain as “difficult”. These discussions likely contribute to high levels of physician stress, dissatisfaction and burnout. Relying on a mixed-method approach that will include analysis of video and audio recordings of clinical visits, post-visit questionnaires and physicians visit elicitation interviews, we aim to identify the interactional contexts in which physicians’ empathetic and compassionate statements are most effective in chronic pain routine visits. This will facilitate training and interventions to help physicians improve patient rapport when discussing chronic pain. 

 

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Implementing and Pilot-Testing a Coordinated Multidimensional Organizational Compassion Intervention to Reduce Burnout and Absenteeism

PI: Ming Tai-Seale, PhD, MPH

Team: Ming Tai-Seale, PhD, MPH, Marlene Millen, MD, Thomas Savides, MD, Christopher Longhurst, MD, MS, Lin Liu, PhD, Gene Kallenberg, Neal Doran, PhD

Project Description: Exacerbated by COVID-19, physician burnout and staff absenteeism challenge many healthcare organizations. In a recent survey of UC San Diego Health physicians, 50% of respondents reported burnout, 86% reported modest to excessive frustration with EHR, 11% viewed the degree to which their care team work together as optimal, and 55% reported no mindfulness practices. The goal of this project is to develop, implement, and evaluate an organizational compassion intervention to reduce physician burnout and improve workforce stability. We aim to reduce EHR workload, implement a brief compassion team practice for integration into daily care team huddles, and evaluate their effectiveness.

 

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Enhancing Neurobehavioral Effects of Compassion Training Using Immersive Visual Imagery

PI: Erik Viirre, MD, PhD

 

Team: Erik Viirre, MD, PhD, Cassandra Vieten, PhD, Ying Wu, PhD, Trisha Williams, Robert Twomey, PhD, Margaret Cullen

Project Description: Approaches to psychosocial compassion training require eyes-closed visualization exercises. However, what if it is difficult for you to visualize? Or to quiet your mind enough to focus? Our project will explore how training for compassion may be enhanced through adding immersive virtual reality experiences mimicking these visualizations, and thus boosting the effectiveness of training. We know that similar immersive VR scenarios can reduce pain ratings during uncomfortable medical procedures, can reduce depression and anxiety, and can induce a sense of awe. Might the development of compassion be facilitated when participants can receive visual imagery support to anchor their "mind's eye"?

 

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Brain mechanisms supporting empathy cultivation and phantom limb-based analgesia by psilocybin therapy

PI: Fadel Zeidan, PhD

Team: Fadel Zeidan, PhD (PI), Adam Halberstadt, PhD, Mark Geyer, PhD, Timothy Furnish, MD

 

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Impact of Proactive Outreach and a Pragmatic Intervention on Provider Compassion and Distress During COVID-19: A Mixed Methods Study

PI: Sidney Zisook, MD

 

Team: Sidney Zisook, MD, Judy Davidson, DPN, RN, Neal Doran, PhD, Nancy Downs, MD, Daniel Lee, MD, PhD, Isabel Newton, MD, PhD

Project Description: The Healer Education, Assessment and Referral (HEAR) program is a unique approach to enhancing UC San Diego trainee and healthcare provider wellbeing and mental health and prevent burnout and suicide. It utilizes a multipronged approach aimed at increasing awareness, reducing stigma, identifying distressed individuals, and providing counseling and mental health referrals. Two key components are: 1) an online, anonymous Interactive Survey Program (ISP) which proactively screens for distress and facilitates referral for mental health care; and 2) a no-cost, personalized, confidential counseling program for housestaff. Focusing on these components, this study will compare pre- and post-COVID sources and levels of distress among UC San Diego healthcare providers and assess the effectiveness of HEAR’s counseling program in reducing distress and promoting compassion and wellness among house staff.

Intracranial Empathy Research in Humans

PI: Eric Halgren, PhD

Team: Eric Halgren, PhD (PI), Jerry Shih, MD, Sharona Ben-Haim, MD, Jacob Garrett, Leena Kansal, MD, June Yoshii-Contreras, MD, David Lee, MD, PhD 

Project Description: Neuroimaging with fMRI and PET have found that the experience of empathy in humans partly involves the same regions as analogous firsthand experiences. However, understanding the mechanisms of empathy requires measuring the moment by moment precise interactions between brain regions. This project will make such measurements in patients who receive intracranial electrodes to guide treatment of their epileptic seizures, revealing on the scale of the local population synaptic and action potentials, how affective and sensory states of oneself and others are mapped to neural populations, and how empathic representations are modulated by social context and personality.

 

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A Pilot Evaluation of the Impact of Compassion Meditation on Brain Functioning

PI: Ariel J. Lang, Ph.D., M.P.H.

Team: Ariel J. Lang, Ph.D., M.P.H. (PI), Deborah L. Harrington, Ph.D., Mingxiong Huang, Ph.D.

Project Description: Compassion meditation (CM) is a contemplative meditation practice designed to strengthen and sustain compassion. Working with a group of US military veterans with posttraumatic stress disorder (PTSD), we showed that CM, as compared to a relaxation training, was associated with clinically meaningful change in symptoms of PTSD and depression as well as increases in social connectedness and empathy. This study builds on those finding to examine change in brain function associated with CM or standard PTSD treatment. We will recruit participants (n = 30) among individuals who are receiving care in VA San Diego PTSD clinics. Prior to treatment, participants from each group will undergo neuroimaging protocols to understand changes in brain reactivity during empathetic processing that arise from meditation. We will also investigate potential downstream benefits of intervention on brain networks underlying CM by analyzing their associations with secondary psychological outcomes. These pilot data will be used to generate hypotheses and demonstrate feasibility to support additional work focused neural markers of cultivating compassion in Veterans with PTSD.

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Training the Neural Basis of Empathic Awareness in Physician Trainees Leveraging Real-time Virtual Reality

PI: Jyoti Mishra, PhD

Team: Jyoti Mishra, PhD (PI), Yuriy Svidinenko, Alana Iglewicz, MD, Dhakshin Ramanathan, MD PhD

Project Description: Studies show that medical students, susceptible to professional burnout and emotional fatigue, can benefit from mindful meditation practice. In this project, we will deliver a highly scalable digital meditation practice to medical students and further integrate closed-loop neurofeedback of relevant anterior cingulate and insula based brain circuitry, delivered in virtual reality, as a complement to the meditative practice. In a three-arm study of (1) Digital Meditation; (2) Digital Meditation plus Neurofeedback; (3) Waitlist Control, we will investigate subjective wellness outcomes, as well as plasticity of neural and cardio-respiratory systems, in order to evaluate efficacy of the novel wellness approach.

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Neurobiological underpinnings of the relationship between loneliness and empathy

PI: Christopher Oveis, PhD

Team: Christopher Oveis, PhD (PI), Charles T. Taylor, PhD

Project Description: Loneliness is an increasing problem within society. Although loneliness’ adverse intrapersonal effects on health and well-being are well-known, it remains poorly understood whether loneliness also has detrimental interpersonal effects. This project examines whether loneliness diminishes empathy and compassion during face-to-face interactions, and tests reduced vagal activity as a potential neurobiological mechanism. We conduct the work through an interpersonal lens, measuring key outcomes in both empathizer and sufferer. Determining whether and how loneliness interferes with empathy and compassion will advance understanding of processes that could be targeted in efforts to reduce healthcare professional burnout and its detrimental impact on patient care.

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Neural foundations of helping and compassion in infancy

PI: Dr. Linsey Powell

Project Description: Helping and compassion emerge early in human development: at one year of age, infants already display concern for others and help them achieve simple goals.  This project will use fNIRS to investigate the neural basis of early prosociality, as well as early parochialism.  What infant brain systems respond when others are in need, and how do these responses predict infants’ efforts to help?  What neural signals of social value predict infants’ favoritism toward some individuals over others?  Characterizing the neural origins of prosocial behavior will help us understand how to promote the growth of helping and compassion early in development.

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An established paradigm for defining the physiological roots of empathy and compassion -- what can rodents teach us?

PI: Laleh Quinn PhD

Team: Laleh Quinn PhD (PI), Andrea Chiba PhD, Nicole La Grange

Project Description: Empathy is often considered to have a dual nature, one side holding an affective component, the other cognitive.  Phylogenetically more ancient, affective empathy may be considered to exist in “lower” animals that are capable of sharing the emotional state of others.  Our studies utilize a rodent model to shed light on the roots of both affective empathy and compassion. We will determine whether rats share in the distress of another, and whether such shared affect enhances or hinders helping behavior, a proxy for compassion. Our findings could also have the benefit of resulting in a better understanding, and thus treatment of “lower” animals.

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 Brain mechanisms supporting empathy cultivation, compassion development, and pain-relief by compassion-based mental training

PI: Fadel Zeidan, PhD

Team: Fadel Zeidan, PhD (PI), Thomas Liu, PhD (Investigator), Douglas Ziedonis, MD (Investigator)

Project Description: The proposed longitudinal psychophysical and neuroimaging study will examine the effects of three different standardized and validated 8 week mental training interventions [Compassion Cultivation Training (CCT); Mindful Self-Compassion (MSC); Mindfulness-Based Stress Reduction (MBSR)] on behavioral and neural empathy, compassion, and pain responses. We will employ a functional MRI (fMRI) based standardized pain empathy evocation paradigm to determine if mental training increases behavioral and neural empathetic responses. The proposed research activities are highly novel and will provide one of the most comprehensive mechanistic dissection of CCT, MSC, and MBSR performed to date.

Alessandro D'Amico

Research Project: Investigating Racially-Modulated Neuromarkers of Pain Empathy with Electrophysiology

Project Description: Racial biases manifest in various forms from a disproportionately Black prison population in the U.S., to Black patients’ pain being consistently underestimated and symptoms inadequately treated. While education and training may be effective at reducing biases, ameliorating biases by increasing empathy and compassion is another worthy goal. In order to accurately measure changes in empathy, we must first better understand the neural correlates of empathy and how those neural correlates are modulated by racial biases. To do this, we will investigate EEG correlates of perceived pain in others versus self. We hypothesize we’ll be able to isolate the neural correlates of empathic pain by comparing the differences between a participant’s response to their own versus other faces and we further expect to see a racial bias such that White participants’ neural responses to their own face look more like those to White faces than to Black faces. Our research is an important first step toward better understanding the neural correlates of racially-modulated empathy and our findings will allow us to design novel interventions in order to ameliorate racial bias in individuals.  

 

Amy Bellinghausen, MD

Research Project: Development and Implementation of a Mindful Self-Compassion Curriculum to Reduce Burnout in Critical Care Providers

Project Description: Burnout frequently affects critical care workers, due to long work hours and high patient mortality rates. Once burnout develops, providers give less empathetic patient care. My work in the ICU Recovery Clinic – where I see thankful patients who were critically ill but now returning to health and work – has brought fulfillment to myself and others when I bring these stories back to ICU providers. Using these stories as a foundation, I aim to build and implement a compassion curriculum for critical care providers addressing both personal resiliency and moral distress. I will assess burnout pre- and post-intervention using the Maslach Burnout Inventory. The funding provided and proposed course of study will enable me to increase my knowledge of current strategies in empathy and compassion research and establish a foundation as a national leader and funded clinician scientist in critical care-related burnout study and treatment, as well as to refine the burnout curriculum further. 

 

Jon Dean, PhD

Research Project: Brain Mechanisms Supporting Empathy Cultivation and Phantom-limb Based Analgesia by Psilocybin Therapy

Project Description: Psilocybin is a serotonergic psychedelic that induces enhancements in positive affect, social connectedness, and empathy and compassion. Moreover, pilot studies and our own case report have demonstrated that serotonergic psychedelics including psilocybin ameliorate intractable phantom limb pain. Psilocybin decreases default mode network (DMN) activity, circuitry supporting self-referential processing, and increased DMN-sensorimotor cortex connectivity is associated with phantom pain. Existing therapies for phantom limb pain are associated with modulation of classical inhibition of pain. Yet, the psychological and neural mechanisms supporting empathy, compassion, and analgesia by psilocybin are unknown. This trial will test the effects and neural mechanisms supporting psilocybin (versus placebo-niacin) for empathy-cultivation and analgesia in individuals with chronic phantom limb pain.

 

Zhenggang Zhu, PhD

Research Project: The evolutionary origins of empathy – molecular and neuronal basis of social motivation in rodents

Project Description: Motivation elicited by observation of the actions of a conspecific is prominent in mammals and is an evolutionarily conserved proxy for human empathy and compassion. However, the relationship between how the brain encodes self-motivated behaviors versus social motivation is unclear. For example, are there distinct cell types in the brain for self-motivation and observation-evoked empathy, or is there a shared circuitry encoding motivated-behavioral states that reflect convergence points between self-motivated and social behaviors? This question can be investigated in the mouse hypothalamus, which has diverse cell types and is a key integratory site for self-motivation (e.g., feeding and drinking), social interaction, and encoding others' motivation. Our hypothesis is that molecularly defined hypothalamic 'empathy neurons' act as a bridge for integrating social information and interacting with the self-motivation neurons to trigger social empathy. Our project will test the hypothesis by modeling empathy behaviors, functionally identifying empathy neurons via volumetric two-photon calcium imaging, and delineating their molecular identity.

 

Melissa Karnaze Hedayati, PhD

Research Project: Assessment of Compassion Cultivation Training

Project Description: This qualitative evaluation study will investigate how trainees and professionals in health fields perceive facilitators and barriers to implementing Compassion Cultivation Training (CCT; Compassion Institute) in their daily lives. My main research questions are: (1) How do participants think about facilitators of, and barriers to, compassion prior to, and after completing CCT?; (2) How do they view their ability to implement CCT into daily life?; (3) How do they perceive how it feels to receive compassion, as well as show compassion to others and oneself?; and (4) How do they define compassion and thus describe situations in which compassion occurs?