Neural dynamics between anterior insular cortex and right supramarginal gyrus dissociate genuine affect sharing from perceptual saliency of pretended pain

Empathy enables us to share and understand the emotional states of other people, often based on their facial expressions. This empathic response involves being able to distinguish our own emotional state from someone else’s, and it is influenced by how we recognize that person’s emotion. In real life, knowing and identifying whether the facial expression we are witnessing reflects genuine or pretended pain is particularly important so that we can appropriately react to someone’s emotions and avoid unnecessary personal distress. How our brains manage to do this is still heavily debated. Two areas, the anterior insular (aIns for short) and the mid-cingulate cortex, appear to be activated when someone ‘feels’ someone else’s pain. However, these regions might just automatically be triggered by vivid emotional facial expressions, regardless of whether we really respond to that pain. To examine this question, Zhao et al. measured brain activity as healthy adults watched video clips of people either feeling or pretending to feel pain. The activation of aIns was particularly related to the emotional component that someone shared with another person’s genuine pain, but not to pretended pain. This suggests that neurons in the aIns track a truly empathic response when seeing someone who is actually experiencing pain. Effective connectivity analyses which reflect how brain areas ‘crosstalk’ also revealed distinct patterns when people viewed expressions of genuine, as opposed to pretended pain. Zhao et al. focused on the interactions between the alns and the right supramarginal gyrus, a brain region which helps to distinguish another person’s emotions from our own. This crosstalk tracked others’ feelings when participants viewed expressions of genuine but not of pretended pain. Put together, these findings provide a more refined model of empathy and its neural underpinnings. This will help further our understanding of conditions such as autism or depression, in which a person’s social skills and emotional processing are impaired.