Interacting and dissociable effects of alexithymia and depression on empathy.

Major-depressive-disorder (MDD) and alexithymia have both been associated with empathy deficits. We examined whether depression and alexithymia show dissociable or interacting effects on cognitive and emotional trait and state empathy. Healthy controls with high and low alexithymia and MDD-patients with high and low alexithymia were assessed. We used the Interpersonal-Reactivity-Index-questionnaire (IRI) for trait cognitive and emotional empathy and the Multifaceted-Empathy-Test (MET) for state cognitive and emotional empathy. Firstly, we found a main effect of alexithymia, irrespective of depression, on trait and state cognitive empathy: High alexithymia subjects showed lower scores in perspective taking (IRI) and in the cognitive-empathy-component of the MET. Secondly, we found main effects of alexithymia and depression on trait emotional empathy (IRI-subscale personal distress). Moreover, we found a significant depression-by-alexithymia-interaction on trait emotional empathy: MDD-patients showed particularly high personal distress when affected by alexithymia (IRI). Thirdly, alexithymia and depression had no impact on state emotional empathy (MET). However, analyzing positive and negative trials separately, we found more emotional empathy in MDD-patients concerning negatively valenced stimuli. Our data suggest dissociable and interacting effects of MDD and alexithymia on empathy. Importantly, except for heightened personal distress, empathy deficits in MDD-patients were entirely due to concurrent alexithymia.

Empathy in depression: Egocentric and altercentric biases and the role of alexithymia.

BACKGROUND: Major depressive disorder (MDD) has been associated with empathy deficits. The exact nature of these deficits and their relation to concurrent alexithymia remain unknown. Here we tested under which conditions MDD patients with high and low alexithymia show deficient empathy, particularly investigating empathic abilities when inhibition of self-related emotional states is needed and when it is not. METHODS: Healthy controls (low: n=28, high: n=14) and currently depressed MDD patients (low: n=11, high: n=18) with low or high alexithymia performed an emotional egocentricity paradigm based on tactile stimulation. This task measures empathic judgements, when emotional states of self and other differ and inhibition of self-related emotional states is needed, and when they do not and thus empathic judgments can be based on simple projection mechanisms. RESULTS: Only alexithymia but not depression decreased empathy, in situations when simple projection sufficed. However, when inhibition of self-related emotional states was needed, MDD patients showed an egocentric bias during empathic judgments and an altercentric bias during self emotion judgments, the latter suggesting heightened emotional contagion, both independent of alexithymia. Across the entire sample, alexithymia decreased the size of the egocentric bias. LIMITATIONS: This study was based on a relatively sample size. CONCLUSIONS: These results suggest that MDD patients show intact empathic judgments, when simple projection is required and no concurrent alexithymia is present. In situations when incongruent emotional states of self and other have to be resolved, MDD patients are prone to egocentric and altercentric biases.

Where the depressed mind wanders: Self-generated thought patterns as assessed through experience sampling as a state marker of depression.

BACKGROUND: Self-generated thoughts (SGTs), such as during mind wandering, occupy much of our waking life. Individuals with Major Depressive Disorder (MDD) are less in the "here and now" and prone to rumination. Few studies have looked at SGTs in depression using experience sampling methods and no study has so far investigated the specific contents of depressive SGTs and how they vary from one time point to another. METHODS: MDD patients (n=25) and matched healthy controls (n=26) performed an established mind wandering task, involving non-demanding number discriminations. Intermittent probe questions ask for participants' current SGTs, that is, how off-task the thoughts are, how positive or negative, self- or other-related, and past- or future-oriented. RESULTS: Multi-level modelling revealed that MDD patients engaged in more mind wandering than healthy controls. Their SGTs were predominantly negative and less positive, more self-related and past-oriented. Strongest predictor of depressive SGT was the decreased positive valence of thoughts. MDD patients' future and past-oriented thoughts were particularly more negative compared to healthy controls. Within MDD patients, the less positively valenced thoughts they had and the less variable these thoughts were, the more depressive symptoms they showed. LIMITATION: No other measures of rumination and worry were used. CONCLUSION: MDD patients show a very specific SGT pattern, possibly reflecting ruminative and anxious thoughts. This SGT pattern in depression might represent a useful state marker and even constitute an etiological factor of this debilitating disease, considering the importance of current SGT on and individual's cognitive processes and affective states.