Treating social cognition impairment with the online therapy 'SoCoBo': A randomized controlled trial including traumatic brain injury patients.

OBJECTIVE: Acquired brain injuries (ABIs), such as traumatic brain injuries (TBIs), often entail impairments of general cognition (e.g., memory, attention or executive functions) and social cognition (e.g. emotion recognition, theory of mind [ToM], social problem-solving). The availability of fully computerized interventions targeting sociocognitive deficits specifically in neurologically impaired patients is extremely limited. Therefore, the Treatment Program for Deficits in Social Cognition and Social Competencies of the Ruhr University Bochum (SoCoBo), a fully computerized online therapy designed for ABI patients was evaluated in a randomized controlled trial involving TBI patients. METHOD: Sixty-four patients with TBI were randomly assigned to two groups with 43 patients fully completing either SoCoBo (N = 27) or a commercially available computerized program for cognitive rehabilitation (RehaCom®, N = 16). All participants underwent comprehensive pre-post online neuropsychological assessment and worked with their respective rehabilitation programs for four days a week during a scheduled period of 12 weeks. RESULTS: After treatment, the SoCoBo group, but not the RehaCom® group showed significant improvements in facial emotion recognition and self-rated empathy. Moreover, in the SoCoBo group, an increase in empathy was also associated with increased life satisfaction after treatment. There were no improvements in ToM and social problem-solving. Furthermore, general cognition did not improve in any of the groups. CONCLUSIONS: SoCoBo represents an effective new online therapy for the amelioration of deficits in key domains of social cognition. Its implementation in clinical practice will serve as a meaningful addition to the existing fully computerized approaches specifically in neurological patient groups.

Social cognition and occupational reintegration in primary central nervous system lymphoma long-term survivors: a secondary analysis of a combined data set.

OBJECTIVE: Although sociocognitive impairment is linked to failure of occupational reintegration in other clinical populations, less is known on the association of sociocognitive functioning and occupational reintegration in brain tumor patients such as primary central nervous system lymphoma (PCNSL). METHODS: Twenty PCNSL patients with ongoing complete response to therapy for at least one year were evaluated of whom eight resumed work. The association between occupational status, empathy, alexithymia and social problem solving was analyzed. RESULTS: Employed and non-employed patients were significantly different in their ability to provide appropriate solutions for social situations even when accounting for neurocognition. Decreased quality of life was associated with sociocognitive impairment. CONCLUSIONS: Although the results must be replicated in larger, more representative populations, this exploratory analysis tentatively adds facets to the literature on occupational reintegration in brain tumor patients. Forthcoming psychosocial research and clinical practice may target sociocognitive impairment when addressing reintegration after neuro-oncological treatment.

Impairments of Sociocognitive Functions in Individuals with Behavioral Addictions: A Review Article.

Since little is known about the exact pattern of social cognitive impairments related to behavioral addictions, the aim of the PRISMA-oriented review was to (i) provide an overview of relevant empirical publications, and to (ii) to elucidate which specific aspects of social cognition (i.e., emotion recognition, empathy, and theory of mind (ToM)) are impaired in different types of behavioral addictions. Behavioral addictions have been associated with cognitive deficits which may contribute to impaired social cognitive functioning. More recently, this domain has been investigated in patients with behavioral addictions as impaired social cognition detrimentally affects daily functioning and thus forms a relevant target for treatment. A systematic search in the PubMed and Web of Science databases was performed focusing on social cognitive functions in behavioral addictions. Studies focusing on the same social cognitive component were grouped together, this was done based on the used assessment measures. In total, 18 studies met the specified inclusion criteria. Five studies focusing on emotion recognition concluded that individuals with behavioral addictions show impairments in this domain. As for the 13 studies focusing on empathy and/or ToM, most of them found deficits linked to different types of behavioral addictions. Only two studies, one of which was investigating a distinct population (multiplayer online role-playing gamers) did not link empathy to behavioral addictions. The results show that the majority of studies focusing on social cognition and behavioral addictions found some deficits. Additional research focusing on this topic is urgently needed in behavioral addictions, addressing several methodological issues.

Fatigue and its relation to general cognition, social cognition and social activity in multiple sclerosis and stroke.

INTRODUCTION: The relationship between fatigue and (socio-)cognitive deficits in neurological diseases has sparked increasing research interest in the past years. So far, findings are inconsistent. Most studies focused on general cognitive functioning in specific disorders, particularly cancer or multiple sclerosis (MS). METHODS: This study aims to examine the relationship between fatigue, social cognition and social activity, also taking into account general cognition, more closely, including a stroke patient group (n = 57), a MS patient group (n = 31) and a healthy control group (n = 20). The participants underwent a comprehensive (socio-)cognitive test battery and completed questionnaires on fatigue and psychopathology which, in addition to fatigue, can also affect (socio-)cognitive performance. RESULTS: In both MS and stroke patients high fatigue scores were observed. Irrespective of aetiology, patients with high and low fatigue did not differ with regard to general cognition and social cognition. However, high fatigue scores were associated with a reduction of social activities in both patient groups. No other significant relationships were observed between fatigue and (socio-)cognitive measures. CONCLUSIONS: Future studies ought to further explore the potentially complex nature of fatigue symptoms and their relationship with (socio-)cognitive performance and social activity in neurological populations.

The effects of Autonomous Sensory Meridian Response (ASMR) videos versus walking tour videos on ASMR experience, positive affect and state relaxation.

OBJECTIVE: Autonomous Sensory Meridian Response (ASMR), the experience of a pleasant tingling on the neck and scalp, is known to be triggered by a characteristic type of videos (ASMR videos). The present study examines whether this experience is indeed specific to these ASMR videos, or whether it can also be triggered by other types of videos, e.g. walking tour videos. A further goal was to investigate differences between ASMR-responders and ASMR-non-responders regarding their ASMR sensation and to compare ASMR and walking tour videos with regard to the elicitation of positive affect and state relaxation. METHOD: Two online assessments were carried out in two different predominantly student samples, one involving ASMR videos (n = 205) and the other one walking tour videos (n = 96). In both groups, ASMR experience, positive affect and state relaxation were assessed. RESULTS: Compared to the walking tour video group, the ASMR-responders in the ASMR video group reported a pronounced ASMR sensation, higher state relaxation and higher positive affect scores. For ASMR-non-responders, lower scores in ASMR sensation, state relaxation and positive affect were revealed compared to the walking tour group. Without differentiating ASMR responder types, the ASMR group showed higher ASMR scores and lower positive affect scores compared to the walking tour group. CONCLUSIONS: Watching ASMR videos induced significantly more characteristic ASMR sensations compared to walking tour videos. Since ASMR videos typically include a simulated interaction of the video protagonist with the viewer and walking tour videos do not, the simulated interaction with the viewer might be one important factor for triggering ASMR. As the ASMR observer type (responder or non-responder) is crucial for benefitting from ASMR videos, future scientific evaluation of ASMR needs to consider this differention when evaluating effects of ASMR on mental heath associated domains.

Use of Technologies in the Therapy of Social Cognition Deficits in Neurological and Mental Diseases: A Systematic Review.

Objective: This article systematically reviews the effects of technology-based (TB) treatments on impaired social cognition (SC) in neurological and mental disorders. Methods: Strictly adhering to the PRISMA guidelines, a systematic search was carried out in PsycINFO, PubMed, and Web of Science (last search: April 22, 2021) to identify studies that, implementing a control group design, evaluated TB treatments targeting deficits in emotion recognition, Theory of Mind (ToM) and social behavior in adult patients with nondevelopmental and nonprogressive neurological or mental disorders. Risk of bias was assessed using the PEDro Scale, certainty assessment followed the GRADE approach. Results: Sixteen studies involving 857 patients, all focusing on psychotic disorders, were retrieved. The most pronounced effects were observed concerning emotion recognition with all studies revealing overall improvements. Regarding ToM and social behavior, results were mixed. However, the number of studies including outcome measures for these domains, is significantly lower compared to the domain of emotion recognition, limiting the validity of the results. Risk of bias and certainty assessment revealed further limitations of evidence. Conclusion: TB treatment achieves positive effects especially with regard to emotion recognition impairments, at least for patients with schizophrenia. Future research should expand the evaluation of TB training of other SC domains, ought to be carried out in more diverse patient populations, rely on different devices, and include follow-up measurements.

Social problem solving and trait socioemotional abilities in ambulatory stroke patients.

INTRODUCTION: Stroke has been associated with sociocognitive impairment, so far well documented for emotion recognition and Theory of Mind. However, more complex abilities, such as social problem solving, which directly facilitate appropriate behavior in social situations have been neglected in previous research. METHOD: The present study aimed to address this gap by focusing on performance-based social problem solving abilities and self-reported socioemotional abilities (i.e., empathy and alexithymia) in outpatient stroke patients (n = 36) compared to a group of healthy controls (n = 36) equivalent on age, gender, and education. In further analyses, potential lateralization effects and correlations between social problem solving/socioemotional functioning and demographic and clinical data were investigated. RESULTS: In the main analyses, patients were impaired in their ability to freely generate appropriate solutions for challenging interpersonal situations depicted in written scenarios but performed on a comparable level as healthy controls when they had to choose the optimal solution presented amidst a range of less optimal options. While showing difficulty in identifying the awkward elements in the scenarios, the patient group nevertheless rated the degree of discomfort attributed to these elements on a level comparable to the control group. On the self-report measures, stroke patients reported overall higher degrees of alexithymia (i.e., an inability to describe and identify one's own and other persons´ emotions) and more personal distress in response to other individuals´ emotional suffering as assessed by self-report. CONCLUSIONS: The present results suggest that stroke is associated with a broad impact on socioemotional and social problem solving abilities. As difficulties in social problem solving might be associated with increased psychosocial burden they ought to be addressed in stroke rehabilitation.

Point-of-Care Testing Using a Neuropsychology Pocketcard Set: A Preliminary Validation Study.

Neurocognitive screening instruments usually require printed sheets and additional accessories, and can be unsuitable for low-threshold use during ward rounds or emergency workup, especially in patients with motor impairments. Here, we test the utility of a newly developed neuropsychology pocketcard set for point-of-care testing. For aphasia and neglect assessment, modified versions of the Language Screening Test and the Bells Test were validated on 63 and 60 acute stroke unit patients, respectively, against expert clinical evaluation and the original pen-and-paper Bells Test. The pocketcard aphasia test achieved an excellent area under the curve (AUC) of 0.94 (95% CI: 0.88−1, p < 0.001). Using an optimal cut-off of ≥2 mistakes, sensitivity was 91% and specificity was 81%. The pocketcard Bells Task, measured against the clinical neglect diagnosis, achieved higher sensitivity (89%) and specificity (88%) than the original paper-based instrument (78% and 75%, respectively). Separately, executive function tests (modified versions of the Trail Making Test [TMT] A and B, custom Stroop color naming task, vigilance 'A' Montreal Cognitive Assessment item) were validated on 44 inpatients with epilepsy against the EpiTrack® test battery. Pocketcard TMT performance was significantly correlated with the original EpiTrack® versions (A: r = 0.64, p < 0.001; B: r = 0.75, p < 0.001). AUCs for the custom Stroop task, TMT A and TMT B for discriminating between normal and pathological EpiTrack® scores were acceptable, excellent and outstanding, respectively. Quick point-of-care testing using a pocketcard set is feasible and yields diagnostically valid information.

Sociocognitive Functioning and Psychosocial Burden in Patients with Brain Tumors.

Brain tumors may represent devastating diseases and neuro-oncological research in the past solely focused on development of better treatments to achieve disease control. The efficacy of tumor-directed treatment was evaluated by progression-free and overall survival. However, as neuro-oncological treatment became more effective, preservation and improvement of quality of life (QoL) was noticed to represent an important additional outcome measure. The need to balance between aggressive tumor-directed treatment and preservation of QoL was increasingly acknowledged in brain tumor patients. QoL is comprised by many determinants; one of those may have been rather neglected so far: social cognition. Since diagnosis and treatment of brain tumors represent demanding life situations, patients may experience increased psychosocial burden and the negative consequences of illness on well-being may be buffered by intact social relationships. These skills to build and maintain supportive social relationships essentially depend on the ability to empathize with others and to recognize and appropriately address social conflicts, i.e., "sociocognitive functioning". Therefore, sociocognitive functions may influence QoL and treatment outcome. In this article, we review the literature on psychosocial burden and sociocognitive functioning in adult brain tumor patients.

Mental time travel in patients "cured" from primary central nervous system lymphoma.

Introduction: Significant advances in neuro-oncological treatment led to considering neurocognitive functioning and everyday functional needs in patients with long-term survival. Since a potentially lethal disease interrupts normal life and represents a threat to physical and psychological integrity, patients have to cope with the new challenges. Long-term survival and even "cure" is possible in primary central nervous system lymphoma (PCNSL), however, suffering from a life-threatening disease may affect patients´ cognitive processing of past and future (i.e., the generation of personal past memories and generation of personal future events). Therefore, the present study aimed to assess how PCNSL long-term survivors remember their past and anticipate their future.Methods: Recall of past and anticipation of future events (i.e., mental time travel), both positive and negative, was assessed in 39 PCNSL patients with ongoing complete remission to therapy for at least 1 year in an adapted verbal fluency paradigm. A group of 39 healthy controls matched for age, gender and education was assessed with the same paradigm evaluating retrospective and prospective cognitions.Results: Concerning the generation of personal future events PCNSL patients anticipated significantly fewer negative events for the distant future as compared to healthy controls. At trend level, patients also reported fewer negative events regarding their recent past.Conclusions: The results provide support for an altered generation of personal future events (i.e., future-directed assumptions) in PCNSL patients with ongoing complete remission. Being "cured" after experiencing a threat to life might induce cognitive reappraisal processes and lead people to reexamine their priorities and principles in life, resulting in a less negative evaluation of (future) life (i.e., "optimism bias") after facing death. Clinicians should be aware of these possible cognitive and affective processes and of chronic psychological disturbances in cancer survivors. Possible adaptive strategies ought to be promoted in supportive (neuro)psychological therapy.

What Is on Your Mind? Impaired Social Cognition in Primary Central Nervous System Lymphoma Patients Despite Ongoing Complete Remission.

Within the past decades, long-term survival was achieved in a substantial fraction of primary central nervous system lymphoma (PCNSL) patients, expanding the focus of research to their quality of life (QoL). Social relationships crucially contribute to well-being in the context of adversity. Therefore, abilities that facilitate social interactions essentially determine QoL. The present study specifically targeted those sociocognitive abilities. Forty-three PCNSL patients with ongoing complete remission to therapy for at least one year and 43 healthy controls matched for age, gender and education were examined with standardized self-report and behavioral measures of social cognition. An impaired ability to comprehend others' feelings was found in patients for both positive and negative mental states. Patients had difficulties in identifying the awkward element in challenging social situations, whereas the degree of discomfort experienced in those situations was comparable between groups. Both the production of optimal solutions for social situations and the mere recognition of these among less optimal strategies were impaired in patients. Clinicians should be aware of possible sociocognitive impairment and ought to address this in additional supportive interventions. Impaired sociocognitive abilities may entail social conflicts at a time when patients rely on social support. This, in turn, could detrimentally affect QoL.

Configural processing of emotional bodies and faces in patients with attention deficit hyperactivity disorder.

Introduction: Attention Deficit Disorder (ADHD) is associated with interpersonal problems and difficulties in inferring other peoples' emotions. Previous research has focused on face processing, mostly in children. Our study investigated configural processing of emotional bodies and faces in adults with ADHD in comparison with healthy controls, analyzing P100, N170 and P250 event-related potentials (ERPs) and relating them to (socio)cognitive functioning. Method: Nineteen patients with ADHD and 25 healthy controls were presented upright and inverted bodies and faces which had to be categorized as neutral, happy or angry while ERPs were recorded. Additionally, sociocognitive and executive functioning was assessed. Results: In ADHD patients relative to controls, recognition of emotions depicted by bodies but not by faces was impaired and P100 amplitudes were enhanced for angry bodies. Furthermore, patients showed enhanced P250 amplitudes in response to both bodies and faces, specifically for happy and neutral emotions. Larger N170 amplitudes to bodies and faces correlated with lower alexithymia scores only in controls, while enhanced P250 amplitudes to both categories were associated with poorer inhibition only in patients. Conclusion: Adults with ADHD show potentially compensatory enhanced semantic processing of emotional bodies and faces, as reflected by increased P250 amplitudes, associated with poorer executive functioning and subtle alterations of emotional and configural processing, as reflected by ERPs.

Complete response to therapy: why do primary central nervous system lymphoma patients not return to work?

PURPOSE: Although primary central nervous system lymphomas (PCNSL) represent extremely aggressive brain tumours, high-dose methotrexate in combination with other chemotherapeutic agents has resulted in long-term disease control in a substantial fraction of patients. Advances in treatment efficacy with longer survival resulted in a focus on additional outcome measures such as quality of life (QoL) and neurocognition. Despite recent evidence of return to work as an important aspect of patients' QoL, little is known about occupational reintegration in PCNSL long-term survivors. This study aimed to detect specific characteristics of patients who successfully resumed work after complete response to therapy. METHODS: Patients with ongoing complete response to therapy completed a test battery capturing neurocognition, social integration, QoL and psychological burden. Of 25 patients who had been in regular employment before diagnosis only eight returned to work after treatment (32%). RESULTS: Patients who resumed work rated important aspects of their QoL and social integration as higher and suffered less from symptoms affecting QoL than patients who did not resume work. Also, the subjective confidence in their ability to work was higher in patients who resumed work, but independent predictors of return to work were not found in logistic regression analyses. CONCLUSION: Occupational (re)integration is of clinical relevance in PCNSL patients after complete response to therapy. Due to the small size of our cohort the present results should be considered an exploratory first step. Return to work might be a crucial aspect of QoL and (re)integration into society after cure of PCNSL.

Selective recall deficits for heterogeneous associations in detoxified individuals with alcohol use disorder.

AIM: Alcohol use disorder (AUD) has been associated with recognition memory deficits. However, it remains unclear whether these deficits occur at the general recognition memory level or whether they selectively affect its subcomponents. Evidence suggests that recognition memory deficits may vary according to the heterogeneity of memory stimuli. Our aim was to investigate stimuli pair-dependent recognition memory deficits in AUD, using a cued recall task including homogeneous and heterogeneous stimuli pairs. METHODS: Twenty-three patients with AUD (days since last alcohol consumption: 11.70 ± 10.20) and 23 healthy controls (HC) underwent a neuropsychological examination tapping attention, verbal fluency, logical, working and long-term memory, and a recognition and recall task involving both homogeneous (tool-tool) and heterogeneous (tool-scene, tool-animal) stimuli pairs. Group (AUD-HC) by condition (tool-tool, tool-scene, tool-animal) ANOVAs were performed on all neuropsychological indices. RESULTS: In the neuropsychological examination, AUD individuals showed deficits in delayed recall and faster reaction times compared with HC. The administration of the recognition and recall task revealed specific performance decreases in cued recall occurring in the whole sample (AUD + HC) for heterogeneous (tool-scene, tool-animal) pairs compared with homogeneous pairs. Within this pattern, AUD patients showed a lower cued recall rate than HC only for tool-animal pairs. CONCLUSIONS: Our results support the existence of specific recall/recollection deficits in AUD which occurred for heterogeneous, but not for homogeneous stimuli pairs. This finding calls for further neuroimaging investigations aimed at investigating the neurobiological substrate of (i) different recognition memory subcomponents, and (ii) the processing of stimuli with different degree or type of heterogeneity.

Research on cognitive and sociocognitive functions in patients with brain tumours: a bibliometric analysis and visualization of the scientific landscape.

BACKGROUND: Many patients with brain tumours exhibit mild to severe (neuro)cognitive impairments at some point during the course of the disease. Social cognition, as an instance of higher-order cognitive functioning, specifically enables initiation and maintenance of appropriate social interactions. For individuals being confronted with the diagnosis of a brain tumour, impairment of social function represents an additional burden, since those patients deeply depend on support and empathy provided by family, friends and caregivers. METHODS: The present study explores the scientific landscape on (socio)cognitive functioning in brain tumour patients by conducting a comprehensive bibliometric analysis using VOSviewer. The Web of Science Core Collection database was examined to identify relevant documents published between 1945 and 2019. RESULTS: A total of 664 English titles on (socio)cognitive functions in patients with brain tumours was retrieved. Automated textual analysis revealed that the data available so far focus on three major topics in brain tumour patients: cognitive functions in general and in paediatric cases, as well as psychological factors and their influence on quality of life. The focus of research has gradually moved from clinical studies with cognitive functions as one of the outcome measures to investigations of interactions between cognitive functions and psychological constructs such as anxiety, depression or fatigue. Medical, neurological and neuropsychological journals, in particular neuro-oncological journals published most of the relevant articles authored by a relatively small network of well interconnected researchers in the field. CONCLUSION: The bibliometric analysis highlights the necessity of more research on social cognition in brain tumour patients.

The role of trait empathy in the processing of observed actions in a false-belief task.

Empathic brain responses are characterized by overlapping activations between active experience and observation of an emotion in another person, with the pattern for observation being modulated by trait empathy. Also for self-performed and observed errors, similar brain activity has been described, but findings concerning the role of empathy are mixed. We hypothesized that trait empathy modulates the processing of observed responses if expectations concerning the response are based on the beliefs of the observed person. In the present study, we utilized a false-belief task in which observed person's and observer's task-related knowledge were dissociated and errors and correct responses could be expected or unexpected. While theta power was generally modulated by the expectancy of the observed response, a negative mediofrontal event-related potential (ERP) component was more pronounced for unexpected observed actions only in participants with higher trait empathy (assessed by the Empathy Quotient), as revealed by linear mixed effects analyses. Cognitive and affective empathy, assessed by the Interpersonal Reactivity Index, were not significantly related to the ERP component. The results suggest that trait empathy can facilitate the generation of predictions and thereby modulate specific aspects of the processing of observed actions, while the contributions of specific empathy components remain unclear.

Social problem solving in adult patients with attention deficit hyperactivity disorder.

Patients with Attention Deficit Hyperactivity Disorder (ADHD) experience interpersonal difficulties potentially linked to impaired social cognition. We aimed to investigate social problem solving strategies in adults with ADHD. Nineteen patients with ADHD and 20 healthy controls were assessed with a scenario-based battery gauging the ability to understand other people's mental states, to recognize interpersonal conflicts and to generate and identify optimal (i.e. both socially sensitive and practically effective) solutions to these conflicts. Furthermore, measures of socioemotional and executive functioning were administered. Patients and controls performed on a similar level with respect to theory of mind, the generation of the "best" solution to problematic social situations and the selection of the optimal solution out of alternatives. However, in a fluency task, patients generated fewer optimal solutions, while the number of only socially sensitive, only practically effective or irrelevant solutions was comparable in both groups. The overall ability to freely generate problem solutions was not linked to executive functioning or trait empathy, but better generation abilities were related to lower social interaction anxiety in the patients only. This suggests impaired generation fluency of optimal interpersonal conflict solutions in patients with ADHD which might contribute to higher levels of anxiety in social interactions.

Impairment of sociocognitive functions in patients with brain tumours.

The ability to decode mental states and to come up with effective solutions for interpersonal problems aids successful initiation and maintenance of social interactions and contributes to participation and mental health. Since these abilities of social cognition are challenged in highly demanding situations, such as diagnosis and treatment of a life-threatening illness, this article reviews the literature on emotion recognition, empathy, Theory of Mind and socially skilled behaviour in brain tumour patients. The data available suggest that patients are affected by a slight but consistent impairment of emotion recognition, empathy and Theory of Mind before and immediately after brain tumour treatment, with the degree of impairment being influenced by tumour histology and localization. Impairments mostly decrease a few months after surgery due to assumed neuroplasticity. Future research may address more complex sociocognitive functions, such as social problem solving, and may investigate to which degree sociocognitive difficulties act as risk factors for poor or failed reintegration into occupational and social life following successful brain tumour treatment.

Cortical thickness and trait empathy in patients and people at high risk for alcohol use disorders.

RATIONALE: Alcoholism not only affects individuals with alcohol use disorder (AUD) but also their biological relatives. This high-risk (HR) group has a higher probability to develop AUD. The aim of our study was to compare cortical thickness (CT) in AUD patients relative to participants with (HR) and without (non-HR) familial predisposition for AUD. We focused on empathy-related brain areas as sociocognitive impairment represents a known risk factor for AUD. METHOD: We examined 13 individuals with AUD, 14 HR individuals, and 20 non-HR participants using high-resolution T1-weighted magnetic resonance images (3 Tesla) to investigate differences in CT. CT was correlated with self-reported empathy in empathy-related areas. RESULTS: AUD patients showed decreased CT in the left inferior and superior frontal gyri, the right precuneus and bilaterally in the middle frontal gyri/the insula relative to the HR group, and in the left insula, the right middle frontal gyrus and bilaterally in the superior frontal gyrus/the precuneus relative to the non-HR group (all ps < 0.036, all ƞp2 between 0.161 and 0.375). Reduced CT in inferior, middle, and superior frontal gyri was related to cognitive (all ps < 0.036) and reduced CT in the inferior frontal gyrus to affective (p = 0.031) empathy. CONCLUSIONS: We present preliminary evidence of CT reduction in empathy-associated brain regions in patients with AUD relative to healthy participants with and without familial predisposition for AUD. The results have to be interpreted with caution due to low sample sizes and potential confounding effects of medication, gender, and withdrawal.