The effects of emotional valence and intensity on cognitive and affective empathy after insula lesions

The insula plays a central role in empathy. However, the complex structure of empathic deficits following insular damage is not fully understood. While previous lesion research has shown variable deficits in patients with insular damage on basic discrimination tasks or self-report measures, it is unclear in how far patients with insular damage are impaired in cognitive (CE) and affective empathy (AE) functions depending on valence and arousal of stimuli using an ecologically valid paradigm. In the present study, patients with insular lesions (n = 20) and demographically-matched healthy controls (n = 24) viewed 16 videos (duration: 60 sec each) that varied in terms of valence and emotional intensity. The videos showed a person (target) reporting on a personal life event. In CE conditions, subjects continuously rated the affective state of the target, while in AE conditions they continuously rated their own affect. Mean Squared Error (MSE) assessed deviations between subject and target ratings (CE: deviation between targets and participants ratings of targets emotions; AE: deviation between targets and participants self-ratings of emotion). Patients differed from controls only in negative, low intensity AE, rating their own affective state less negative than the target rated his/her affect. This deficit was not related to trait empathy, neuropsychological or clinical parameters, or laterality of lesion. Our findings provide important insights into the profile of social cognition impairment after insular damage. Empathic functions may be widely spared after insular damage in a naturalistic, dynamic setting, potentially due to the intact interpretation of social context cues by residual networks outside the lesion. The particular role of the insula in AE for negative states may evolve specifically in situations that bear higher uncertainty, which points to a threshold role of the insula in online ratings of AE.