Periodic Reporting for period 2 - PARENT_EMPATHY (Imaging circles of engagement: Neural correlates of parent empathic distress in the context of chronic pain) Reporting period: 2021-04-01 to 2022-03-31 Summary of the context and overall objectives of the project Chronic pain affects the lives of over a quarter of adolescents world-wide. Chronic pain in youth does not only affect the adolescent themselves, but also their caregivers. For a parent to see their child suffering is particularly distressing. Parents of children with chronic pain are more likely to suffer from stress, anxiety or depression. On the other hand, the parents' response can also powerfully modulate (i.e. mitigate or magnify) their child’s pain-related functioning. A key, so far neglected, variable may be parent empathic distress, hindering the parents’ ability to respond in ways to promote the child’s functioning. The mechanisms underlying parent empathic distress and its impact have not been studied before.The PARENT_EMPATHY project examines the mechanisms underlying parent empathic distress and its impact on parent responses and child's functioning. The project included a functional magnetic resonance imaging (fMRI) study aiming to understand parent empathic responses to their child’s pain. The project utilizes an empathy paradigm that harnesses each child's personal and unique pain experiences. Due to COVID-19, part of the project is carried out virtually with a stronger emphasis on behavioural correlates of parent empathy.The current objectives are:1. to define the behavioural correlates of parent empathic distress triggered by observing their own child’s pain2. to examine to what extent parent empathic distress responses contribute to individual differences in parent pain-related cognitions, fears and behaviours.3. to examine what extent parent empathic distress responses contribute to individual differences in child functioning.The central hypothesis is that parents’ empathic distress triggered by observing their child’s pain is of key importance for understanding parent-child interactions in the context of paediatric pain and that identifying the driving mechanisms will provide novel points for parent-targeted treatment strategies, having important clinical implications. Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far During the first, outgoing phase of the MSCA, the PARENT_EMPATHY core project was started at the host institute Stanford University in the Biobehavioral Pediatric Pain (BPP) lab, under the mentorship of Prof. Laura Simons. The preparation phase included refinement of the empathy paradigm, obtaining ethical approval, programming of the questionnaires and the paradigm, and the start of participant recruitment and data collection. Due to the COVID-19 pandemic, research with human participants was halted for a long time and it was decided to continue data collection virtually with a focus on behavioural correlates of parent empathy. Data collection has finished now, but with substantial delays.Our first results show that the empathy paradigm is feasible, and elicits empathic distress as well as compassion in the parents. Preliminary analyses shows that parent empathic responses are stronger for their own child compared to an unfamiliar child. In addition, an existing measure to assess empathy for pain (the Empathy for Pain Scale by Giummarra and colleagues, 2015) was adapted to be used in parents in the context of paediatric pain. Analyses support the idea that empathic distress is a key variable that explains associations between parent pain-related cognitions (e.g. worries) and their behaviour and responses (e.g. overprotectiveness, psychology flexibility), and hence may be a viable target for parent interventions. Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far) Treatment strategies are starting to actively target parent distress and behaviour, to enhance overall treatment success and family functioning. Thus far, parents’ affective responding has not been studied extensively. Hence, parent empathic distress represents an important, additional target for psychological interventions. The PARENT_EMPATHY project will increase understanding of mechanisms driving parental affective responses and behaviours to their child’s pain and will determine to what extent empathic distress responses contribute to individual differences in parent cognitions and behaviour as well as in individual differences in child pain-related functioning. Together, this knowledge is imperative to inform and optimize parent-targeted treatments to impact child health.Furthermore, we are building a repository of the stimulus materials we are collecting for the empathy paradigm, including the audio vignettes and photos of various facial expressions (when explicit consent and assent is provided for video use). We expect that this could have an enormous impact on future research projects by our group and other groups worldwide.Lastly, although data analyses are still ongoing and dissemination will continue after the end of the MSCA, preliminary findings of the PARENT_EMPATHY project have already been disseminated via oral and poster presentations at (inter)national conferences, social media, teaching of (under)graduate students, and participation in clinical work groups focused on pain rehabilitation for youth and their families. These efforts to achieve societal impact will be continued after the end of the MSCA. Visual summary of PARENT_EMPATHY
