Psychiatry & Psychotherapy Podcast - Microexpressions: Fear, Surprise, Disgust, Empathy, and Creating Connection Part 2

Episode Date: May 15, 2018

Microexpressions are brief, involuntary facial expressions that are cues to the true emotions that someone is feeling. We see microexpressions in tiny twitches of the brows, the lips and nose. They can last for as little as 1/15th of a second on the face. In this episode, we describe the science of the microexpressions of fear, disgust, and surprise and how to use it to connect with others. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. For full PDF of the episode with links to videos of each emotion go to: https://psychiatrypodcast.com/resources Join Ariana on Instagram: @joyspotting Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Welcome to the Psychiatry and Psychotherapy Podcast, the podcast to help you in your journey towards becoming a wise, empathic, genuine, and connected mental health professional. I'm your host, Dr. David Puter, a psychiatrist who splits his time practicing psychopharmacology, individual and group psychotherapy, medical director of a day treatment program, medical education research, and teaching, residents, and medical students. All right, so this is the second part of the podcast. I am here with soon-to-be Dr. Arianna Cunningham. Hello, welcome to the sequel.

And we are going to start out with fear. So, Ariana, how is fear seen in the face? So fear on the face, you're going to see raising the upper eyelids, tensing of the lower eyelids, kind of bugging out, the eyes get bigger when you're looking at the face. And the eyebrows are going to go up and together. Yeah, so unlike fear, which goes down and together. And like anger. And like, oh, sorry.

Yeah, I was thinking anger. We keep going back and forth between fear and anger, which can sometimes come next to each other timewise, yeah. Yeah, so anger goes down and together, disgust goes down and together. Yeah. Fear goes up and together, the eyebrows, and surprise goes straight up, and sadness,

the inner part of the eyelids go up. So looking at those sorts of pictures of the different emotions side by side may be helpful when we're talking about that, because the eyebrows can be so expressive and helpful and telling what emotion is going on. Totally. So where do we feel fear in the body?

So fear in the body, everyone who's listening just kind of go back to the last time when you felt fear and even in describing some of these sensations that might trigger your memory is like a sense of a heavy weight on your chest, maybe a constriction around your neck and butterflies in your stomach.

It's sort of something that you might be experiencing. Yeah. And then another thing that they found in some studies about like the blood flow is that when you're experiencing fear you can have increased blood flow to your lower extremity versus anger was increased blood flow to your upper extremities. Just kind of a cool like in case you feel any like sensation of tingling or things like that. Just like, huh, interesting factored. And part of that is because fear leads to sort of that running response.

Whereas when the running is not able to accomplish its goal, you might move into an anger response where you would need more of that upper body. Yeah. So the flight away versus the fight with your fist. Cold hands with fear. Yeah, and that's part of it is you have decreased blood flow in the upper extremities because it's being shunted downwards. So those cold, clammy hands that sometimes people experience.

Absolutely. So tell me a little bit about the different areas of the brain and having different effects with fear. Yeah, so this was something that was really interesting to me is that when we talk about fear, obviously fear arises in situations that can be life-saving for us to experience fear because we avoid it. So in the short-term sense, you're actually going to have like an analgesic effect when it comes to pain versus a chronic, in the chronic sense, this was found in like a cool

thing that Echman talked about in its 2007 work is you're going to have like actually magnification of pain sensations when you're undergoing chronic experiences of fear. It's like an interesting thing. And then the areas of the brain that are involved, I'm pretty sure that was like the amygdala, through limbic system stuff, which we talk about in affect labeling, being helpful in depressing the activity in those areas.

So short-term fear, you have decreased pain because you need to survive. But long-term fear leads to increased pain signals. So just interesting. Short-term fear can be so helpful to us, but if it goes uncontrolled, unmanaged, long term it can have some pretty serious effects even on some of our like physical sensations. So let me talk a little bit about the development of fear. So early on children have fear with

abandonment from their mothers. So the fear of abandonment around the age of two, they get stranger anxiety where they get fearful of strangers. And also children read their, their parents on what induces fear in their parents, and they watch them and respond to that. Remember that happened in our household with spiders. It was always telling my mom, like, no, no, no, if you react this way, like, the kids are going to get freaked out. Yeah. Yeah.

First-hand experience with that. Interestingly, I tested that out with, like, dogs, so when I would take my daughter on frequent walks when she was young. And we'd always pass dogs, and I would just stand, like, right at the fence with the barking dog and just be, like, utterly fearless. and she would like embody that. And it almost got to a point where she would go up to dogs and like was like overly friendly to the point of like potential danger.

It worked too well. It worked too well potentially. Yeah. But that's cool. As you're talking about the like you trying to embody that for your daughter specifically, I remember you told me about the study with the fear messages we give to boys versus girls growing up. Yeah.

Yeah. Go ahead. What do you remember from that? I remember that you brought it up probably because of the fear of. you have a daughter, but that in average, I'm forgetting what the statistics was on it, but that we give more fear messages to daughters than we do sons when it comes to, like, facing obstacles. We give like empowering enabling, enabling statements to the boys like, hey, you can do it.

Come on, you got this versus the girls. It's more. Be careful. Be careful. Don't hurt yourself. Yeah. Kind of the psyche that that could enable. I remember the paper is really interesting for that.

Yeah. And I think it's like somewhere around like we give boys like, 30% what we give girls and like fear worried things. And I think that's where like I think it's really important to teach bravery. So in my, with my kids, we do like feats of bravery and feats of strength. So feats of bravery is like, uh, we'll have, I'll have them like stand on a chair and then jump to the couch. Okay. Yeah. And they can do it from like a foot away and without any, without any fear. Right. Yeah. Yeah. And then we move the chair further and further until like, it's like, I don't want to do this.

And then it's like, okay, you're feeling some of the fear right now. Can you push through it a little bit? And then, you know, she'll do it. And then I get all excited with her. Oh. So we, what an awesome thing to celebrate with your kiddos. Right. But it's like that daily practice of like, okay, feats of courage, feats of strength.

And I found it, that was a, oh, how do you say his name? Morong, Giello, 1999. That was the paper that that was from. That was the daughters get more fear, fear messages. than sons. So fear can be helpful, right? And children have it with heights, even without parents, you know, teaching them what it is. Yeah. They have, uh, all of a sudden my, my son is very fearful of dogs. He's never had a bad dog interaction, but all of a sudden he's fearful of dogs, fearful of snakes. Um, that one feels pretty appropriate. That's, that's deeply in there.

Yeah. So it's to avoid danger, right? To protect oneself from bodily harm, to protect other. other people. So fear can be a good thing. Yeah. Oh, absolutely. So when we think about fear and let's say we see someone's expression of fear in a session, we can become curious as to what was the triggering event that led to the fear? Or let's say you're talking to a friend and they like all of a sudden they widen their mouth. It can be helpful to sort of come back to like, oh, okay, this is why. this is important to sort of pay attention to this. Yeah. And I think something you've always imparted on me is that people relaying a time where they were fearful

and they didn't react in a way that they wish they had. You know, let's say they react by freezing as opposed to standing up or having courage. And there's some like, ah, just really sad examples, you know, where someone's being, let's say, like, molested or certain boundaries are being crossed. And they are so fearful that they don't stand up that that can be super shame. for them to just even recount that. Yeah. So when you see the fear expression, like, to be aware that they could also be having a lot

of shame around that memory or things like that sort of regard. Yeah. So then it becomes like, you know, we want to reduce shame wherever possible. We want to, you know, of course, it makes sense that you would be fearful in that situation. And sometimes freezing is the most adaptive response to avoiding, you know, more harm, right? Like if we feel like freezing and allowing something to happen to us is going to protect ourselves, we may do it. And I think our bodily response may be that actually on a deep level. We're programmed to be able to do that.

Yeah. It's a natural sort of response to intense fear. One thing, though, there's a couple ways of dealing with fear that maybe we could throw out. And one of that would be, okay, where is? is can you can you listen to the voice of courage in the midst of the fear would be one of those for me yeah so anytime you have fear there's also the courageous part of you um which you can start to pay attention to more than the fear so if we listen to the fear and the messages of the fear sometimes we'll get stuck we'll get frozen yeah but we can listen and pay attention and sort

of strengthen those messages of courage and in practice let's say you you were practicing to do something and the actual event is very fear-inducing, whether it be public speaking or test-taking or, you know, some athletic event. Oh, I used to always get such butterflies before track meets. Yeah. Yeah. Yeah, I used to, well, I used, it would be hard to sleep the night before, right? Mm-hmm.

So there's like different calming things that you can do. during the event, slow breathing and mindful breathing. But there's also things that you can do to train in such a way that when you train, you bring yourself to that point of fear and you decide to push through and decide to have courage. Kind of like training an instinct in those situations. Yeah, you train the sort of you train the part of you that's courageous. And I think that's where like sports is so important for youth. Oh, yeah.

Performance sports especially. Performance sports. I was never a musician, but my siblings had to do those violin recitals. And you're the only one up there just like squeaking along. Super great to sort of condition yourself to fear over time, right? And to some degree, that's what we do with patients with fear disorders. So let's say someone has like a phobia. You know, we might have them first think of that thing.

that causes them fear and teach them how to calm their bodies through breathing through relaxation while they think about that thing. And then maybe they see it in another room and then maybe they, you know, the spider is under a cup in another room and then they move a step closer. And maybe over like a couple weeks they're like, you know, putting the spider in their hand. Right? And the fear of the spiders has decreased. and now there, or the fear-inducing event has increased,

but the fear has slowly extinguished. And that's like a behavioral approach to fears and phobias. Kind of like learning how to handle that emotion without being totally overwhelmed. Yeah. And I think it's so important that we face our fears in very slow increments. You know, and stresses, to some degree facing a fear is kind of a stress, but we need just the right amount of stress to cause an adaptation, not too much of a stress that sends us into something that might be traumatic.

Yeah. I think small plug for just like regular, healthy cardiovascular exercise too was that study about how your cardiovascular health is in part tied to, like, your emotional ability. Yeah. Because like your flight or flight system kind of kicks in the same gear. Right. So you're training that parasympathetic,

the sympathetic system to be able to handle stresses. So exercise is a great way to train your mind to handle interpersonal stresses even because of how your mind and body is wired. I just love that those two are so close. That paper was really interesting. I need to hunt down what that was. I think the other, so breathing, the sort of the behavioral approach, and then there's the top-down approach,

which is kind of like activating the more frontal lobe, kind of going back to the episode on cognitive distortions and how to do kind of more of the cognitive therapy towards it. You know, are there thoughts like all or nothing thinking over generalization? So using more of those frontal lobe types of ways to decrease the fear. Yeah. And then affect labeling for sure in those situations to be able to say, I am experiencing fear. Like putting the name on it can help you gain more frontal lobe control as well.

Yeah, totally. Because that putting words to it activates the verbal areas of your brain, which, you know, a pure fear response might be more of that basic limbic system rather than the frontal lobe. So you've got to bring that frontal lobe into it. Get the frontal lobe involved. That's the takeaway message. Okay. So let's go on to surprise. Yeah. So surprise is, I think, appropriately, we're talking about it right after fear because they're pretty hard to distinguish between. Like, you know, we talked about. way back, like how they discovered that emotions were pancultural, kind of universal. When they were doing those studies in the non-Western cultures, that's where they had the most difficulty to distinguish between fear and surprise.

So it even brings in, I'm sure we've also talked about startle. So like surprise versus startle as well. Like startle is not an emotion. It's a physical response itself and it's super transient, whereas surprise itself is an emotion. And so surprise, the eyebrows go straight up and the jaw goes straight down. Yeah. Whereas in fear, the eyebrows go up and together and the mouth goes wide. Like wide.

Yeah. And I think when we were learning, we kind of, I guess, big picture thought about fear as being on a vertical, on a, sorry, horizontal axis more so and surprise being more on a vertical axis. Okay. And that was Kevin. And, you know, surprise. I think therapeutically, how, how, like, or, you know, just noticing in other people, you know, we, we often will see that moment of surprise and we may not, we may be surprised that they had the surprise almost. Yeah.

What was it about that that was surprising? You know, surprise can be kind of awe or like curiosity or, you know, a lot of those sort of like, oh, wow, what am I learning here? You could say something that might surprise someone. they might be thinking of something in their head totally unrelated to your conversation. So kind of coming back to like helping us understand that someone has a different experience than ours and what is that experience? Super cool. Okay. Shall we go into disgust?

This one I think is like the most interesting of all the emotions to me because it seemed so like poignantly. I don't know. Like when we categorize the emotions, this one seemed the most difficult to rationalize is being good. Interestingly, not a lot of people speak in this language. Yeah. Not a lot of people will say to you, I'm disgusted.

It feels so strong. Like, just the word itself feels really strong. And I was quite surprised when I was building the app, Emotion Connection, the amount of disgust that was elicited by, you know, animals being hurt or by children being abused or a circumcision-inspired, disgust. Eyeball surgery inspired disgust. But I was interested because people don't really think like, oh, I'm disgusted by that. But it's really there a lot and it really does drive a lot of behavior.

And it's a really important one just in the different studies that they've done. So I found that people almost like need to develop a vocabulary around disgust, like feeling it in their own. own face and their own experience. Yeah. And knowing like, oh, what does this mean? What is the purpose of it? And therefore, like, how do I understand it? So how is disgust experienced in the body?

Man, so imagine the last time you drank a cup of milk that had gone bad or ate a super mushy part of a banana. You know, anything like that. Like you start to feel queasy, gagging in your throat. Yeah, I think that the sensation for me is so mentally tied. to bad food. So go back to any mental occurrence that you've had that, that'll pop up, just that queasiness. Yeah.

And just like yesterday, I thought I ate something bad and the thought that I might throw up made me feel more nauseous, that kind of thing. So just even the thought of. Oh, yeah. I think we both made that face at each other for sure. So what has happened in the face? The face, you know, the eyebrows go down and together. Yeah.

Like anger. But there's wrinkling around the nose. And that's like the most poignant one. That like that lip curl wrinkle nose thing. Yeah. And then there's the upper lip goes up. Yeah. And that's like the dead giveaway.

When the upper lip goes up, the eyebrows come down and together. And then there's that wrinkling around the nose. Ah, it's really interesting when you see that pop up. Something that was really interesting to me was in studying and looking at different articles in relation to this micro-expression specifically was different populations that have either a difficulty identifying disgust or a higher frequency of expressing disgust. So they talked about, I think it was in like an echo in 2007 and Merton 2003, that people who are experiencing OCD, certain phobias or eating disorders. express their, one observed, their faces are shown to have a higher frequency of expressing disgust than like your average Joshmo population. Yeah, super interesting.

Just as far as like what's driving some of those behaviors, some of the cognitive distortions that might be involved. Right. And with like OCD, you can make sense of it as like every, you know, they touch a doorknob and they just get that feeling of disgust. Like there's something on my hands, maybe feast. or, you know, I'm contaminated in some way. And those thoughts are super intense and they continue to sort of like show up in your brain over and over again until you react by like, okay, I'm going to wash my hands.

I know it's the 50th time I wash my hands today, but I'm going to go do it. I'm going to wash them until they're red. And I'm going to use soap and I'm going to do it for five minutes and I'm going to do it, you know, clean my nail beds as well. And, you know, and this is the kind of behavior that leads to people just having a hard time because when you're washing your hands, that long, that many times a day, you can't do a lot of other things. No. You can't. Sounds exhausting.

It's exhausting. Okay, so there's also a really cool study that Gottman did. Yeah. Where he looks at couples and then he follows the couples for like five years. And one of the micro expressions that showed the most dissatisfaction later was discussed. Yeah. So, like, he watched videos of... couples talking to each other. They weren't aware that this was part of the experiment. Of course,

they agreed to it later, but you know, it's just a regular conversation and the number of times that they flash discussed in relation to their partner was pretty predictive, right? Yeah. Marriage stability. And I think we do not want to feel discussed towards our partner. Oh, super upsetting to experience that towards someone you love. And so most of the patients that I see it on, when they're talking about their partner, it's a very unconscious process. And it's not like they consciously register

that they're feeling disgust. Yeah. And then I think you've told me in some of the times that I've been able to shadow you that you'll see disgust and then you'll see something flashed right after it or kind of like a reaction to that negative feeling they're having towards the person they love. Yeah, so whether they flash like shame,

like they are bad for having this feeling or anger, like, that they would have this feeling in the first place. Or, you know, they could just come up with, it's like you see the flash of the emotion and then you see the defense right after like intellectualization or rationalization or denial. Yeah. Or a reaction formation, like they have the disgust and then they talk about how they immediately go into how they talked about cleaning the bathroom or they clean the house or, you know, like, but wait, we're. just talking about your, and they don't even realize why they go on to talk about that, but it happens. Yeah, I'm just even, like, even just hypothetically talking about that burden, that's such a, that's such a weight to feel towards someone you love, for sure.

Towards anyone, right? Yeah. And I think, um, humanizing. That goes into like the, the theory of, you know, where this came from, um, you know, at an earliest level, developmentally, uh, I noticed my infants having it when they, they put something in their mouth that doesn't taste good. Sometimes when they put something that they don't like the texture even or, you know, they think it's, basically it's poison, right?

Yeah. The purpose of disgust is to get rid of something poisonous that was put into our mouth. It's beneficial for survival. Right. And it's early. Basic. And there's also a moral disgust, which is, um, what, one might feel disgust towards someone having sexual desires for small children.

That would be a pretty normal sort of discussed response. And it sort of separates you from the other person as well. It makes the other person less human. Which has dangerous potential when we talk about like widespread. Gosh, like racial tensions and looking at one group of people is like having more disgust than the other group of people and just how dehumanizing that can be. Right. So they looked at like Hitler and they looked at his actual conversations were recorded at the dinner table over many, many years. And they found that he actually spoke in these words over and over and over again. So it wasn't that he was just against the Jewish people. He was actually disgusted by them. And a lot of the propaganda was, you know, Jewish people are cockroaches and stuff like that. All these super dehumanizing disgust-related concepts.

Discussed evoking propaganda. Yeah. Right? And, you know, that can allow someone, I think, to hurt someone else on a level that they maybe wouldn't if they felt like the other person was a human. Yeah. I think there was a cool theory when they were talking about like disgust is inversely related to the amount of intimacy and a relationship. So you look at like parent to child, that's a very intimate, beautiful relationship, and the threshold for disgust is very different when it comes to handling, like, they're bodily fluids. You clean up their diapers and all these things that in any other person would be a much lower threshold for disgust.

But like you suspend the threshold of disgust in intimate relationships. And there's a part, like maybe in therapy settings where certain things, like we mentioned, I think, one of the highest triggers for moral disgust was pedophilia when they, like, did an average of these different morally apprehensible actions. So there might be some of that that you require to do in therapy settings, or I don't know have you ever encountered that where you really had to engage that. I think that when you have, when you do therapy against someone who, um, who you have, some disgust towards some of their action.

I think that after seeing a number of people with a similar issue, you become a little bit like, just like fear can decrease over time. I think disgust can decrease over time. Yeah. Now, I don't work with children predators. I don't think I would be able to. But there's other things, you know? Other sort of sexual fetishes and stuff like that that I've worked with.

then over time you just like, it just doesn't bother you as much. Which is helpful for the patient to not have as much shame experiencing in the session so that they can better work through stuff. That's the other thing. It's like if you're a patient, there's a reason why you keep something secret. And one of them is because if you shared it, there may be a disgust towards you that is fairly strong. You know, this, interestingly, they were looking at gay sex versus lesbian sex, homosexual sex versus lesbian sex

and they found that in general lesbian sex evoked less disgust in people than gay sex and they correlated with the amount of times in some of the historical sort of wisdom books against these practices and they found that gay sex was more sort of represented in those texts and in one study on micro-expressions for better or worse

and you know putting this out there is that they found found that there was the sort of micro expressions have discussed, even when people thought that they were not biased in this sort of realm. So that's an interesting way of sort of understanding.

Unconscious bias. Unconscious bias, yeah. You know, I think a lot of the implicit bias tests have issues. The micro-expression is a great way to sort of get around and get a very accurate picture of if there is bias there. Right. So you show pictures of things and you see how much disgust something elicits.

That's really interesting. It's just such a cool tool to kind of get better understanding of a lot of things we've been grasping at straws with a bit. The other thing about disgust, which is really interesting, is that disgust is associated with kind of a, in the personality sort of characteristic of very orderliness. So people who tend to be high order have higher disgust. and you can kind of see it in on a political realm as well. Oh, what do you mean? Well, I mean just like Hitler, for example, would be like the sort of the archetype of orderliness.

Yeah. Probably you organize people out there. Yeah. Don't take that too much to heart. No, I mean like the, but he was like obsessed. He was incredibly obsessive about creating order and everything. And he was also very, very high disgust. And so you don't have, it doesn't have to always be a negative thing.

Like it could be like a very positive thing. We need people who are incredibly orderly. Oh, absolutely. And those people are really good with systems and creating structures. Oh, we need those on every team. We need those in every house. Yeah. We need them.

But just maybe if that's you to also be aware, you know, oh, maybe I do get a little bit more disgusted. And how does that influence me and so on and so forth? Okay. The other thing about disgust in relationships is, or discussed in like the therapy. Let's talk about disgust and what you would do with someone. So if you see them expressing that. First of all, there's the thing of like getting them to get it into words and being able to tolerate that they have this and that this could be more normal than they realize it. Oh, yeah, normalizing statements, just creating an atmosphere to reduce shame so it's easier to talk about or help guide them towards recognizing that?

Or what would you say? It's kind of like your end goal there. Yeah, yeah, all of those things. decreasing the shame that they may feel around the feeling of disgust, or decreasing the anger towards themselves that they feel about having this, and then talking about it and trying to make sense of why they have it. Maybe they're a person who's very orderly had a patient like that, very, very orderly had disgust towards his wife.

Once he was able to realize, like, oh, I'm just an incredibly orderly person. I've discussed towards a lot of things. I don't feel completely disgusted towards my wife, but when she does that one action... burden from recognizing her as versus some of her actions as yeah and so there's this one action that causes disgust that she does so then how do i decrease my how do you sort of help him work through that to a point where maybe it doesn't bother him as much or maybe he just doesn't even have as much disgust towards her in the midst of yeah oh that's so gosh that even in talking about that just

feels so burdensome and to be able to separate the action from the person who's doing the action especially if it's unintentional if it's like a cleanliness thing or a, I don't know, socks in the hamper kind of thing. For him it was when he felt like his wife wasn't taking care of his kids very well. Oh, wow, that's very different than it was. For him, yeah, it also came with a meaningful message. Like, hey, maybe this is something that you need to discuss with her. Maybe this is something you could bring up in therapy with her. maybe this is something that like, you know, you could tactfully sort of process through.

That being said, you know, that's a hard conversation to have. Oh, yeah. About like the value and identity in your roles in the family. That's way more serious than socks in the hamper that I was imagining. Okay, so there's disgust. And so we will go into a little bit of a review of micro-expression. and psychotherapy. So how do you generally use it? Yeah. So I'd say, you know, I was kind of sitting down the other day trying to create almost like a checklist for myself if I step into future practice

and get to use this skill is that you see the emotion on the patient's face. You detect it. You bear that in mind. And then I think you would also be comparing that to the context in what they're speaking. Do their words match the expression that you saw in their face? If it doesn't match, than maybe to explore, like, is it something that they're recalling from the event that they're talking about that elicited that emotional expression, or is it something from your current context that you did or in the environment that elicited that, and that to use that to, I guess, harness some of your curiosity to help them figure out what the origin of that unconscious or conscious emotion was, and then that will enable you to get real-time feedback on how is this

interaction going, and also increase your ability to give empathy that's actually therapeutic. therapeutic and create an environment that's reducing shame if you feel like that's needed. And it just kind of helps you. Yeah, I'd say it's just such a cool therapeutic tool to put to use. Right. So inevitably, how do you increase your empathic sort of immersion? And then how do you also, you know, create a connection, a meaningful connection? And so we're we're using this as part of a tool, part of your toolkit. It's information. And what you do is. with it is is something that takes a while. It takes a while to learn how to, number one, register like, okay, this person just had this emotion. And then two, to not be totally like information overloaded. And then three, to know how to skillfully then use the information to respond in a way that shows the person that you have empathy for them. And then finally, to have that sort of increased connection from that.

Because when we talked about those like three steps of empathy, there was the cognitive, the emotional, and the compassionate. It was like those broad categories. And I think that this affects all three in a lot of ways. But sort of that end goal is being the compassionate, how do we respond, whether that's with silence or with certain words. Or like we talked about like reducing shame, giving an empathic statement,

normalizing what they're feeling, what have you. Yeah, so I want to go into a little bit more about empathy. And let's talk about how to use this specifically to increase empathy. One thing to talk about is mirror neurons. The mirror neuron system. So, you know, I first learned about this in an advertising class in college. Oh, no. They played us a commercial of a hamburger, you know, and it's like the glamorous, like, all-around shots.

someone bites into it. And then our professor, like, paused it. It's like, what are you guys feeling right now? And everyone's like, ah, my mouth is salivating, you know, and describing the sensation. He's like, this is because you have mirror neurons. And just that concept that, like, what you see, you will impart, like, you see an action being done in front of you and parts of your brain that are involved in doing the action or lighting up in your own brain, even though you have no physical contact with that hamburger on the screen kind of thing. but this can be harnessed for like interpersonal, emotional displays and things like that. Yeah, and so we are now going to talk about how to use it for the increased benefit of the person in front of you.

Yeah, not just marketing campaigns to make you hungry and get cravings. Not just to benefit yourself, but to benefit the person in front of you. But just to give a little background, there was a researcher in Italy who had a brain electrode attached to an ape's brain. and the ape's electrode would go off when the ape raised his hand. Yeah. And the researcher put the thing on pause and the electrode was still attached and still on. And then he ate his food. And every time he reached up his hand to put the sandwich into his mouth, the electrode would cause the noise to go off.

And at first they were puzzled why this happened. But then they realized this was the greater sort of find that they had. And since then, so the idea is that your neurons, light up in the same way as someone that you're watching, whether it's you're watching sports or you're watching a tearjerker or you're just sitting next across from a friend listening to their story. Yeah. Your brain is going to light up to some degree like the other person.

And this is, this is beautiful. This is how affective empathy takes place. Oh, yeah. And it's inherent. It's automatic. It's something that if you're, you know, it's going to happen almost as like a secondhand smoke is such a bad example. But you being nearby and witnessing it will cause it.

Yeah. And then with intentional focus, you can kind of like increase your mirror neuron response, right? I think you can tune into it. I mean, this is what psychics do. I honestly think they just have, because I know a couple people who are psychics. And they're the most empathic. I don't know any, but I'd love to meet one someday. I'll introduce you to one.

They're the most empathic people. and what they've been able to do is if they want to. Now, it's exhausting for them, I think, to do it. But they can turn on their mirror system and mirror neuron system and really look at someone. And it's like their brain lights up in a more parallel way. And they've learned how to pay attention to the changes. Yeah.

And so I think in therapy we do the same thing, but we may not know. We can get trained in it almost to do it better and better over time. And the reason why we can get better at it is because, we can actually ask the person across from us, like what's going on, and then we can check to see if we were accurately registering or not. And to see, like, is this something that I'm feeling out of a mirror neuron system, or is this originating from me outside of their experience, kind of like to differentiate what is stemming from your patient versus what is stemming from you?

And that's where microexpression is so powerful, because if they just flashed a microexpression of anger, and that's what your mirror neuron system is picking up. And then you start to feel that heavy chest, that like, all those anger. Anger, physical sensations. Then you're like, okay, it started with their microexpression, and then I started feeling it. Therefore, what I'm doing is I'm picking up their neuron system. What it can also do there is it can guard you against reacting towards the emotion that you're experiencing. Oh, yeah.

By feeling that you need to own it. Empathically engaged with a patient because you aren't going to get swept away by these different emotions you're picking up. Yeah. That was like the fourth branch of empathy that we didn't really touch on because it's not necessarily part of that construct, but it's the self-other distinction, which maintaining that is crucial to staying empathically involved and continuing to express that third step, which was that compassionate, responsive empathy. What we're describing is, I think it's called empathic distress by some people.

Yeah, vicarious trauma, vicarious burnout. You feel the other's emotion, and then you take on the burden of their emotion and their experience on yourself. Oh, yeah. So many of my classmates, when they hear like, oh, you're going to psychiatry, I could never do that. Two days on psychiatry and I was emotionally burnt out. Like I would go home every day, just carrying the weight of. And I think that's something that turns a lot of people off to maybe even medicine in general is the fear of, man, just that vicarious trauma. And I think that's where,

like, I do a lot of the training for the first year residents and teaching them this early on and teaching them how to pay attention to what is going on in the other person, what is going on to myself. Am I starting to own or take responsibility for their emotions where I shouldn't? What is my role in this and how can I have boundaries and keeping my role the same? Yeah, I think it's pretty crucial just stepping into, I think, any branch of any sort of job where you interact with people, but specifically those re-interact with people who are at a vulnerable state or, yeah, experiencing something like that. So we are going to have to go to part three of this.

Okay. And that's okay. I'm looking at the time and realizing that we have... We have a lot more... We have a lot more to get through, but this is... That's fine. Okay, so part deficits in empathy. Alexathymia.

Yeah. Alexathemia is kind of that clinical word for someone who doesn't experience empathy in someone else. And a lot of these people get labeled Asperger's, but that's no. longer in the DSM-5, so now it's autism spectrum disorder. I think a lot of people are actually mislabeled because I think a lot of people can eventually experience empathy, but for whatever reason, they're not allowing themselves to experience empathy. And in some way, kind of what we were talking about, this is sort of shooting in the wind a little bit, but that can be protective

if you've been so vicariously burnt out or if you're so receptive to people's emotions that you get exhausted by it to kind of tune out or shut up. Tune out pretty chronically. Yeah. Like I've had several patients who, you know, they have to tune it out and they have to not be that because when they are that, it's so overwhelming to them. Yeah. To feel someone else's emotions, they immediately feel responsible.

And then when they feel responsible, it just really exhausts them. So they have to kind of like create this huge divide, which is an unfortunate. But usually when we think of Alexothymia, we think of that there are certain people that are just wired to be less empathic. Yeah. And we also, I think it was in Carlotzi's study, they found schizophrenic populations to kind of have the same issue of like less empathically linguistic. I don't know,

a right way to say it. Like, it's harder. Psychopaths also have, if they're completely psychopathic, then they'll have no empathy. Yeah. If they have some psychopathic traits, maybe they have very, very low empathy. Narcissistic individuals, I think, will have low empathy for anyone outside of their immediate family. And some of them have no empathy or they turn it off. It's not that they don't have it unless they're psychopathic narcissist, then they won't have it.

What about, you know, when you're watching the news and I think there's especially, I mean, ongoing to an extent, but like repeat cycles of just trauma being reported in the news. I even felt myself be a little bit desensitized. Like the first time I heard about a mass shooting, it was like, that's so devastating. And as those reports continue to continue to come, I felt each time I was like a little less impacted in a sense. I don't know. How would you feel about that sort of empathy response? We get desensitized. Absolutely.

Also, think about like if someone's telling you their story in a way that they're dissociated from the story. Hmm, that's always so interesting to observe. Your mere neuron response will not be to feel emotion for their story. It'll be actually to feel numbness or to feel distant. And that can be a very troubling mirror neuron experience. Yeah. If you're not knowing why it's happening, if you don't know why it's happening, you may then feel the shame that they may feel as well about you're not caring,

which can be very sort of troubling. Yeah. And so sometimes we don't feel empathic sort of strain into someone else's story because they're not accessing the story in a way that would lead us to have evoked emotions. Yeah. But getting back to your sort of, you know, the news and everything, yeah, I mean, I feel very desensitized to a lot of things going on. And because if I were to feel completely for them, I would be not able to cope with the realities that I do have to cope with, you know? Yeah. So, yeah, compartmentalizing, I think, is adaptive.

And we have to take it in small pieces. Is there anything that you do, I don't know, in your own practice, just from patient to patient on a, you know, on a smaller scale? It's not like the news or things that are, I guess, out there, but more so like these are people, individuals with stories stepping in your office that you do to stay empathically more sensitive? Yeah, I think. so I do think that it is a stress, right,

when someone tells you a really difficult story that they're going through. You vicariously feel some of that. You know, going for a little walk after for me, you know, enjoying some laughter with my colleagues here, doing other projects that are completely unrelated to patient care like this. You know, going home to my kids

when my kids are just like laughing and giggling and running around. You know, I feel that mirror neuron experience as well, and that really, like, is very calming and sort of joy, sort of rehabilitating, you know, doing exercise, doing sort of those things to calm down my physiological system. But, yeah, I agree with you. Early on in my training,

I would get a ton more exhausted than I do now by hearing stories, like to the point that I didn't want to go into psychiatry as a third-year medical student until, like, I realize like, oh, I'm feeling those things. And maybe I could do some training around that, you know, where I know how to handle those affects in a way that would be therapeutic to the person rather than instructive to myself. It's kind of like a drug side effect where if you're experiencing the side effects of empathy,

it might also be indicative that you could really harness that as a tool that could be very beneficial. Yeah. So that is the end of this session. We will come back for part three and look forward to it. Thank you for hanging in there with us. And if anything here was of value to you, we'd love to get some feedback. We'd love to get some of your thoughts. We'll have a social media post on this topic and you could post up a comment there.

We'll put a link in the show notes to the notes from this that are well-sighted. Yeah, we've got lots of studies for you. And we will also have a link to Emotion Connection app. If you have an iPad or iPhone and want to learn how to actually read these, I think that's a good way to start. Yeah. And we'll go from there.