Photography by Amy Kobos

Photography by Amy Kobos

I felt guilty.  I felt not deserving.  I felt that if I sacrificed my emotional needs to please everyone else that I would gain self-worth.  I didn’t know any better because I thought sacrificing my own needs would bring happiness. Frequently, months would go by where I wouldn’t take a day off because of what I felt were “obligations” to take care of others. I wanted to be the hero to everyone’s problems. I never felt like I forced myself to get involved, but somehow I felt bad if I couldn’t offer my help. I usually ended up getting sucked into someone else’s drama, someone’s else’s healthcare issues, someone else’s responsibilities, and felt like I had to be that extra hand to help in the community because of the county’s or government’s inability to assist.
For those of you who really know me, you know I struggled most of my life  just trying to simply survive. Growing up as a teenager, my worries were about how I was going to pay for my school lunch, if I had a warm house to sleep in at night, and how I was supposed to be able to go to college if I have to spend most of my time working 2 or 3 jobs just to pay the bills.  I know what it’s like to suffer.This is why my sense of empathy became so strong. I felt I had to obligate myself to “save the world” because I felt no one else understood what it was like to suffer. I seriously thought this was God’s plan for me. I felt a strong sense of guilt if I spent any time to take care of myself because that was time I could have spent helping someone else.

I couldn’t even sit down for 2 hours and watch a TV program or relax without feeling guilty.


Now, I’m in my mid-30s.  Looking back, I realized that I’ve never done what I’ve always wanted to do in my life: Focus on me.  My body is literally tired of being empathetic.

Because of my obsession with neuroscience, I wanted to understand how empathy worked in the brain and why I was feeling more and more fatigued.  I wanted to know why I wasn’t happier for sacrificing my needs to make sure other people were happy before me.  I wanted to know why I wasn’t feeling more worthy for all of the hours, days, months I put in to help others in the community.  I didn’t understand.  I was also becoming tired just hearing about how we all need to be more empathetic in this world all over the news and social media.  I just couldn’t take it anymore! That was the last thing I needed more of! This is why I chose to write about empathy for my undergrad research at the University of North Carolina.

This literature review explains how empathy can be hazardous to our health and how we can use empathy in the form of self-compassion, which can literally restructure our neural pathways to accommodate a better quality of life.  To fully benefit from this, I believe it’s vital to understand what empathy is and how it physiologically processes in our bodies before you attempt to generate changes to your lifestyle.  It’s tough to make an effective change when we don’t possess a theoretical logic.  

Empathy allows us to emulate others’ cognitive and emotional states. It helps us know how to appropriately react and function in society, but what happens if you possess too much empathy? Can it be hazardous to your health? And who is most at risk? The tone of our society is formed based on the contagion (transmission) of emotions and also plays into how we view gender roles or even how we vote. It turns out that the perceived emotions we feel from being empathic turn on the same neural circuits, as if we are experiencing it ourselves; for example, fear produces the inflammation-producing hormone, cortisol, through the fight or flight response, and positive feelings, like love, will produce oxytocin, which regulates blood pressure. This inevitably impacts our health. Research has shown why our brains are more prone to activate fear/unpleasant responses, which explains why anxiety is the “most common mental illness in the United States” (Anxiety and Depression Association of America, 2014). Being too empathetic can increase these health risks, especially in caregivers.

Historically, science has focused on how negative stress affects our bodies. Only in the past decade has research narrowed in on the neurophysiologic aspects of how we can use positive emotional therapy, in the form of self-compassion, to prevent and reverse the potential damage created by stress caused by being too empathetic. By understanding how these systems work, we can develop evidence-based health practices that can be implemented in clinical settings, employee health programs, schools, and the media. A philosophical shift in the thinking about empathy may lead to a tipping point that may reduce the fear-based tones and negative standards set by society and improve overall quality of life.

Photography by Amy Kobos

Photography by Amy Kobos

Empathy is our ability to understand feelings of someone else which gives us the capability of figuring out how to respond to an individual. There are two types of empathy:  cognitive and affective. Cognitive empathy (CE) is understanding what someone is feeling. It helps us formulate appropriate social response to another individual based on a perceived understanding of what he or she might be going through. Affective empathy (AE) is our ability to feel what someone else is feeling, and “puts ourselves in someone else’s shoes” by mirroring someone else’s emotional state (Aglioti & Betti, 2016; Tone & Tully 2014). AE explains why people get so hyped up about sports and politics because people imagine themselves in those roles (All About Empathy). Further, empathy is what cultivates societies, and since it allows us to imitate others, from both observational and emotional levels, this is can explain why societies can evolve (Ramachandran, 2009). For example, women imitated other empowered women in the early 1900s to create a revolution where they earned the right to vote. But, it all started by imitating those few who were brave enough to advocate.

Empathy works in a way where we seem to react more to adverse emotions, both individually and societally, resulting in the thinking that emotions can be infectious (emotional contagion). Researchers tested the different types of empathy and found that when exposed to images depicting threatening situations, areas in the brain lit up that were associated with affective empathy. Participants “integrated the emotional information represented on the scene to form a global affective representation of the picture” (Nummenmaa, et al, 2008). Further studies utilized this theory to measure an emotional state of a society by using the susceptible-infected-susceptible disease (SISa) model. In this study, findings suggested that the rate of someone who is pessimistic had a higher chance of staying pessimistic than individuals who wanted to be happy (Hill et al., 2010). Would this explain why the United States lives in a fear-based society?

Photography by Amy Kobos

Photography by Amy Kobos

The key brain structures involved in our ability to empathize are found in the frontal, parietal and temporal lobes, specifically derived from the mirror neuron system (MNS) which connects to the limbic system (hypothalamus, amygdala, hippocampus, and anterior cingulate cortex) and other associated structures, but not limited to, the prefrontal cortex, insula, and pituitary gland (Corradini & Antonietti, 2013; Blakeslee, n.d.; Fricchione, 2011; Jarrett, 2012Winerman, 2005). The MNS possesses its own neural circuit to code and store how we react to a stimulus. One fMRI study revealed significant activity in the areas of the brain that encompassed the MNS when exposed to facial expressions, depicting happiness, sadness, angriness, surprise, disgust, and afraid. Subjects were asked to both observe and imitate what they saw. This helped figure how and where the MNS responded. There was activation of the same hormones and neurotransmitters that are secreted through the fight or flight response (Carr & Iacoboni, et. al, 2003). There were similar findings when subjects were exposed to the word, “no.” When hearing, the word, “yes,” the findings did not detect a stress response in the brain (Newberg & Waldman, 2012). When imaging another person’s perceived threat, physical pain or negative emotions, the MNS sends a signal to the amygdala which messages the hypothalamus to secrete fight or flight hormones (cortisol, norepinephrine, adrenaline, and others). This increases our heart and respiratory rates (Goldin, 2013; Corradini & Antonietti, 2013) and puts the body into an inflammatory state.

Researchers found that more neurons are fired with aversive stimuli than with positive stimuli.  Evolutionarily, our brains our designed to survive, but our brains cannot detect irrational threats (Toohil, 2015). Toohil referenced the basis of the Hebbian learning theory which states “cells that fire together, wire together,” indicating that the more we expose ourselves to certain stimuli, the more sensitive we are to react. This idea evolved into what is now known as “long term potentiation (LTP),” where our brain will pave pathways comprised of axons and dendrites through associative learning. Since the MNS is connected to our hippocampus (structure responsible for encoding memory), this puts individuals at risk who exhibit empathetic behavior, especially when repeatedly placed in a negative environment. These individuals will remember feelings with the last time they were put in those situations, resulting in more rapid triggering of the fight or flight response. The neurons connected to the hippocampus and other structures in the brain during LTP possess higher numbers of dendrites which sensitize the propensity for the brain to react quicker (Kolb & Whishaw, 2011).

Normally when the brain responds to a perceived stress, cortisol is released through the hypothalamic–pituitary–adrenal axis (HPA). This, and other hormones, tells our body how to appropriately respond to a rational threat. Once the stressor has gone, the body regulates itself back to baseline. If an individual is repeatedly exposed to perceived or real stressors, the body thinks it is supposed to be in constant survival mode. What happens in this case is that the cortisol receptors in the hippocampus are damaged, which will not get the signal that the stress response is over. If there is frequent exposure to perceived stress, the body thinks it needs cortisol. The damaged cortisol receptors and the constant flow of cortisol in our body result in what we know as anxiety. Having a chronic elevated cortisol level can inflict other harmful effects, like muscle wasting and fatigue, metabolism irregularity, inhibition of growth hormones, dysfunction in the reproductive system, and ultimately chronic diseases since the immune system becomes suppressed (Kolb & Whishaw, 2011).

Photography by Amy Kobos

Photography by Amy Kobos

Research suggests that women’s mirror neuron systems are more reactive than men’s.  One study revealed that women were very responsive to moderately negative facial expressions, whereas men showed little to no response. They discussed the neurological structural differences and how that may play a part in how the MNS reacts between the sexes, but this was an ERP (event-related potential) study, so exact locations could not be pinpointed to determine the exact neural structures (Li, Yuan & Lin 2008). Another study showed there was more blood flow in limbic and paralimbic structures in women than men when self-inducing sadness by remembering an adverse emotional event. They theorized that women’s sociological role and pressures could put them at higher risk to mood disorders, including anxiety and depression (George, et. al 1996). Another journal emphasized the social implications that put women more at risk related to empathy. It discussed how interpersonal guilt may contribute to ruminating or internalizing maladaptive symptoms. This comes from the notion that women feel more responsible for alleviating others’ perceived pain because of their role as caregivers. This creates burnout, for which an individual will experience anxiety, grief, and a loss of self due to the effects of dysregulation in the neural system caused by an overactive mirror neuron system.   This same study challenged that more research needs to be done to determine if females are at risk due to genetics or if it is based more on gender social norms (Tone & Tully, 2014).

Photography by Amy Kobos

Photography by Amy Kobos

By using the mirror neuron system through imitation and observation, we can create neuroplastic changes that form new connections elsewhere in the brain. This technique is currently used in patients with neurodegenerative diseases, Parkinson’s and Huntington’s disease, as well as in patients with mental disorders. This improves overall health by learning new and better ways to function and cope (Demarin, 2013). The old neural connections that are not used any more atrophy, which supports the brain principles, stating that if we do not use it, we lose it (Kolb & Whishaw, 2011).

Neuroscience has shown us that we can turn empathy inwards, into self-compassion. By allowing our MNS to be exposed to more positive stimuli, this can prevent and/or reverse the damage that has been done by being too empathetic. Each time we are exposed to negative stressors, it creates a “downward spiral” meaning that it becomes harder to get ourselves out. The reason why it is difficult is because the LTP is so strong, resulting in more frequent relapses.

To push ourselves into a healthier mental state, we must do three positive activities for every one negative before “optimal functioning first emerges.” Hypothesizing on the 3-to-1 ratio theory, extensive research has been done to see if someone could create an “upward spiral” that would essentially create a protective barrier to one’s mental health. Many studies were conducted and reviewed, all showing “sustained changes in brain function” when participants underwent treatment that included, but not limited to, mindfulness meditation, cognitive behavioral therapy, playing an instrument, and practicing gratitude over short-term and long-term timeframes. Additionally, brain imaging revealed evidence for newly created neural connections and activity which have resulted in better cardiovascular health, increased self-awareness, and overall positive moods. Participants felt they were able to adapt and become more resilient when dealing with stressful events (Garland et al., 2010 & Fredrickson 2004).

Photography by Amy Kobos

Photography by Amy Kobos

The capability of neuroplasticity may be hampered in people suffering from neurological deficiencies, as seen in people with schizophrenia and autism, when trying to utilize the mirror neuron system to empathize within. People with autism spectrum disorder show thinning in the MNS. Many studies have shown that these individuals are not as capable of interpreting other people’s facial expressions or emotions, therefore, suggesting there may be a challenge in how these individuals are able to understand and apply this method to form inward empathy (Hoff & Yuan, 2008). In addition, researchers have also suggested that it depends on the area and severity of the deficiencies in the MNS, as there are separate branches designated to the different types of empathy: cognitive (observation) and affective (imitation) (Fricchione, 2011).

Additionally, there are aspects beyond the mirror neuron system that can inhibit inward empathy. People with schizophrenia have neurological deficits that limit their ability to possess anticipatory pleasure. Neuroscientists found a dysfunction in the ventral striatum as well as dysregulation in dopamine, which adversely affects the brain’s capability to effectively process reward. This article suggests that an individual must be neurologically competent to “want” cognitive growth, and that we need to keep in mind how these type of limitations can affect individuals who possess other neurological deficits, like post-traumatic stress disorder or Alzheimer’s (Garland et al., 2010).

Extensive neurobiological and sociological research has been done to reveal how empathy cultivates society and how we use it to feel for ourselves and others. The recent discovery of the mirror neuron system has allowed us to hone in on its complexity which helps us better define how empathy can be hazardous to our health. Empathy triggers the fight or flight response which increases our chances of developing anxiety disorders and other chronic diseases. The literature suggests that women have the propensity to experience more maladaptive symptoms due to being empathetic because of their social roles, but concludes that being a “caregiver” is ultimately who is at the highest risk (Denholm, 2012).

In the past, science has focused on how negative stimuli pathophysiologically affects the body, but research has shifted. It now shows us how positive stimuli can prevent or reverse the damage that has been caused by being too outwardly empathetic. This helps us understand the possibilities and limitations of how self-compassion can heal us from a neurobiological perspective and how we can implement this evidence-based research into new programs. Using platforms, such as healthcare organizations and schools, we can develop pilot programs that utilize the findings found in this literature review. This allows us to collect the data needed to assess and evaluate how to move forward with creating evidence-based practices that create more effective interventions, especially in those who may have limitations affecting their ability to fully benefit from the program. By understanding how empathy impacts our health, we can feel empowered to create solutions to enhance our individual health, which ultimately improves the tone set by society.

Photography by Amy Kobos

Photography by Amy Kobos

Through my literature review, I learned that turning empathy inwards via self-compassion will positively impact a person’s wellbeing for most of us. It is logical to implement a program based on these neuroscience principles. Barbara Fredrickson, professor of psychology at University of North Carolina, Chapel Hill, designed the broaden-and-build model which is a strength-based intervention which means that if we broaden our ideas into how we could solve problems, then we can build a foundation that will reduce our fight or flight response from triggering when exposed to negative stimuli. This has been shown to help prevent and/or reverse maladaptive symptoms that occur when exposed to both irrational and rational stressors, which ultimately lowers our risk for developing chronic disease and gives us a better quality of life.

Fredrickson’s model is structured through the utilization of self-compassion which creates, builds, and maintains an “upward spiral of flourishing.” This results in individuals to become more self-aware and capable of creating healthier strategies that “regulate their experiences of negative emotions.” The upward spiral is made of different steps which start from the bottom and go up:

1. Stress Appraisal: Being aware of your feelings about a stressor.
2. Decentering: Being capable of thinking about multiple perspectives and differentiating between irrational and rational threats.
3. State of Mindfulness: Being nonjudgmental, letting go.
4. Positive Reappraisal: Noticing the positive effects of being able to cope/adapt to stressors in a healthier way.
5. Positive Emotions & Decreased Stress: Overall good outcome and less stress due to steps 1 through 4.

After step 5, the cycle repeats except the foundation will be stronger which will allow an individual to deal with the next stressor more easily. Before you know it, stress becomes less noticeable, which ultimately prevents triggering the fight or flight response. This increases gray matter as well as rewires the brain, leading to long-term potentiation that increases our ability to shift our attention, so we can focus on healthier coping strategies which lessens future relapses.  Fredrickson expresses that building the upward spiral can be done through practicing love-kindness meditation, specifically through activities that comprise of love, joy, contentment, gratitude, pride, hope, interest, amusement, and awe (Fredrickson, 2004; Garland et al., 2010).

Whether it be a Powerpoint on a specific topic, introducing you to convenient healthy meals to prepare, or worksheets that will help you through obstacles in your life, I can assist you in constructing materials that are unique to your needs.  Let my expertise in wellness program development and health and wellness promotion help guide you to the quality of life you deserve.  Up your ability.

Photography by Amy Kobos

Photography by Amy Kobos

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