1. Matthew S. Shane, Ph.D. University of Ontario Institute of Technology, Oshawa, Ontario, Canada The Mind Research Network, Albuquerque, New Mexico Psychopathy: A Deficit of Ability or Motivation?

2. What is Psychopathy? Myths

3. PCL-R Interview 2 hour semi-structured interview The individual is queried about various facets of their life: childhood, school, work, family, relationships, criminal, substance abuse, etc. More than the fact, the intent is to gain some sense of their interpersonal, emotional and behavioral nature Following the interview, the individual receives a score of 0, 1 or 2 on each of the 20 items that comprise the PCL-R

4. Glib and Superficial Charm Grandiose Self-worth Pathological Lying Conning and Manipulative Lack of Remorse or Guilt Shallow Affect Callousness or Lack of Empathy Failure to Accept Responsibility Many Short-term Marital Relationships Promiscuity Parasitic Lifestyle Poor Behavioral Controls Early Behavioral Problems Lack of Realistic Long-term Goals Need for Stimulation Impulsivity Irresponsibility Juvenile Delinquency Revocation of Conditional Release Criminal Versatility Psychopathy Checklist - Revised

5. Glib and Superficial Charm Grandiose Self-worth Pathological Lying Conning and Manipulative Lack of Remorse or Guilt Shallow Affect Callousness or Lack of Empathy Failure to Accept Responsibility Parasitic Lifestyle Poor Behavioral Controls Early Behavioral Problems Lack of Realistic Long-term Goals Need for Stimulation Impulsivity Irresponsibility Juvenile Delinquency Revocation of Conditional Release Criminal Versatility Psychopathy Checklist - Revised Factor 1 Affective/Interpersonal Components Factor 2 Impulsive/Antisocial Components Many Short-term Marital Relationships Promiscuity

6. Psychopathy Psychopathy versus Antisocial Personality Disorder Factor 1 Affective/Interpersonal Components Factor 2 Impulsive/Antisocial Components

7. Psychopathy ASPD Psychopathy versus Antisocial Personality Disorder Factor 1 Affective/Interpersonal Components Factor 2 Impulsive/Antisocial Components

8. Psychopathy ASPD Sometimes referred to as the primary essence of psychopathy Psychopathy versus Antisocial Personality Disorder Factor 1 Affective/Interpersonal Components Factor 2 Impulsive/Antisocial Components

9. Relationship Between Psychopathy and ASPD Prison Population Antisocial Personality Disorder Psychopathic Prison prevalence of ASPD: ~65-85% Prison prevalence of psychopathy: ~15-25%

10. The hypothesis states that the psychopath does not experience sufficient fear to promote conditioning or avoidance learning Core Fear Processing Deficit Low level of subjective fear Reduced impact of aversive stimuli on emotional systems Failure to correct dysfunctional actions Failure to recognize other’s fear Failure to avoid fear- provoking situations The “Low Fear” Hypothesis Other flavours focus on other emotions: Low guilt Low empathy Low negative affect

11. Patrick et al. (1993): Participants are asked to watch pictures while they are randomly given painful shocks Deficient fear-potentiated startle magnitude in psychopaths Reduced Sensitivity to Aversive Stimuli

12. Reduced Sensitivity to Anticipation of Aversive Information Reduced anticipatory skin conductance Mean Change in HR Skin Conductance 10 9 8 7 6 5 4 3 2 1 0 Seconds P-SCLNP-SCL Hare, 1966 Ogloff and Wong, 1990

13. Reduced ability to identify fearful/sad faces (Blair et al., 2004) Reduced ability to identify fearful vocal intonations (Blair et al., 2002) Reduced attributions of guilt to others (Blair et al., 1995) Reduced sensitivity to distress cues (Blair, 1997) Emotional Deficits in Psychopathy cont.

14. Disrupted Neural Processing of Emotional Information

15. Largely Intact Cognitive Abilities Already noted that intact awareness of right/wrong was almost necessary for the diagnosis of the disorder Psychopathic individuals score normal to above average on IQ tests Often show increased cortical response (perhaps compensatory) One proposed problem was in processing, and learning from, committed mistakes

16. S Intact Error Monitoring Shane et al. (2008), NeuroImage Shane (resubmitted)

17. The Importance of Controlling for Substance Abuse Shane et al. (in progress)

18. “Don’t” doesn’t equal “Can’t” The fact that psychopathic indiviudals don’t show reactivity to aversive/emotional stimuli doesn’t necessarily mean they can’t. If so, we may expect quite drastic neural abnormalities While some evidence exists, these differences, to date, are fairly small, and fairly transient Another possibility is that they can, but simply don’t under the vast majority of (naturalistic) settings

19. Emotion Regulation in Psychopathy

20. NonPsychopathic (N = 16) Psychopathic N = 18) tp Age37.37 (9.00)33.75 (8.25)1.19ns IQ102.68 (13.53)101.75 (18.16).17ns Verbal IQ39.00 (13.80)38.94 (15.13).02ns Performance IQ18.31 (4.36)17.25 (5.74).59ns PCL-R Score15.40 (4.88)31.47 (1.34)12.69<.001 Factor 13.87 (2.72)11.93 (1.58)9.93<.001 Factor 210.10 (3.88)16.10 (1.83)5.42<.001 Substance Use Years of Alcohol Use11.25 (7.55)7.00 (6.48)1.71ns Composite Years of Substance Use21.21 (20.63)12.03 (12.93)1.51ns Comorbid Diagnoses Antisocial Personality Disorder86.9%100% Substance Abuse Disorder94.4%100% Past Mood Disorder15 Other Personality Disorder00 Emotion Regulation in Psychopathy - Demographics

21. Emotion Regulation in Psychopaths NonpsychopathicPsychopathic NegWATCH vs NeutWATCH Shane, MS (under review)

22. Emotion Regulation in Psychopaths NonpsychopathicPsychopathic NegWATCH vs NeutWATCH NegINCREASE vs NegWATCH Shane, MS (under review)

23. Emotion Regulation in Psychopaths NonpsychopathicPsychopathic NegWATCH vs NeutWATCH Shane, MS (under review) NegINCREASE vs NegWATCH

24. Empathic Deficits in Psychopathy Quite a lot of studies over the years However, a number of recent studies have investigated this from a neuroscience perspective

25. “Imagine self” versus “imagine other” in pain

26. Performance Condition: Participants must press a button as quickly as possible to all ‘X’s, and stop their button press to all ‘K’s. Observation Condition: Participants watch a video of another person performing the same task; press a button to indicate correct/error responses. Error Performance/Observation Study Design All participants performed the ‘Performed’ task first, followed by the ‘Observed’ task, followed by the self-report measures.

27. Error Performance/Observation Study Results Performed Errors Observed Errors Shane et al. (2008), NeuroImage

28. Error Performance/Observation Study Results Performed Errors Observed Errors Shane et al. (2008), NeuroImage Similar dACC activity was obtained during both the performance of one’s own errors, and also the observation of another’s errors.

29. Error Performance/Observation Study Results Performed Errors Observed Errors In addition, several regions showed unique activity only during processing of other’s errors Shane et al. (2008), NeuroImage

30. Error Performance/Observation Study Results Correlations between vACC response to observed errors and Levenson Self-report Psychopathy (LSRP) scores Shane et al. (resubmitted)

31. Error Performance/Observation Study Results Correlations between vACC response to observed errors and self-reported empathic concern Shane et al. (2009), SCAN Thus, participants who scored higher on self-reported empathic concern showed increased vACC activity during the observation of another person’s failures.

32. “Try to feel the other’s pain”

33. Entire Sample (N = 26) With ASPD (N = 9) Without ASPD (N = 15) AgeM = 33.52 (8.62)M = 35.22 (10.77)M = 34.38 (7.64) IQM = 104.69 (12.17)M = 101.67 (10.45)M = 105.00 (14.25) PCL-RM = 21.12 (6.23)M = 23.59 (6.80)M = 19.42 (5.42) PCL-R Factor 1M = 7.24, (3.38)M = 8.51 (3.56)M = 6.35 (3.08) PCL-R Factor 2M = 10.57 (2.90)M = 11.02 (3.32)M = 10.26 (2.67) Comorbid Diagnoses Alcohol Dependence50.00%55.56%46.15% Drug Dependence68.18%77.78%61.54% Current Psychotropic Meds13.64%11.11%15.38% Anxiety18.18%11.11%23.08% Depression31.82%55.56%15.38% Psychotic Disorders4.55%11.11%0.00% “Try to increase your level of concern for the individual in pain” Study 1: Probation/Parole sample

34. “Try to feel the other’s pain” Arbuckle and Shane (resubmit)

35. “Try to feel the other’s pain” Arbuckle and Shane (resubmit)

36. “Try to feel the other’s pain” Z-scores of Subjective Pain Ratings and Left Insula Response Arbuckle and Shane (resubmit)

37. Study 2. Demographics Total (N = 27) High PCL-R (N = 14) Low PCL-R (N = 13) Age32.56 (8.44)35.27 (7.54)30 (9.58) IQ104.04 (6.77)104.00 (6.77)102.21 (10.81) PCL-R23.11 (7.89)32.18 (1.33)15.41 (4.13) PCL-R Factor 18.67 (3.76)12.79 (1.69)5.00 (1.88) PCL-R Factor 211.26 (3.69)15.18 (0.87)8.06 (2.24) Comorbid Diagnoses Alcohol Dependence73.53%90.91%50.00% Drug Dependence85.29%100%64.29% Anxiety23.53%18.18%21.43% Depression20.59%18.18%21.43% ASPD73.53%90.91%50.00% Arbuckle and Shane (in progress)

38. Study 2. Results Arbuckle and Shane (in progress) NegWatch > NeutWatch Activity represents greater responses in low PCL-R Activity represents greater responses in high PCL-R NegIncrease > NegWatch

39. ACC Left IFG Study 2. Results Arbuckle and Shane (in progress) NegWatch > NeutWatch Activity represents greater responses in low PCL-R Activity represents greater responses in high PCL-R NegIncrease > NegWatch

40. ACC Left IFG Study 2. Results Arbuckle and Shane (in progress) NegWatch > NeutWatch Activity represents greater responses in low PCL-R Activity represents greater responses in high PCL-R NegIncrease > NegWatch

41. Motivated Empathy? Meffert and colleagues (2013) devised the terms “spontaneous” versus “deliberate” empathy, Impaired in “spontaneous” empathy Normal “deliberate” empathy In the place of “deliberate”, I may instead suggest the term “motivated” Received a direct instruction to feel… Coincides with recent work by Zaki and colleagues (e.g. Zaki, 2014), in which he puts out a call for researchers to consider the extent to which empathy is, at its very nature, a motivation

42. Next Steps? Better demonstrate that increased neural response indeed represents empathy Behavioral metrics Functional connectivity analyses Manipulate motivation to feel for another person Evaluating empathic accuracy for ingroup versus outgroup versus family members Constructing situations within which the psychopath may want to empathize (to manipulate?) Also evaluating a variety of neuromodulation techniques Have used rt-fMRI in the past Considering attempting HD-tdcs to stimulate subcortical emotion regions For me, external stimulation is less satisfying, however

43. Previous Treatment Attempts Rice, Hare and Cormier, 1991 May be considerable implications for potential therapeutic concerns Treatable versus untreatable