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Prepare a research that  seeks to evaluate the role of mirror neurons in vicarious trauma


Subject Nursing Pages 11 Style APA


Research Question 

This research seeks to evaluate the role of mirror neurons in vicarious trauma


H0 – Mirror neurons are responsible for countertransference of vicarious trauma

H1 – Mirror neurons are not responsible for countertransference of vicarious trauma

Literature  Review


Imitation is a powerful tool for learning . This tool is mostly used by children as they emulate and subsequently reproduce the actions, mostly the facial expressions of the adults around them (Garcia, 2017) . In the process, they assimilate the basic behaviors exhibited by the adults. In the same breath, children can imitate laughter. This is the reason why psychologists believe that emotions are contagious. Adults equally exhibit same traits as children, only that they have a better understanding of their environment and the emotions. However, when adults watch sad movies, they have a tendency of becoming emotional and sad while others cry along with the actors. These reiterations justify the ability for human beings to feel, empathize, and be emotionally in synch with the feelings of the people around them (Garcia, 2017). To provide a detailed explanation of these scenarios and the inherent dynamics, psychologists have undertaken a detailed study and analysis of the human brain. One of the most convincing arguments is associated with the mirror neuron .

Various definitions have been presented explaining the meaning and functioning of the mirror neurons . According to Praszkier (2016)  mirror neurons are brain cells found in primate and human brains and are activated when the individual sees another person doing something. Acharya and Shukla (2012) define mirror neurons as a distinctive class of brain cells that are activated when an individual either observes or executes a motor act. In yet another definition, mirror neurons are described as the part of the brain cells that fires when a primate or an animal either acts or when it observes an action performed by another animal. The neurons therefore mirror, emulate or imitate the behavior of the other person as though they were the original doers of the action. Scientific and psychological studies have associated mirror neurons with the transfer of emotions such as empathy and imitation of behavior during socialization .

Given the correlation between mirror neurons and emotions, psychologists have strongly associated the brain cells with the causation of vicarious trauma . Schechter (2017) defines vicarious trauma as an emotional transformation of a person working with traumatized persons. A more succinct definition associates vicarious trauma with the emotional outcome resulting from exposure of counsellors and trauma workers/ helpers to traumatized clients. The trauma is passed on to the counsellors through hearing stories or witnessing the fear, terror, horror, and pains of the trauma survivors. As much as it is certain that exposure to traumatized clients could potentially cause vicarious trauma, it is important to explore in detail how mirror neurons contribute to countertransference leading to vicarious trauma (Charles, 2015) . Guided by this backdrop, this paper details a scoping review of the role of mirror neurons in vicarious trauma. It achieves this goal by coalescing past and current literature on the two topic and explaining how the neurons contribute to countertransference and vicarious traumatization of the counsellors and trauma helpers. 

The Role of Mirror Neurons in Vicarious Trauma 

  1. Vicarious Trauma 

Extensive research has shown that some professions are prone to vicarious trauma . For instance, research by Taylor et al. (2016) recognizes that nurses work in an environmental that is emotionally and intellectually challenging and demanding. Their willingness to help patients and immersing themselves selves deeply in the stories of traumatized clients over prolonged periods creates vicarious trauma. Taylor et al. (2016) describes vicarious trauma as an unavoidable change in the inner experiences of persons involved with traumatized patients resulting from the sharing of their disturbing experiences. The definition implies that consistent exposure to traumatic patients makes the health workers vulnerable to countertransference (Piedfort-Marin, 2018). This type of trauma was most prevalent in professions that encouraged higher levels of empathetic openness. It is feared that as the professionals continue to engage with diverse clients, they equally become traumatized. This problem also affects people extensively involved in research on topics such as dying and violence, transcriptionists and translators, and lawyers who are constantly listening to sensitive issues from their clients. Bar (2018) laments that whereas these professions have put in place ethical protocols to prevent specialists from countertransference, the process occurs unconsciously.

An article by Madert (2015) refers to vicarious trauma as a secondary traumatic stress.  The topic has attracted research for the past 25 years. In the article, authors such as Sartos (2016) associates vicarious trauma with experiences that cause profound psychological effects on the trauma helpers to the extent that the impacts can be painful and disruptive. These effects can persist for years or months. Contrary to early researches associating the trauma with counsellors and therapists, modern research has observed similar trends across different professionals, where some are unrelated to medical and psychological professions such as lawyers. Notably, the primary risk factor for vicarious trauma is abuse, violence, and bereavement. Recent researches have also classified interpreters, transcriptionists, and researchers as vulnerable professions since they deal with sensitive issues that predisposes them to trauma (Howard, 2016). Regardless of the extensive researches touching on vicarious trauma, it is less clear how the trauma is transferred from the victims to the professionals. 

  1. Mirror Neurons

Mirror neurons are considered as one of the important discoveries made in the last decade in the field of neuroscience . Acharya and Shukla (2012) note that these neurons are part of the visuospatial neurons which are responsible for social interactions in human beings. Mirror neurons enable people and primates to respond to actions performed by others. Interestingly, these neurons enable people to not only recreate actions but also to feel the same way as the other person. In addition to facilitating imitations, the mirror neurons are responsible for sophisticated though processes and human behavior. These neurons are so significant to the human body that any defects to them is strongly linked to a high risk of autism (Khalil et al. 2018). Lamm and Majdandžić (2015) explain that the mirror neurons were discovered in the brains of monkeys. These findings motivated a corresponding study on the human brain. The findings presented that the human brain had a mirror neuron located in the premotor cortex, inferior parietal cortex (IPL), primary somatosensory cortex, and the supplementary motor area of the brain.  This area is summarized in figure 1 below. 

Figure 1: Location of the Mirror Neurons in the Human Brain (Acharya & Shukla, 2012)

The inferior parietal lobule (IPL) receives signals from the cortex located in the superior temporal sulcus (STS) . This region performs the functions of coding biological motions which are simultaneously transmitted through ventral premotor cortex and effected as an output signal. According to experiments done on the human brain using PET and fMRI, it is certain that the front-parietal circuit in human beings and monkeys have similar features. Mirror neurons develop in the human infants before 12 months of age. That is why children can easily emulate and understand actions performed by adults. The mirror neurons are then consistently trained to be effective through associative or Hebbian learning (Catmur, Press & Heyes, 2016). This approach to learning is hypothesized in the Hebbian theory by Donald Hebb who noted that the persistent and repeated stimulation of the presynaptic and postsynaptic cells could facilitate associative learning. As a result, this theory is often stated as ‘cells that fire together, wire together’ (Acharya & Shukla, 2012). This theory explains associative learning and it is essential in explaining the role of mirror neurons in vicarious trauma 

In addition to associative learning, Catmur et al. (2016) explain that the mirror neurons play a vital role in facilitating intentional understanding . This approach to learning is encouraged when professional counsellors are sharing experiences with traumatized patients. In such cases, the mirror neurons are responsible for the complex thought process involved in realizing intention understanding. In the case of the counsellors, countertransference arises when the brain performs two distinct processes after observing the trauma on the patient (Piedfort-Marin, 2018). First, the mirror neurons internalizes what action is being done. It then transitions to the second and even complex component that questions why or what for. This second component represents the intention of the action. The mirror neurons easily capture the subject being discussed and premonate a future action that is yet to occur. Kilner and Lemon (2013) clarify that this explanation was hypothesized by two neuroscientists and was later backed by fMRI studies. In the study experiment, the subjects were provided with hand actions executed within a given context and hand actions without a context. The context was aimed at allowing the subjects to understand the intention of the agents of the action. The findings from the study justified that actions attached to contexts often led to selective activation of mirror neurons.

These findings imply that mirror neurons have to interpret and understand an action to effectively mediate the intention of the other person . By doing so, the mirror neurons enable the counsellors and people involved with trauma victims to achieve intention understanding. Given the significant role played by mirror neurons, people with defective neurons suffer autism which hampers their ability to understand intention (Khalil et al. 2018). This sentence is justified by the inability for children and people suffering from autism to relate well with life situations and other people. To prove this claim, Khalil et al. (2018) explain that people with autistic conditions have suppressed EEG recordings of mu waves emitted from their motor areas. As a result, watching another person’s movements does not fire their neural system to emit similar signals. As opposed to people with autistic conditions, the mirror neurons mostly create negative effects leading to vicarious trauma in emotional and empathetic people.

Most of the people involved in helping trauma victims are highly emotional and this predisposes them to showing empathy which triggers the mirror neurons to imitate the traumatic patterns exhibited by the patients. Jeon and Lee (2018) enlighten that various studies done independently show that mirror neuron systems are involved in empathy and emotions. Studies using self-reported questionnaires have confirmed that people with high levels of empathy exhibited stronger activation of their mirror systems for both their hand actions and their emotions (Wagaman et al. 2015). This explanation justifies scenarios where people deeply involved in trauma counselling are more prone to vicarious trauma. Another interesting finding is that as much mirror neurons play a vital role in the assimilation of vicarious trauma, the degree of trauma is dependent on the physiological properties and anatomy of the circuits in the mirror neurons.

A further explanation of these observations justify that the mirror neurons have a direct correlation with vicarious trauma since they are responsible for the empathetic and emotional activation of the parieto premotor circuits that are responsible for controlling motor actions. To justify these sentiments, an fMRI experiment was schematically done where two groups of subjects were used. In the first group, short movie clips were used where the subjects were asked to watch disgusting facials. The second group was made to smell disgusting odorants. Shockingly, it was established that exposure to both smells and visuals activated anterior insular and anterior cingulate divisions of the brain (Carrillo et al. 2019). Similarly, fMRI experiments done on counselling experts suffering vicarious trauma showed that overexposure to traumatic patients had caused an activation of their anterior insula. This process was speculated to have occurred during the sharing of the empathetic emotions, recreation of horrific visual images, and imitation of the facials depicted by the trauma patients. To justify these findings further, Carrillo et al. (2019) report that similar results have been observed in people who shared painful experiences either through narration or observation. In most cases, the people affected by the vicarious trauma had to share a form of bond founded on love. Unfortunately, some therapies encourage bonding between the therapist and the clients which, when done over a prolonged period, creates the much needed bond to activate the circuits in the mirror neurons responsible for causing vicarious trauma.

Unlike the previous articles, Madert (2014) introduces the concept of self-reference in explaining the role of empathy in providing trauma therapy . The journal article further explains how the mirror neurons help individuals in psychological fields enhance their mindfulness. Madert presents a neurobiological viewpoint which helps explain the role of mirror neuron systems in trauma. The author begins by acknowledging the multiplicity of researches showing the connection between mirror neurons and empathy. Based on previous research, a mindfulness-based practice has always been proposed as the best means of training psychotherapists. Madert (2014) argues that any form of trauma arises when all the available and viable options to solving a problem are exhausted. The feeling of hopelessness triggers immense stress which is unbearable to the person in the traumatizing situation. The possible coping mechanisms usually fail to support the person’s psychological processes during this period. Similarly, their ability to process information becomes overtaxed.  The end result is unbearable levels of stress. Both the acute state of stress, and a failure to find a way out of unbearable stress cause trauma (Beckerman & Wozniak, 2018). When the traumatized patients interact with therapists, they find an avenue for venting and releasing the pent up energy. On the other hand, the therapists predispose themselves to sharing in the trauma which causes countertransference. To enhance the effectiveness of the therapies, Piedfort-Marin (2018) note that they have to be empathetic and create an atmosphere of trust. It is at this point that the author delves deeper into explaining the role of mirror neurons in either causing or healing trauma.

According to Madert (2015), the mirror neuron system is also known as the Dalai Lama neurons. He adds that whenever a person plans to act or wants to imitate something, the mirror neurons fire up thus initiating the action. The mirror neurons are so sensitive that they fire when a person feels emotions such as fear or job, when they pay attention to sharing emotional experiences of others, and when they watch another person execute a similar action. When a therapist shares in the traumatic experiences of a client, the mirror neuron fires and automatically recreates the scenes in the therapist’s brains. The therapist then engages voluntary suppression to prevent the body from reacting directly to the traumatic experiences. Garcia (2017) expound that the mirror neuron system reacts even to the slightest resonance even when a stimuli to which the client reacted to is only imagined and not perceived in reality. This process is known as subliminal stimulated simulation. In explaining the role of mirror neurons in the causation and even treatment of vicarious trauma, Steward (2017) states that these neurons form the neurological base upon which the therapists build their intuition about the intentions and emotions of other human beings.

A group of neuronal networks often contribute to the way the brain construes actions by other people. Imaging methods have shown that the there are some internal processes in the brain that are associated with traumatic changes. This include a saturation of oxygen in lower parietal cortex and lower premotor cortex. According to biologists, the lower parietal cortex is responsible for body sensations while the lower premotor cortex is liable for action planning. A change in the chemical composition of these parts due to oxygen saturation then affects the insula which is the system responsible for mapping of the body. Other systems that are affected include the gyrus cinguli which processes emotional ego-feelings and the amygdale region responsible for fear. These systems of the brain work collaboratively to create not only a representation of self, but also of the others. Isobel and Angus-Leppan (2018) add that the mirror neurons in the premotor system helps in planning actions and in verbal production. Therefore vicarious trauma tends to affect the speech roots creating verbal deficiencies. For this reason, problems with speech is a common indicator of trauma in therapists and other professional trauma helpers. A change in oxygen concentration in mirror neurons is blamed for neuronal malfunctioning in therapists suffering vicarious trauma. 

A journal article on the impact of mirror neurons on vicarious trauma argues that the work of therapists include, among other activities, interpreting the feelings and emotions of others, and helping them through the healing process . The nature of their work creates an environment where the emotional state of the client is reconstructed in the system of the therapists (Sartor, 2016). This state happens when the mirror system imitates the emotional state of the traumatized client. In so reacting, it creates a new format of archetypical neuronal that significantly differs depending on the personality and individuality of the therapist. This new neuronal format forms the base for empathetic reactions which enhance the trust and comfort levels between the therapist and the client. It is in this state that vicarious trauma is mostly transferred to the therapist. At this point, Sosic-Vasic et al. (2019) introduces a new ideology comparing a therapist’s work to a ‘container’. The authors explain that in the field of psychoanalysis, there is a psychic or metaphorical image of the therapists being equated to a container that accommodates intolerable emotions and expressions from their patients.

The process of sharing allows them to assimilate a lot of emotions which they predigest to create meaning of the situations. Neurobiological, these functions are performed in the cortical level of the brain. As a result, there is a high possibility that the emotional interactions force the therapist to simulate a similar state using the mirror neuron system. Doing this helps them build a virtual place where neuronal physical excitation happens. It is only by simulating the scenarios that the therapist is able to understand the emotional state of the patient. The interchange allows the patient to feel that their emotions are being shared by a loving and caring person (Sosic-Vasic et al. 2019). However, the interchange causes vicarious trauma on the counsellor. Using the metaphor referring to therapists as containers, it is certain that psychologists warn therapists against mirroring the emotions of the patients as it would lead to sympathetic co suffering, however, dissociating from the emotions of the patient would reduce the effectiveness of the counselling therapies. In addition, it is very hard dissociating the conscious therapeutic ego of the patient from that of the therapist. Leeson (2016) explains that when therapists are suffering from vicarious trauma, they are likely to concordantly drift into a state of shock. It includes overreacting to narrations of trauma by expressing freezing reactions and holding breath, instead of remaining composed and reassuring the patient. Some therapists show signs of vicarious trauma by engaging in complementary counter-aggression by initiating either flight or fight responses in form of emotional counter attack. When the therapist exhibits these reactions, the patient is often made to feel re-traumatized, a condition, which slows the healing process .

Russell and Brickell (2015) lament that human empathy is a double edge sword. In their research, the authors focused on unifying the topic of empathy and neurobehavioral theory of compassion.  Russell and Brickell (2015) intentionally used the word double edge sword to criticize the detrimental impact of vicarious trauma on helping professionals, trauma helpers, and care givers. By explaining the neurophysiological mechanism that enables these professionals to show empathy to people suffering from trauma, the authors highlight the role of mirror neurons in the countertransference of vicarious trauma (Piedfort-Marin, 2018). These narrations reinforce previous findings showing that mirror neurons are rooted in the inferior parietal cortex, primary somatosensory cortex, premotor cortex, and supplementary motor area (Case, Pineda & Ramachandran, 2015). However, unlike previous literature such as Taylor et al. (2016) who expresses certainty on the functions and functioning of the mirror system, Russell and Brickell (2015) express uncertainty by noting that the key functions of the mirror neurons is still a contested subject. 

There explanation evidences that until now, there is no comprehensive and acceptable neural model describing the specific activities within the neural system and how they support cognitive functioning in the brain.  Because of the speculations attached to this topic, there are still debates on the role of mirror neurons in explaining how the countertransference and vicarious trauma occur within the brain. Notwithstanding this negation, Russell and Brickell (2015) document studies on cognitive neuroscience and psychology credit the mirror neurons for their role in perception coupling and psychological action. This argument is backed by the common coding theory which is a theory applied in cognitive psychology to describe the link in motor and perceptual representation. Mirror neurons are handy in understanding how the actions by other people affect others. In addition, the mirror neurons help understand how learning occurs through imitation. These arguments insinuate that the mirror system is important in simulating observed actions therefore plays a role in explaining the transfer of vicarious trauma.  

To further reinforce these observations by Russell and Brickell (2015), literature by Rauvola, Vega and Lavigne (2019) was introduced to explain the role of mirror neurons and compassion fatigue . According to Radeka and Hicks (2020), compassion fatigue is transferred in a similar manner as vicarious trauma. The process of transfer centers on the transfer of empathy between the therapists and the client. Frans de Waal, Stephanie Preston, Christian Keysers, Jean Decety, Vittorio Gallese are credited for seminal works in this area. A common observation noted in an analysis of the research studies by these authors’ shows that the mirror neuron system is actively involved in triggering empathy among therapists. Observations by Kilpatrick (2016) support the views presented by Acharya and Shukla (2012) explaining that mirror neurons are responsible for the causation of vicarious trauma.

The article illuminates that research experiments done using magneto encephalography (MEG), electroencephalography (EEG), and fMRI, collectively indicated that the existence of a brain region tacked within the insula, anterior cingulate cortex, and interior frontal cortex, whose function is to activate emotions.  The range of emotions that were observed to activate this region include pain, happiness, and disgust. The region was so sensitive that it could fire even when a person shared or experienced the suffering or happiness of another person. The only contentious observation presented is that the mirror neurons are not responsible for mirroring hand actions. Current studies conducted by Christian Keysers and her colleagues from the Social Brain Lab used self-reported questionnaires to evaluate the functioning of mirror neurons in emotional people. The findings expressed that empathetic people reported stronger amplitudes of activation of the mirror systems. This is unlike less emotional people who exhibited lower magnitude.  These findings provide a solid justification that the mirror system is directly linked to empathy thus responsible for the causation of vicarious trauma. 

Another research that enlightens the role of mirror neurons in vicarious trauma analyzed the functioning of the mirror neuron systems in regard to automatic imitation and motor mimicry.  Genschow et al. (2017) define automatic imitation as the process through which an individual observes the body movement of another person and involuntarily or unintentional performs similar actions or body movement. Automatic imitation is further described as a concealed form of imitation. Most researchers associate the automatic imitation with the mirror neurons. Similarly, the mirror neurons are associated with motor mimicry. Nonetheless, motor mimicry, unlike automatic imitation, arises in natural social environments or situations Genschow et al. 2017). Considering these divergent definitions of automatic imitation and motor mimicry, the latter is better placed to explain how mirror neurons activate vicarious trauma.  Given that motor mimicry occurs in social situations, then it is certain that the interaction between a trauma therapist and traumatized client, could trigger the therapist into mimicking the emotional state of the patient. This causes vicarious trauma.  


This scoping review paper acknowledges that the mirror neuron system was discovered in the early years of the 1990s and has been used by neuroscientists and psychologists to explain the process of countertransference of trauma between traumatized patients and their therapists.  The mirror neurons were first identified in the brains of monkeys. This was after the exhibited behaviors that mimicked those of human beings. A research at the University of Parma identified that a part of the Brain contained hundreds of neurons was responsible for the performance of similar actions. Since the discovery of these neurons, there has been debates on whether they are responsible for the transfer of vicarious trauma among therapists and other professions involved in sharing emotions and empathy. A critical comparison of peer reviewed journal articles and other credible sources widely support the view that the mirror neurons play the primary role in the transfer of vicarious trauma. However, there are some contradicting studies that support otherwise. Whereas other researchers fail to find a connection between mirror neurons and vicarious trauma, others have noted that the role of the mirror neurons is insignificant. The findings made through this research however, confirm that most of the literature profiled for this proposal showed that the mirror neurons played a central role in countertransference and causation of vicarious trauma. 

Research Methods 

The actual research will entail conducting secondary research. The nature of the topic favors secondary collection of data and analysis, also known as desk research. It would be impractical to conduct scientific experiments to establish the role of mirror neurons. However, information is available on digital databases on the functioning of mirror neurons. The information can be collected and analyzed to make inferences that will either support H0 or H1. 
















































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