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A recent theoretical framework suggests a complex interplay of empathy, theory of mind (ToM), and negative thinking processes as a crucial risk combination for internalizing symptoms. To disentangle these relationships, this study utilizes neural, behavioral, and self\u2010report data to examine how the interplay between empathy, ToM, and negative thinking processes relates to stress and negative affect. We reanalyzed the baseline data of <jats:italic>N<\/jats:italic>\u2009=\u2009302 healthy participants (57% female, <jats:italic>M<\/jats:italic><jats:sub>age<\/jats:sub>\u2009=\u200940.52, <jats:italic>SD<\/jats:italic><jats:sub>age<\/jats:sub>\u2009=\u20099.30) who participated in a large\u2010scale mental training study, the ReSource project. Empathy and ToM were assessed using a validated fMRI paradigm featuring naturalistic video stimuli and via self\u2010report. Additional self\u2010report scales were employed to measure internalizing symptoms (perceived stress, negative affect) and negative thinking processes (rumination and self\u2010blame). Our results revealed linear associations of self\u2010reported ToM and empathic distress with stress and negative affect. Also, both lower and higher, compared to average, activation in the anterior insula during empathic processing and in the middle temporal gyrus during ToM performance was significantly associated with internalizing symptoms. These associations were dependent on rumination and self\u2010blame. Our findings indicate specific risk constellations for internalizing symptoms. Especially people with lower self\u2010reported ToM and higher empathic distress may be at risk for more internalizing symptoms. Quadratic associations of empathy\u2010 and ToM\u2010related brain activation with internalizing symptoms depended on negative thinking processes, suggesting differential effects of cognitive and affective functioning on internalizing symptoms. Using a multi\u2010method approach, these findings advance current research by shedding light on which complex risk combinations of cognitive and affective functioning are relevant for internalizing symptoms.<\/jats:p>","DOI":"10.1002\/hbm.26576","type":"journal-article","created":{"date-parts":[[2024,2,24]],"date-time":"2024-02-24T19:05:32Z","timestamp":1708801532000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Risk factors for internalizing symptoms: The influence of empathy, theory of mind, and negative thinking processes"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7263-9693","authenticated-orcid":false,"given":"Annika C.","family":"Konrad","sequence":"first","affiliation":[{"name":"Clinical Psychology and Behavioral Neuroscience Technische Universit\u00e4t Dresden  Dresden Germany"},{"name":"MRC Cognition and Brain Sciences Unit University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"F\u00f6rster","sequence":"additional","affiliation":[{"name":"Clinical Psychology and Behavioral Neuroscience Technische Universit\u00e4t Dresden  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Stretton","sequence":"additional","affiliation":[{"name":"MRC Cognition and Brain Sciences Unit University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Dalgleish","sequence":"additional","affiliation":[{"name":"MRC Cognition and Brain Sciences Unit University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"B\u00f6ckler\u2010Raettig","sequence":"additional","affiliation":[{"name":"Department of Psychology Julius\u2010Maximilians\u2010Universit\u00e4t W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fynn\u2010Mathis","family":"Trautwein","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine Medical Center\u2014University of Freiburg  Freiburg im Breisgau Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Singer","sequence":"additional","affiliation":[{"name":"Social Neuroscience Lab Max Planck Society  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Kanske","sequence":"additional","affiliation":[{"name":"Clinical Psychology and Behavioral Neuroscience Technische Universit\u00e4t Dresden  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(94)90005-1"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2016.09.019"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(00)00309-8"},{"key":"e_1_2_12_5_1","volume-title":"Beck depression inventory\u2013II [psychological assessments]","author":"Beck A. 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