Empathy present and future

Understanding of empathetic communication in acute hospital settings: a scoping review

OBJECTIVE

Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of 'empathetic communication' remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented.

DESIGN

Scoping review.

DATA SOURCES

Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted.

STUDY SELECTION

All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers.

DATA EXTRACTION

Data were assessed through the use of a pre-set analysis tool.

RESULTS

After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term 'empathetic communication'; however, 33 unique definitions of 'empathy' were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process.

CONCLUSION

Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures.

PRACTICE IMPLICATIONS

Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.

Effects of emotional valence and intensity on cognitive and affective empathy after insula lesions

The insula plays a central role in empathy. However, the complex structure of cognitive (CE) and affective empathy (AE) deficits following insular damage is not fully understood. In the present study, patients with insular lesions (n = 20) and demographically matched healthy controls (n = 24) viewed ecologically valid videos that varied in terms of valence and emotional intensity. The videos showed a person (target) narrating a personal life event. In CE conditions, subjects continuously rated the affective state of the target, while in AE conditions, they continuously rated their own affect. Mean squared error (MSE) assessed deviations between subject and target ratings. Patients differed from controls only in negative, low-intensity AE, rating their own affective state less negative than the target. This deficit was not related to trait empathy, neuropsychological or clinical parameters, or laterality of lesion. Empathic functions may be widely spared after insular damage in a naturalistic, dynamic setting, potentially due to the intact interpretation of social context by residual networks outside the lesion. The particular role of the insula in AE for negative states may evolve specifically in situations that bear higher uncertainty pointing to a threshold role of the insula in online ratings of AE.

Introspective self-narrative modulates the neuronal response during the emphatic process: an event-related potentials (ERPs) study

Empathy is the ability to perceive and understand others' emotional states generating a similar mental state in the self. Previous behavioural studies have shown that self-reflection can enhance the empathic process. The present event-related potentials' study aims to investigate whether self-reflection, elicited by an introspective self-narrative task, modulates the neuronal response to eye expressions and improves the accuracy of empathic process. The 29 participants included in the final sample were divided into two groups: an introspection group (IG) (n = 15), who received an introspective writing task, and a control group (CG) (n = 14), who completed a not-introspective writing task. For both groups, the electroencephalographic and behavioural responses to images depicting eye expressions taken from the "Reading the Mind in the Eyes" Theory of Mind test were recorded pre- (T0) and post- (T1) 7 days of writing. The main result showed that only the IG presented a different P300 amplitude in response to eye expressions at T1 compared to T0 on the left centre-frontal montage. No significant results on accuracy at T1 compared to T0 were found. These findings seem to suggest that the introspective writing task modulates attention and implicit evaluation of the socio-emotional stimuli. Results are discussed with reference to the hypothesis that such neuronal modulation is linked to an increase in the embodied simulation process underlying affective empathy.

A Scoping Review on the Concept of Physician Caring

BACKGROUND

Physicians' interest in the health and well-being of their patients is a tenet of medical practice. Physicians' ability to act upon this interest by caring for and about their patients is central to high-quality clinical medicine and may affect burnout. To date, a strong theoretical and empirical understanding of physician caring does not exist. To establish a practical, evidence-based approach to improve health care delivery and potentially address physician burnout, we sought to identify and synthesize existing conceptual models, frameworks, and definitions of physician caring.

METHODS

We performed a scoping review on physician caring. In November 2019 and September 2020, we searched PubMed MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL Register of Controlled Trials to identify conceptual models, frameworks, and definitions of physician caring. Eligible articles involved discussion or study of care or caring among medical practitioners. We created a content summary and performed thematic analysis of extracted data.

RESULTS

Of 11,776 articles, we reviewed the full text of 297 articles; 61 articles met inclusion criteria. Commonly identified concepts referenced Peabody's "secret of care" and the ethics of care. In bioethics, caring is described as a virtue. Contradictions exist among concepts of caring, such as whether caring is an attitude, emotion, or behavior, and the role of relationship development. Thematic analysis of all concepts and definitions identified six aspects of physician caring: (1) relational aspects, (2) technical aspects, (3) physician attitudes and characteristics, (4) agency, (5) reciprocity, and (6) physician self-care.

DISCUSSION

Caring is instrumental to clinical medicine. However, scientific understanding of what constitutes caring from physicians is limited by contradictions across concepts. A unifying concept of physician caring does not yet exist. This review proposes six aspects of physician caring which can be used to develop evidence-based approaches to improve health care delivery and potentially mitigate physician burnout.

Consistency Analysis in Medical Empathy Intervention Research

Various studies have examined the effectiveness of interventions to increase empathy in medical professionals. However, inconsistencies may exist in the definitions, interventions, and assessments of empathy. Inconsistencies jeopardize the internal validity and generalization of the research findings. The main purpose of this study was to examine the internal consistency among the definitions, interventions, and assessments of empathy in medical empathy intervention studies. We also examined the interventions and assessments in terms of the knowledge-attitude-behavior aspects. We conducted a literature search for medical empathy intervention studies with a design of randomized controlled trials and categorized each study according to the dimensions of empathy and knowledge-attitude-behavior aspects. The consistencies among the definitions, interventions, and assessments were calculated. A total of 13 studies were included in this study. No studies were fully consistent in their definitions, interventions, and assessments of empathy. Only four studies were partially consistent. In terms of knowledge-attitude-behavior aspects, four studies were fully consistent, two studies were partially consistent, and seven studies were inconsistent. Most medical empathy intervention studies are inconsistent in their definitions, interventions, and assessments of empathy, as well as the knowledge-attitude-behavior aspects between interventions and assessments. These inconsistencies may have affected the internal validity and generalization of the research results.

Listen to my feelings! How prosody and accent drive the empathic relevance of complaining speech

Interpersonal communication often involves sharing our feelings with others; complaining, for example, aims to elicit empathy in listeners by vocally expressing a speaker's suffering. Despite the growing neuroscientific interest in the phenomenon of empathy, few have investigated how it is elicited in real time by vocal signals (prosody), and how this might be affected by interpersonal factors, such as a speaker's cultural background (based on their accent). To investigate the neural processes at play when hearing spoken complaints, twenty-six French participants listened to complaining and neutral utterances produced by in-group French and out-group Québécois (i.e., French-Canadian) speakers. Participants rated how hurt the speaker felt while their cerebral activity was monitored with electroencephalography (EEG). Principal Component Analysis of Event-Related Potentials (ERPs) taken at utterance onset showed culture-dependent time courses of emotive prosody processing. The high motivational relevance of ingroup complaints increased the P200 response compared to all other utterance types; in contrast, outgroup complaints selectively elicited an early posterior negativity in the same time window, followed by an increased N400 (due to ongoing effort to derive affective meaning from outgroup voices). Ingroup neutral utterances evoked a late negativity which may reflect re-analysis of emotively less salient, but culturally relevant ingroup speech. Results highlight the time-course of neurocognitive responses that contribute to emotive speech processing for complaints, establishing the critical role of prosody as well as social-relational factors (i.e., cultural identity) on how listeners are likely to "empathize" with a speaker.

Toward feeling, understanding, and caring: The development of empathy in young autistic children

LAY ABSTRACT

Empathy is a highly valued human capacity. Yet, autistic people are often portrayed as lacking in empathy. Recent research, which views empathy as a complex construct emerging from multiple interrelated emotional and cognitive processes, argues that, although many autistic people do have difficulty understanding others' emotions, and this may hinder them from responding to others in a prosocial manner, they are not indifferent to other people's feelings. Hoping to contribute to a better understanding of the unique challenges that autistic children face in their empathy development, we followed the development of four empathy abilities: emotion contagion, attention to others, emotion acknowledgment, and prosocial actions, in 1- to 6-year-old autistic children, in comparison with non-autistic children. Once a year, for 4 consecutive years, children's empathy abilities were evaluated by experimenters who acted out emotional episodes to provoke empathy in children, and by parents who filled out empathy questionnaires. We found that autistic children experienced indeed more difficulty attending to others, acknowledging others' emotions, and initiating prosocial actions toward others. However, according to parents, they did not differ from their non-autistic peers in feeling along with others' negative emotions. This indicates that it might not be the case that autistic children did not want to act empathetically toward others. Rather, they might not know how to do so. Notably, despite these difficulties, when looking at children's developmental trajectories, autistic children showed similar improvements over time as non-autistic children. This provides evidence that autistic children have the potential to learn and to improve their empathy skills.

I will help you survive but not thrive: Helping decisions in situations that empower women

This research examines gender-based helping behavior from a social dominance perspective. We focused on the interplay between the gender of a prospective donor and the gender of the recipient in shaping donation decisions in contexts that either empower recipients or not. In two studies ( N = 866), male (but not female) donors chose to donate less often (Study 2) and to give lower amounts (Studies 1–2) to women in need than to men when donations were made in a potentially empowering context – a business context (e.g., donating to a person whose shop burned down), than in a nonempowering context – a domestic context (e.g., donating to a person whose house burned down). Lack of empathy for the female recipient among men partially mediated this gender–donation bias effect (Study 2). These findings suggest that men are less likely to help women in situations that empower women and challenge the existing gender hierarchy.

Getting our Affect Together: Shared Representations as the Core of Empathy

Empathy is a construct that is notoriously difficult to define. Murphy and colleagues argue for leaning into the construct's inherent fuzziness and reverting to what they term a classical definition informed by the observations of philosophers and clinicians: as a dynamic, “unfolding process of imaginatively experiencing the subjective consciousness of another person, sensing, understanding, and structuring the world as if one were that person.” Although consistent with some historical conceptualizations, this definition risks incorporating so many processes it would make empathy difficult to operationalize or distinguish from any generally socially sensitive interaction. Defining empathy instead as the attempted representation, or simulation, of another's subjective internal experiences (whether sensory, affective, or cognitive) would increase its clarity and empirical utility.

Differences in personality functioning impairment in mood, anxiety, and personality disorders: a cluster analysis

BACKGROUND

The Alternative DSM-5 Model for Personality Disorders and the latest eleventh version of the International Classification of Diseases implement the level of impairment in self and interpersonal personality functioning (Level of Personality Functioning Scale - LPFS) as a core feature of personality pathology. However, some studies have indicated that personality functioning is also impaired in other mental disorders, but a more thorough exploration is missing. Thus, this study aims to develop profiles of levels of personality functioning in people with personality disorders and some other psychiatric diagnoses as well as without diagnosis.

METHODS

One-hundred-forty-nine people participated in the study. They came from three groups - healthy controls (n = 53), people with personality disorders (n = 58), and people with mood and anxiety disorders (n = 38). The LPFS was assessed by the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1). An optimal clustering solution using agglomerative hierarchical cluster analysis was generated to represent profiles of personality functioning.

RESULTS

The two patient groups showed significantly higher levels of personality functioning impairment than healthy controls. People with personality disorders showed higher levels of impairment than the other groups. In addition, the clustering analysis revealed three distinct profiles of personality functioning.

CONCLUSIONS

The impairment of personality functioning seems to be useful in the clinical assessment of other than personality disorders as well. As the resulting clustering profiles suggest, LPFS can be seen as an overall indicator of the severity of mental health difficulties and the presence of mental disorders symptoms. The LPFS provides valuable and detailed information about the individual's mental health and can thus serve as a broad basis for case formulation, treatment and therapy planning, and prognosis.

Why we Should Reject the Restrictive Isomorphic Matching Definition of Empathy

A growing cadre of influential scholars has converged on a circumscribed definition of empathy as restricted only to feeling the same emotion that one perceives another is feeling. We argue that this restrictive isomorphic matching (RIM) definition is deeply problematic because (1) it deviates dramatically from traditional conceptualizations of empathy and unmoors the construct from generations of scientific research and clinical practice; (2) insistence on an isomorphic form undercuts much of the functional value of empathy from multiple perspectives of analysis; and (3) combining the opposing concepts of isomorphic matching and self-other awareness implicitly requires motivational content, causing the RIM definition to implicitly require the kind of non-matching emotional content that it explicitly seeks to exclude.

Resonance as a Design Strategy for AI and Social Robots

Resonance, a powerful and pervasive phenomenon, appears to play a major role in human interactions. This article investigates the relationship between the physical mechanism of resonance and the human experience of resonance, and considers possibilities for enhancing the experience of resonance within human-robot interactions. We first introduce resonance as a widespread cultural and scientific metaphor. Then, we review the nature of "sympathetic resonance" as a physical mechanism. Following this introduction, the remainder of the article is organized in two parts. In part one, we review the role of resonance (including synchronization and rhythmic entrainment) in human cognition and social interactions. Then, in part two, we review resonance-related phenomena in robotics and artificial intelligence (AI). These two reviews serve as ground for the introduction of a design strategy and combinatorial design space for shaping resonant interactions with robots and AI. We conclude by posing hypotheses and research questions for future empirical studies and discuss a range of ethical and aesthetic issues associated with resonance in human-robot interactions.

Investigating adult age differences in real-life empathy, prosociality, and well-being using experience sampling

While the importance of social affect and cognition is indisputable throughout the adult lifespan, findings of how empathy and prosociality develop and interact across adulthood are mixed and real-life data are scarce. Research using ecological momentary assessment recently demonstrated that adults commonly experience empathy in daily life. Furthermore, experiencing empathy was linked to higher prosocial behavior and subjective well-being. However, to date, it is not clear whether there are adult age differences in daily empathy and daily prosociality and whether age moderates the relationship between empathy and prosociality across adulthood. Here we analyzed experience-sampling data collected from participants across the adult lifespan to study age effects on empathy, prosocial behavior, and well-being under real-life circumstances. Linear and quadratic age effects were found for the experience of empathy, with increased empathy across the three younger age groups (18 to 45 years) and a slight decrease in the oldest group (55 years and older). Neither prosocial behavior nor well-being showed significant age-related differences. We discuss these findings with respect to (partially discrepant) results derived from lab-based and traditional survey studies. We conclude that studies linking in-lab experiments with real-life experience-sampling may be a promising venue for future lifespan studies.

Attentional Features of Mindfulness are Better Predictors of Face Recognition than Empathy and Compassion-Based Constructs

Recent research has employed measures of either empathy, compassion or mindfulness and linked better face recognition memory to higher scores of identification with all humanity and mindfulness but not empathy or compassion. Additionally, empathy, compassion and mindfulness have been suggested as concepts that intertwine, but research has not yet examined how their respective personality questionnaires map onto latent concepts. We employed these measures together to explore their factor structure and, using structural equation modelling, we investigated if the suggested latent variables predict recognition memory performance for face and non-face stimuli. Attentional notions of mindfulness described a latent factor that predicted face recognition. All self-compassion facets and the non-react mindfulness facet described a latent factor, which predicted false alarms in face recognition. Finally, empathy and compassion-based notions described one latent factor, which did not predict recognition performance. None of the latent variables predicted performance in either object or voice recognition. Collectively, findings indicate attention-based mindfulness to benefit face recognition, prompting further research into the potential of mindfulness to support the face recognition process.

A Call for Compassionate Empathy: Analysis of Verbal Empathic Communication between Veterinary Students and Veterinary Clients and their Dogs

In human medicine, empathy contributes to enhanced patient satisfaction and trust, decreased litigation, and increased adherence to medical recommendations. Understanding client perspectives is crucial in the empathic process; failure to explore these perspectives has been linked to decreased client satisfaction in veterinary consultations. This article explores how veterinary clients verbally expressed emotional concerns during consultations and how veterinary students addressed them. The "Model of Empathic Communication in the Medical Interview" by Suchman et al., is the starting point for a thematic analysis of consultation transcripts. Clients expressed multiple emotional concerns both directly by using explicit words (coded as empathic opportunities-EO), and indirectly (coded as potential empathic opportunities-PEO), throughout the consultations. Indirect examples prevailed and included stories about previous experiences with pet illnesses and pet care received elsewhere. Clients used explicit words, including "fear" and "panic." Students usually responded with a biomedical focus, including asking medical questions and giving medical explanations. Although students demonstrated various communication skills, they failed to demonstrate a complete verbal compassionate empathic response (a novel code) that includes exploring and verbalizing accurate understanding of the clients' perspectives and offering help based on this understanding. These findings suggest that strategies to teach compassionate empathy and support its use in the clinical setting are not fully effective, and veterinary students risk entering practice unprepared to employ this vital competency. The authors also introduce an operational definition for compassionate empathy.

Empathic Validation in Physician-Patient Communication: An Approach to Conveying Empathy for Problems With Uncertain Solutions

Interest in systematic approaches to improving clinical empathy has increased. However, conceptualizations of empathy are inconsistent and difficult to operationalize. Drawing on video recordings of primary care visits with older adults, I describe one particular communication strategy for conveying empathy-empathic validation. Using conversation analysis, I show that the design of empathic validations and the context in which they are delivered are critical to positive patient responses. Effective empathic validations must (a) demonstrate shared understanding and (b) support the patient's position. Physicians provided empathic validation when there was no medical solution to offer and within this context, for three purposes: (1) normalizing changes in health, (2) acknowledging individual difficulty, and (3) recognizing actions or choices. Empathic validation is a useful approach because it does not rely on patients' ability to create an "empathic opportunity" and has particular relevance for older adults.

How cognitive and emotional empathy relate to rational thinking: empirical evidence and meta-analysis

Empathy is frequently described in opposition to rationality. Yet in two studies, we demonstrate that the relationship between rationality and empathy is nuanced and likely context dependent. Study 1 reports correlational data from two American samples and Study 2 presents a meta-analysis of existing literature (k = 22). We demonstrate that various types of cognitive empathy (perspective-taking, emotion recognition, and fantasy) are positively correlated with self-reported rationality, but unrelated to rational performance. In contrast, types of emotional empathy (empathic concern, personal distress, and emotion contagion) are generally negatively correlated with performance measures of rationality, but their relationships with self-reported rationality are divergent. Although these results do not settle the debate on empathy and rationality, they challenge the opposing domains hypothesis and provide tentative support for a dual-process model of empathy. Overall, these results indicate that the relationship between rationality and empathy differs depending upon how rationality and empathy are measured.

Empathic choices for animals versus humans: the role of choice context and perceived cost

People appear to empathize with cases of animal suffering yet to disregard such suffering when it conflicts with human needs. In three studies, we used an empathy regulation measure - the empathy selection task - to test whether people choose or avoid sharing in experiences of animals versus humans. In Study 1, when choosing between sharing experiences of animals or humans, participants preferred humans and rated sharing animal (versus human) experiences as more cognitively costly. In Studies 2a-2b, the choice to share experiences or be objective was done without a forced choice between animals and humans. When empathy opportunities for humans and animals were not contrasted against each other, participants avoided experience sharing for humans but not for animals. Manipulations of prosocial cost in these studies did not consistently moderate choice differences. Freeing people from contexts that pit empathy for animals against empathy for humans may diminish motivated disregard of animals' experiences.

Empathy, an important but problematic concept

The concept of empathy as it is used in scholarly discourse has been challenged for over 50 years, yet the same ambiguities and controversies associated with the concept persist and, indeed, have accelerated with the accumulation of definitions, subconstructs that are included under the empathy umbrella, and measuring instruments. In this article we address the following interrelated problems: many definitions, authors not offering definitions, authors using instruments that do not match their definitions, authors not specifying definitions and measurements in cited studies, the jingle-jangle problem, and the persistent need for more construct validity research. In this Special Issue on empathy and its problems, authors bring new theoretical insights, creative research designs, and a critical focus on the empathy concept itself.

Association of Medical Student Characteristics and Empathy After a Communication Workshop

Medical education values patient-centered communication skills of responding to patient's emotions, however, guidance is limited on how to provide a well-rounded curriculum. This study examines the effect of a 90-minute communication workshop on the level of empathy of the 116 medical students who participated in the workshop. We used three psychometric categories from the Jefferson Scale of Empathy (JSE) as dependent variables. We conducted mixed analysis of variance (ANOVA) analyses to determine the change in empathy scores after the workshop, the main effects for gender and medical specialty, and their interaction with time. We found an increase in perspective taking and compassionate care scales, although no changes on walking in patients' shoes scale. Female and people-oriented specialty students scored higher on all scales. Some gender-specialty groups showed an empathy decrease: people-oriented specialty females on compassionate care scale and people-oriented and other specialty males on walking in patients' shoes scale. We concluded that communication training requires a multidimensional approach to target various areas of building empathy. Standardization of training should be embedded with empathy development within medical education curriculum.

Observer descriptions of the empathic person: a look at the Davis IRI and Hogan empathy scales

We report the different personality profiles associated with five different empathy scales assessed by the face valid Davis Interpersonal Reactivity Index and the empirically derived Hogan Empathy Scale. Participants arranged in groups of 5-7 worked and socialized together in groups for nine weeks before evaluating each other using Ten-Item Personality Inventory. We also recruited the friends and family members of participants to complete Q-Set descriptions of them. As hypothesized, Empathic Concern from the IRI was associated with a target's apparent Agreeableness, a trait that includes the sub-trait of being altruistic. Hogan Empathy, however, was associated more strongly with judgments of a target's Extraversion and Openness, which are traits more aligned with the notion of an empathic counselor as opposed to a bystander intervener. These results make it clear that different empathy scales not only assess theoretically distinct empathy facets but also qualitatively different interpersonal behavior (i.e., perceptions made by family, friends, and colleagues of a target's behavioral and interaction tendencies).

The relationship between empathic concern and perceived personal costs for helping and how it is affected by similarity perceptions

One explanation for the positive effect of state empathic concern on helping is that such other-focused feelings reduce helpers' perceptions of their personal costs for helping. Results from an experiment (N = 186) supported these assumptions and showed further that self-focused feelings of personal distress, another form of affective empathy, were a positive predictor of perceived costs. Moreover, I examined whether the strength of the negative relationship between empathic concern and personal costs depends on two forms of perceived similarity between the helper and the target, person similarity and experience similarity. For this purpose, I manipulated person similarity by portraying the target as either similar or dissimilar with regard to essential characteristics, and assessed experience similarity by asking whether or not participants share the target's negative experience. As predicted, the negative relationship between empathic concern and perceived personal costs was strongest when person similarity was high and experience similarity low.

Empathy, friend or foe? Untangling the relationship between empathy and burnout in helping professions

The relationship between empathy and burnout in helping professions has been debated extensively, with some arguing the tendency to vicariously experience the emotions of another is a risk factor for burnout and others arguing that this disposition protects against burnout. We sought to aid this debate by assessing the relationship between two empathy facets, positive and negative, and burnout across three samples of helping professionals: practicing clinicians (N = 59), medical students (N = 76), and teaching assistants (N = 77). Results across all three samples consistently revealed that one's tendency to share in the positive emotions of another (i.e., positive empathy) was related to lower levels of burnout, even after controlling for several potential confounding factors. Beyond discussing the utility of the emerging study of positive empathy, we offer potential avenues for reducing burnout in helping professions by emphasizing the importance of sharing in the positive emotions of others.

What is your empathy scale not measuring? The convergent, discriminant, and predictive validity of five empathy scales

Recent reviews of the emapthy literature have revealed that nearly half of the published studies on empathy employed an empathy measure that did not align precisely with the theoretical definition the author provided. This may occur because researchers might not know what each published empathy scale actually measures. The present research begins to address this problem by reporting a large set of correlates for five different empathy scales to enable researchers to review the interpersonal traits and abilities each scale predicted. Participants (N = 182) completed the Davis IRI and the empirically derived Hogan Empathy Scale (HES). Each empathy scale produced its own unique pattern of correlates with empathy related traits that more or less supported each scale's description. However, none of the five scales reliably predicted empathy related abilities. We discuss the importance of examining a scale's predictive validity over its reliability, face-validity, popularity, or name.

Empathic accuracy and interpersonal coordination: behavior matching can enhance accuracy but interactional synchrony may not

The study considered two major facets of interpersonal coordination, namely, behavior matching (posture mirroring) and interactional synchrony, and investigated whether interpersonal coordination enhanced empathic accuracy. Interactional synchrony was further classified into simultaneous movement and interaction rhythms. Participants engaged in an eight-minute conversation with a same-gender unacquainted partner and an empathic accuracy task. Each participant viewed the interaction video and reported their thoughts and feelings at pre-determined points of time. Afterward, they rewatched the video and inferred the thoughts and feelings of their partners. The study employed OpenPose, 2D pose estimation software of human body, to quantify posture and bodily movement, which were used to determine coordination. The results indicated that behavior matching was positively associated with empathic accuracy, whereas rhythmic convergence in synchrony was negatively associated with accuracy in female dyads. The additional analysis explored the temporal relationship between coordination and accuracy, which indicated a cause-effect tendency during interactions.

Prosocial Video Game Content, Empathy and Cognitive Ability in a Large Sample of Youth

Whether playing video games with prosocial content has an influence on empathy among players remains contentious in the research literature. Some evidence suggests playing cooperatively with other gamers enhances empathy, but data have not conclusively linked prosocial content with empathy. Further, mechanisms of this potential relationship are unclear, and little work has been conducted on how cognitive skills, such as fluid reasoning, may mediate this relationship. The current study examines these relationships with a large sample of 3034 youth (27.2% female, Mage = 11.2; range 8-17 at time 1) in Singapore. Data were considered longitudinally across two years in three waves. Ultimately, no evidence emerged that prosocial content in video games had any impact on empathy related outcomes, nor was fluid reasoning a mediator variable for any relationship. However, variables such as social competence and depression and anxiety symptoms were highly related to empathy measures. This evidence adds to the growing debate in the field that video games may not dramatically alter, whether positively or negatively, the development of emotional and behavioral outcomes for youth.

Physician empathy according to physicians: A multi-specialty qualitative analysis

OBJECTIVES

To explore how physicians in neurology, family medicine, internal medicine, and emergency medicine characterize clinical empathy.

METHODS

Physicians (N = 94) were asked to describe up to 10 examples of empathic physician behavior. Data were analyzed using template analysis.

RESULTS

Physicians' descriptions of clinical empathy patterned into three themes: Clinical Performance and Professionalism, Interpersonal Communication, and Clinician Orientation. Clinical Performance and Professionalism subthemes included physician competency and accessibility; intersection with institutional resources; and spending/making/taking time with patients. Interpersonal Communication subthemes involved information sharing; verbal and nonverbal approaches; interpersonal sensitivity; physician self-disclosure; and attention to emotion. Clinician Orientation encompassed general physician demeanor and internal thoughts and feelings that might be unobservable by patients. Physicians varied widely in the themes they mentioned in their definition of empathy.

CONCLUSION

Physicians hold diverse notions of clinical empathy. These extend beyond traditional affective and cognitive empathy definitions to include structural elements like team-based care and accessibility after hours. Communication behaviors were perceived as important for demonstrating empathy. Some physician descriptions of empathy may not be perceptible to patients.

PRACTICE IMPLICATIONS

Training physicians to engage in behaviors that both they and patients perceive as empathic may lead to higher patient and physician satisfaction.

Development and Cross-National Validation of a French Version of the Jefferson Scale of Empathy for Students

Empathy is a multifaceted personal ability combining emotional and cognitive features modulated by cultural specificities. It is widely recognized as a key clinical competence that should be valued during professional training. The Jefferson Scale of Empathy for medical students (JSE-S) has been developed for this purpose and validated in several languages, but not in French. The aims of this study were to gather validity evidence for a newly developed version of the JSE-S and compare it between two French-speaking contexts. In total, 1,433 undergraduate medical students from the universities of Lyon (UL), France and Geneva (UG), Switzerland participated in the study completing the JSE-S in French. Total and partial scores of the three subscales (“perspective taking,” “compassionate care” and “walking in patient’s shoes”) were calculated for each site. Construct validity of the JSE-S was analyzed considering three sources of evidence: content, internal structure and relations to other variables. A first-order Confirmatory Factor Analysis using structural equation modeling examined the three latent variables of the JSE-S subscales. Cronbach’s α coefficients were 0.75 (UG) and 0.81 (UL). The items’ discrimination power ranged between 0.29 and 1.60 (median effect size of 1.24). The overall correlations between items and total or partial scores derived from the latent JSE-S subscales were consistently similar in both study sites. Findings of this study confirm the latent structure of the JSE-S in French and its cross-national reproducibility. The comparable underlying structure of the questionnaire tested in two distinct French-speaking contexts endorses the generalizability of its measure.

What is empathy? Oncology patient perspectives on empathic clinician behaviors

BACKGROUND

Oncology patients and physicians value empathy because of its association with improved health outcomes. Common measures of empathy lack consistency and were developed without direct input from patients. Because of their intense engagement with health care systems, oncology patients may have unique perspectives on what behaviors signal empathy in a clinical setting.

METHODS

As part of a cross-sectional study of patient perspectives on clinician empathy at an academic cancer center in the northeastern United States, the authors solicited up to 10 free-text responses to an open-ended question about what clinician behaviors define empathy.

RESULTS

The authors categorized open-ended responses from 89 oncology patients into 5 categories representing 14 themes. These categories were relationship sensitivity, focus on the whole person, communication, clinician attributes, and institutional resources and care processes. Frequently represented themes, including listening, understanding, and attention to emotions and what matters most, aligned with existing measures of empathy; behaviors that were not well represented among existing measures included qualities of information sharing and other communication elements. Patients also associated clinician demeanor, accessibility, and competence with empathy.

CONCLUSIONS

Oncology patients' perspectives on empathy highlight clinician behaviors and attributes that may help to refine patient experience measures and may be adopted by clinicians and cancer centers to enhance patient care and outcomes. High-quality communication skills training can promote active listening and paying attention to the whole person. A system-level focus on delivering empathic care may improve patients' experiences and outcomes.

LAY SUMMARY

Oncology patients' responses to an open-ended question about empathic clinician behavior have revealed insights into a variety of behaviors that are perceived as demonstrative of empathy. These include behaviors that imply sensitivity to the clinician-patient relationship, such as listening and understanding and attention to the whole person. Participants valued caring communication and demeanor and clinician accessibility. Perspective taking was not common among answers. Many existing measures of clinical care quality do not include the behaviors cited by patients as empathic. These results can inform efforts to refine quality measures of empathy-associated behaviors in clinical practice. Cancer centers can use skills training to improve elements of communication.

Feeling you, when you feel me: attachment, empathic concern, and interpersonal emotion regulation

Empathic concern is an important part of social relationships. Attachment orientation may explain individual differences in empathic concern. However, the circumstances under which attachment orientation is related to empathic concern remain unexamined. This exploratory study investigated the moderating role of a novel aspect of emotion regulation, interpersonal emotion regulation, in the relationship between attachment orientation and empathic concern. Study 1 (N = 179) and Study 2 (direct replication, N = 202) yielded consistent main effects for emotion regulation. Interpersonal emotion regulation efficacy (people's belief that interpersonal emotion regulation can effectively change their negative and positive emotions) was positively associated with empathic concern. Avoidant attachment showed a moderately consistent negative association with empathic concern. Negative efficacy moderated the association between anxious attachment and empathic concern only in Study 1. The findings focus attention on the importance of interpersonal emotion regulation efficacy to empathic concern and on the complex relationship between attachment and empathic concern.

Fear leads to suffering: Fears of compassion predict restriction of the moral boundary

Empirical investigations into the psychological drivers of more or less expansive moral thinking are lacking from the psychological literature. One potential driver that warrants deeper investigation is compassion - a prosocial motivation to both identity and alleviate suffering. The current research examined the extent to which compassion, and fears of compassion, act as a driver and inhibitor, respectively, of a morally expansive mindset. We tested these associations across three studies (N = 749) and found robust support for our predictions. Specifically, stronger compassion to others, and greater fears of extending compassion to others, were linked to enhanced and reduced moral expansiveness, respectively. Moreover, over and above empathy and mindfulness, fears of compassion and compassion uniquely predicted moral expansiveness. Finally, compassion was found to consistently mediate the relationship between fears of compassion to others and moral expansiveness. Our findings further our understanding of the psychological factors that may drive and restrict morally expansive mindsets and hold implications for the broader domains of moral decision-making and prosocial motivation as well as the application of practices that are designed to facilitate a compassionate mindset (e.g., Compassionate Mind Training).

The Experience of Empathy in Everyday Life

We used experience sampling to examine perceptions of empathy in the everyday lives of a group of 246 U.S. adults who were quota sampled to represent the population on key demographics. Participants reported an average of about nine opportunities to empathize per day; these experiences were positively associated with prosocial behavior, a relationship not found with trait measures. Although much of the literature focuses on the distress of strangers, in everyday life, people mostly empathize with very close others, and they empathize with positive emotions 3 times as frequently as with negative emotions. Although trait empathy was negatively associated only with well-being, empathy in daily life was generally associated with increased well-being. Theoretically distinct components of empathy-emotion sharing, perspective taking, and compassion-typically co-occur in everyday empathy experiences. Finally, empathy in everyday life was higher for women and the religious but not significantly lower for conservatives and the wealthy.

The neuroscience of empathy and compassion in pro-social behavior

Research in the scientific literature increasingly demonstrates that empathy consists of multiple dimensions, and that defining empathy as a single encompassing term may be imprecise. Recent calls have been made for increasing empathy as means to increase pro-social behavior. However, contradictory evidence exists that empathy may reduce pro-social behavior. This debate has sparked confusion around what is empathy, along with the value of empathy in promoting pro-social behavior. This paper will examine recent advances in affective neuroscience to better understand the construct of empathy and its relationship to pro-social behavior. Individuals' responses to affective empathy, seeing the suffering of others can result in personal distress or empathic concern, which may then subsequently affect motivation for pro-social behavior. Current research in affective neuroscience suggests that combining compassion interventions in conjunction with both affective and cognitive empathy offers the most optimal likelihood that individuals will engage in pro-social behavior.

Placebo Analgesia Does Not Reduce Empathy for Naturalistic Depictions of Others' Pain in a Somatosensory Specific Way

The shared representations account postulates that sharing another's pain recruits underlying brain functions also engaged during first-hand pain. Critically, direct causal evidence for this was mainly shown for affective pain processing, while the contribution of somatosensory processes to empathy remains controversial. This controversy may be explained, however, by experimental paradigms that did not direct attention towards a specific body part, or that did not employ naturalistic depictions of others' pain. In this preregistered functional magnetic resonance imaging study, we aimed to test whether causal manipulation of first-hand pain affects empathy for naturalistic depictions of pain in a somatosensory-matched manner. Forty-five participants underwent a placebo analgesia induction in their right hand and observed pictures of other people's right and left hands in pain. We found neither behavioral nor neural evidence for somatosensory-specific modulation of pain empathy. However, exploratory analyses revealed a general effect of the placebo on empathy, and higher brain activity in bilateral anterior insula when viewing others' right hands in pain (i.e., corresponding to one's own placebo hand). These results refine our knowledge regarding the neural mechanisms of pain empathy, and imply that the sharing of somatosensory representations seems to play less of a causal role than the one of affective representations.

The Empathic Capacity and the Ability to Regulate It: Construction and Validation of the Empathy Management Scale (EMS)

The aim of this study was to develop a measure to evaluate the management of empathic capacity. To this end, two studies were conducted. Study 1 (N = 277, 172 females) describes the scale creation procedure, factorial validity, and internal consistency. The exploratory factor analysis yielded a five-factor model with 18 items (62.4% of the variance explained). The dimensions were as follows: D1: identification, D2: incorporation, D3: reverberation, D4: separation, and D5: projection. The internal consistency was good (alpha values ranging from 0.70 to 0.80). Study 2 (N = 480, 323 females) examined the validity (including convergent validity) of the model and the relationships with sociodemographic variables. The five-factor model showed a robust goodness of fit, χ² = 240.5, p < 0.001, root mean square residual (RMSR) = 0.05. The fit indices were satisfactory, Non-normed fit index (NNFI) = 0.89, comparative fit index (CFI) = 0.90, mean square error of approximation (RMSEA) = 0.04. The convergent validity analysis showed that, as empathy management increased, so too did the empathy level and emotional intelligence. Some differences by age and sex were found. In conclusion, the Empathy Management Scale is a valid and reliable instrument for analyzing the empathic process that allows vulnerabilities and strengths to be estimated, which could improve professional practice in the healthcare context.

Parallel empathy and group attitudes in late childhood: The role of perceived peer group attitudes

Although several studies have examined outgroup empathy, the link between trait empathy and outgroup attitudes has been underinvestigated. In the present study this link was investigated among two samples of ethnic Dutch preadolescents (N = 335, M_age = 10.83 years, SD = 0.94; 53% girls; N = 326; M_age = 10.53 years, SD = 1.03; 48% girls). It examined children's parallel empathy in relation to their ethnic attitudes, and the moderating role of perceived peer norms. Results (partly) support the hypotheses that empathy is associated with more outgroup positivity and less ingroup bias (ingroup minus outgroup attitude). The negative link between empathy and outgroup bias was stronger when peers were perceived to be more biased against the outgroup.

What is clinical empathy? Perspectives of community members, university students, cancer patients, and physicians

OBJECTIVES

To explore what undergraduates, community members, oncology patients, and physicians consider empathic behavior in a physician.

METHODS

150 undergraduates, 152 community members, 95 physicians, and 89 oncology patients rated 49 hypothetical physician behaviors for how well they fit their personal definition of physician empathy. Dimensions of empathy were explored and compared across groups.

RESULTS

Three dimensions of empathy were Conscientious and Reassuring, Relationship Oriented, and Emotionally Involved. Relationship Oriented was the most strongly endorsed, followed by Emotionally Involved, with Conscientious and Reassuring coming in last. There were no group differences for Conscientious and Reassuring, but the Relationship Oriented factor was more endorsed by the clinical groups (physicians and patients) than the non-clinical groups. The Emotionally Involved factor was endorsed by physicians notably more than by patients.

CONCLUSION

What is considered clinical empathy is not the same across individuals and stakeholder groups.

PRACTICE IMPLICATIONS

Physicians and patients differ in how much they include the physicians' emotionality and emotion-related actions in their definition of empathy. Communication training for physicians that emphasizes behaviors associated with empathy (listening, understanding a person's feelings and perspectives, and showing interest in and concern for the whole person) may enhance patients' perception of clinical empathy.

Chilean Version of the Empathy Quotient (EQ) Scale: Adaptation and Psychometric Properties

We evaluated the psychometric properties of the empathy quotient (EQ) scale translated to Spanish in Chile. We estimated its structural validity, and its construct validity with other convergent measures of empathy and attachment, as well an inversely associated construct such as aggression. We used a general sample of students and community individuals (n = 336). Participants completed the EQ, Interpersonal Reactivity Index (IRI), and Buss-Perry Aggression Questionnaire (BPAQ). Another exclusively community group (n = 102) completed Collins Adult Attachment scale and the EQ. CFA and ESEM analyses confirmed the structural model fit of the data to three previously reported dimensions of the EQ: cognitive empathy (CE), emotional reactivity (ER) and social skills (SS). Sex-differences in emotional reactivity, and the predicted relationships with the convergent measures were observed. The current Chilean version of the EQ resulted in an appropriate multidimensional measurement of empathy. Finally, providing a specific social skills dimension extends the traditional conception of cognitive and affective empathy to the social realm in the Chilean context.

Alexithymia and Autistic Traits as Contributing Factors to Empathy Difficulties in Preadolescent Children

Recent evidence suggests that, contrary to traditional views, empathy difficulties may not be a core feature of autism; but are rather due to co-occurring alexithymia. Empathy, alexithymia and autistic traits have yet to be examined concurrently in children. Therefore, we examined the co-occurrence of empathy difficulties and alexithymia in 59 typically developing and 5 autistic children. Multiple measures (self-report, parent-report and a behavioural task) were used to evaluate empathy and to assess differences in self- and parent-reports using multiple regressions. Alexithymia was found to predict empathy significantly better than autistic traits, providing support for the alexithymia hypothesis. From a therapeutic perspective, results suggest autistic children who screen positive for elevated alexithymic traits may benefit from additional support targeting emotion identification.

The Affiliative Role of Empathy in Everyday Interpersonal Interactions

Empathy theoretically serves an affiliative interpersonal function by satisfying motives for intimacy and union with others. Accordingly, empathy is expected to vary depending on the situation. Inconsistent empirical support for empathy's affiliative role may be because of methodology focused on individual differences in empathy or differences between controlled experimental conditions, which fail to capture its dynamic and interpersonal nature. To address these shortcomings, we used ecological momentary assessment to establish typical patterns of empathy across everyday interactions. Associations among empathy, affect, and interpersonal behaviour of self and interaction partner were examined in a student sample (N = 330), then replicated in a preregistered community sample (N = 279). Multilevel structural equation modelling was used to distinguish individual differences in empathy from interaction-level effects. Results show that people are more empathetic during positively valenced interactions with others perceived as warm and when expressing warmth. By confirming the typically affiliative role of empathy, existing research to the contrary can be best understood as exceptions to the norm.

Frankenstein; or, the modern Prometheus: a classic novel to stimulate the analysis of complex contemporary issues in biomedical sciences

BACKGROUND

Advances in biomedicine can substantially change human life. However, progress is not always followed by ethical reflection on its consequences or scientists' responsibility for their creations. The humanities can help health sciences students learn to critically analyse these issues; in particular, literature can aid discussions about ethical principles in biomedical research. Mary Shelley's Frankenstein; or, the modern Prometheus (1818) is an example of a classic novel presenting complex scenarios that could be used to stimulate discussion.

MAIN TEXT

Within the framework of the 200th anniversary of the novel, we searched PubMed to identify works that explore and discuss its value in teaching health sciences. Our search yielded 56 articles, but only two of these reported empirical findings. Our analysis of these articles identified three main approaches to using Frankenstein in teaching health sciences: discussing the relationship between literature and science, analysing ethical issues in biomedical research, and examining the importance of empathy and compassion in healthcare and research. After a critical discussion of the articles, we propose using Frankenstein as a teaching tool to prompt students to critically analyse ethical aspects of scientific and technological progress, the need for compassion and empathy in medical research, and scientists' responsibility for their discoveries.

CONCLUSION

Frankenstein can help students reflect on the personal and social limits of science, the connection between curiosity and scientific progress, and scientists' responsibilities. Its potential usefulness in teaching derives from the interconnectedness of science, ethics, and compassion. Frankenstein can be a useful tool for analysing bioethical issues related to scientific and technological advances, such as artificial intelligence, genetic engineering, and cloning. Empirical studies measuring learning outcomes are necessary to confirm the usefulness of this approach.

Do Social Cognition Deficits Recover with Abstinence in Alcohol-Dependent Patients?

Background

Despite growing evidence of the presence and clinical relevance of deficits in social cognition in individuals with alcohol use disorder (AUD), less is known about the potential of “natural” recovery with abstinence in this neurocognitive domain. This study investigated the abstinence‐based recovery of neurocognitive social abilities in alcohol‐dependent patients (ADP) using a prospective longitudinal design with follow‐up assessment under controlled conditions of abstinence during alcohol dependence inpatient treatment.

Methods

Seventy‐seven participants (42 ADP and 35 healthy controls [HC]) performed social cognition testing, including facial emotion recognition, perspective taking, and affective responsiveness twice (baseline/T1 and follow‐up/T2) during comparable follow‐up periods. Assessment of social cognition in abstinent ADP was conducted at the beginning (T1; within the first 2 weeks) and at the end (T2; within the last 2 weeks) of long‐term (2 months) abstinence‐oriented alcohol dependence inpatient treatment. Only patients abstinent for >14 days (last heavy drinking day >21 days) at baseline (T1) and who remained abstinent at follow‐up (T2) were included.

Results

ADP, who on average were nearly 2 months abstinent at T1, showed poorer social cognition in all 3 areas (emotion recognition, perspective taking, and affective responsiveness) than HC. There was no difference between groups on the change in performance over time, and group differences (ADP vs. HC) remained significant at T2, indicating persistent social cognition deficits in ADP following controlled abstinence during inpatient treatment.

Conclusions

Our findings indicate no natural recovery of social cognition impairments in ADP during an intermediate to long‐term period of abstinence (2+ months), the usual active treatment phase. Research aimed at developing interventions that focus on the improvement of social cognition deficits (e.g., social cognition training) and determining whether they benefit short‐ and long‐term clinical outcomes in AUD seems warranted.