Empathy present and future

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.

How do laypeople define empathy?

The term "empathy" is popular, yet fuzzy. How laypeople define it has not been investigated. In Study 1, we analyzed 99 participants' free narratives describing their personal definition, and in Study 1 (N = 191) and Study 2 (N = 351), we asked participants to rate a list of specific behaviors and tendencies for how well each one matched their personal definition. Out of 10 coded components, perspective taking was mentioned most often and personal distress (anxious reactivity in emotional situations) was never mentioned. Item ratings revealed four Empathy Concept factors: Prosocial Emotional Response, Interpersonal Perceptiveness, Other Perspective, and Anxious Reactivity. Other Perspective and Prosocial Emotional Response were most highly endorsed while Anxious Reactivity showed the lowest endorsement. Individuals varied widely in their endorsements of the factors. These results demonstrate that laypeople hold a multifactorial set of definitions of empathy and differ widely from one another in which ones they endorse.

Another's pain in my brain: No evidence that placebo analgesia affects the sensory-discriminative component in empathy for pain

The shared representations account of empathy suggests that sharing other people's emotions relies on neural processes similar to those engaged when directly experiencing such emotions. Recent research corroborated this by showing that placebo analgesia induced for first-hand pain resulted in reduced pain empathy and decreased activation in shared neural networks. However, those studies did not report any placebo-related variation of somatosensory engagement during pain empathy. The experimental paradigms used in these studies did not direct attention towards a specific body part in pain, which may explain the absence of effects for somatosensation. The main objective of this preregistered study was to implement a paradigm overcoming this limitation, and to investigate whether placebo analgesia may also modulate the sensory-discriminative component of empathy for pain. We induced a localized, first-hand placebo analgesia effect in the right hand of 45 participants by means of a placebo gel and conditioning techniques, and compared this to the left hand as a control condition. Participants underwent a pain task in the MRI scanner, receiving painful or non-painful electrical stimulation on their left or right hand, or witnessing another person receiving such stimulation. In contrast to a robust localized placebo analgesia effect for self-experienced pain, the empathy condition showed no differences between the two hands, neither for behavioral nor neural responses. We thus report no evidence for somatosensory sharing in empathy, while replicating previous studies showing overlapping brain activity in the affective-motivational component for first-hand and empathy for pain. Hence, in a more rigorous test aiming to overcome limitations of previous work, we again find no causal evidence for the engagement of somatosensory sharing in empathy. Our study refines the understanding of the neural underpinnings of empathy for pain, and the use of placebo analgesia in investigating such models.

How to become more grateful? The mediating role of resilience between empathy and gratitude

The current study examined the relationship between empathy, resilience, and gratitude. Specifically, the study investigated the potential mediating role of resilience between empathy and gratitude. The study involved 214 participants who completed the Gratitude Resentment and Appreciation Test-Revised (GRAT-R), the Questionnaire of Cognitive and Affective Empathy (QCAE), and the Resilience Measurement Scale (SPP-25). The results showed significant positive correlations among resilience, empathy, and gratitude. Multiple regression analysis confirmed that resilience, gender, and affective empathy were direct predictors of the level of gratitude. Structural equation modeling (SEM) analysis supported the hypothesis that resilience played a mediating role between empathy and gratitude. Implications for research and the promotion of positive psychology programs for adults are discussed.

The risk of empathy: longitudinal associations between empathy and burnout

OBJECTIVE

Prior research on the relation between empathy and burnout in social professions appears to be inconsistent. Whereas some studies have claimed that empathy functions as a buffer against burnout, others have argued that empathy contributes to the development of burnout. One explanation for this disparity may be methodological as most studies have relied on cross-sectional single-measure designs. To examine their cross-sectional and longitudinal associations, the present study analyzed cross-lagged data of several measures of empathy and burnout.

DESIGN

Data from two longitudinal studies with three to twelve months between measurements were analyzed. The samples contained 172 nursing students and 186 nurses, respectively.

MAIN OUTCOME MEASURES

Empathy was assessed using the Interpersonal Reactivity Index, the Toronto Empathy Questionnaire, the Geneva Emotion Recognition Test, and the Social Mindfulness Test Paradigm. Burnout was assessed using the Maslach Burnout Inventory, the Irritation Scale, and the Copenhagen Burnout Inventory.

RESULTS

Results showed significant cross-sectional correlations between the questionnaire measures of empathy and burnout. However, there was insufficient support for the cross-lagged associations.

CONCLUSIONS

Associations between empathy and burnout may be attributed to the methodological limitations of cross-sectional designs. However, the influence of potential moderators is discussed as a promising direction of future research.

Are clinicians' self-reported empathic concern and perspective-taking traits associated with their response to patient emotions?: Communication Studies

OBJECTIVE

To understand whether clinicians' empathic concern and perspective-taking traits are associated with their response to patient emotions.

METHODS

We audio-recorded 41 HIV clinician interactions with 342 patients at two academic medical centers. We assessed clinicians' self-reported empathic concern and perspective-taking traits using the Interpersonal Reactivity Index and coded emotional communication using the Verona Coding Definitions of Emotional Sequences. We used random effects models to assess associations between clinician traits and clinician responses to patients' negative emotions, accounting for clustering of emotions within encounters and patients within clinicians.

RESULTS

Clinicians with more self-reported empathic concern received fewer emotional expressions from their patients (β -0.06; 95% CI -0.10, -0.01) and had greater odds of responding to emotions by giving information/advice (OR 1.10; 95% CI 1.01, 1.20). There were no associations between empathic concern or perspective-taking and any other clinician responses.

CONCLUSION

Clinicians with higher levels of empathic concern respond to patient emotions by giving information and advice, a response traditionally thought of as a missed empathic opportunity, not by exploring emotions or providing empathy. Whether this is helpful to patients is unknown.

PRACTICE IMPLICATIONS

Clinicians should be aware of their tendency to give information to patients with emotional distress, and consider whether this response is helpful to patients.

Investigative empathy: a strength scale of empathy based on European police perspectives

A growing body of research suggests that empathy plays a major role in establishing and maintaining rapport during police interviews. The benefits of rapport include not only increased cooperation from interviewees, but also gaining more accurate investigation-relevant information. However, there still is no universally agreed-upon definition and very little research on operationalizing empathy, especially within investigative interviewing. The present study analyzed police interviewers' self-reports regarding their (a) training and methods employed during interviews, (b) application of empathy in interviews, and (c) definitions/understanding of empathy. It was found that officers in all seven participating countries varied within each country in their use of accusatory or information-gathering interview styles. The majority of participants in each country claimed to employ empathy in their interviews with suspects, yet they varied regarding the definitions they provided. In no country was empathy defined as having aspects that may not be conducive to investigative interviewing.

Embodying empathy: A phenomenological study of physician touch

CONTEXT

Empathic physician behaviour is associated with improved patient outcomes. One way to demonstrate empathy is through the use of non-verbal communication (NVC) including touch. To date, research on NVC, and specifically touch, has been relatively limited in medicine, which is surprising given the central role it plays in conveying affective and empathic messages. To inform curriculum development on NVC, this study aimed to examine physicians' experiences of communicating by touch.

METHODS

We conducted an interpretative phenomenological study. A total of 15 physicians (seven women and eight men) from different specialties, including both recent graduates and experienced doctors, described in detail specific instances of touch drawn from their clinical practices. Interview prompts encouraged participants to recall exact details such as the context, their relationship with the patient they touched and their physical experience of touching. Interviews (45-100 minutes) were analysed with template analysis, followed by a process of dialectic questioning, moving back and forth between the data and researchers' personal reflections on them, drawing on phenomenological literature to synthesise a final interpretation.

RESULTS

Participants described two dimensions of the experience of touch: 'choosing and inviting touch' and 'expressing empathy.' Touch was a personal and fragile process. Participants interpreted non-verbal patient cues in order to determine whether or not touch was appropriate. They interpreted facial expressions and body language in the present to make meaning of patients' experiences. They used touch to share emotions, and to demonstrate empathy and presence. Participants' experiences of touch framed it as a form of embodied empathic communication.

CONCLUSIONS

Touch is a powerful form of NVC that can establish human connection. Phenomenological accounts of empathy, which emphasise its embodied intersubjective nature, can be used to theoretically enrich pedagogical approaches to touch in medical education and to deepen our understanding of empathy.

Students' perceptions of interventions designed to foster empathy: An integrative review

OBJECTIVE

Empathy is assumed to be an important element of nursing care, and nursing educators are attempting to find ways to effectively foster empathy in their students. The purpose of this review is to gain a deeper grasp of what undergraduate nursing students are learning from interventions educators have designed to cultivate empathy by synthesizing qualitative data.

REVIEW METHODS

Utilizing the review methodology proposed by Whittemore and Knafl, a survey of the CINAHL, Web of Science, PubMed, and PsychINFO databases was undertaken to answer the question: What are undergraduate nursing students' perceptions of interventions designed to foster empathy?

RESULTS

A thematic synthesis of the students' perceptions from the 17 articles meeting inclusion criteria revealed five themes: Understanding the other's experience, embodying the other's experience, becoming aware of self, informing the role of the nurse, and learning or transforming.

CONCLUSIONS

Although additional conceptual work remains to create a coherent, complete, and parsimonious definition of empathy, the results indicate that the students are gaining many of the facets assumed to be part of the concept of empathy through these educational interventions. Immersive simulations that put students in the role of the "other" were particularly impactful, especially if they created a disorienting dilemma followed by guided reflection. These findings can help nursing educators tailor their interventions for their specific intended learning outcomes.

Empathic concern and personal distress depend on situational but not dispositional factors

Empathic concern and personal distress are empathic responses that may result when observing someone in discomfort. Even though these empathic responses have received much attention in past research, it is still unclear which conditions contribute to their respective experience. Hence, the main goal of this study was to examine if dispositional empathic traits or rather situational variables are more likely to evoke empathic concern and personal distress and how the two empathic responses influence motor responses. We presented pictures of persons in psychological, physical, or no pain with matched descriptions of situations that promoted an other-focused state. Approach-avoidance movements were demanded by a subsequently presented tone. While psychological pain led to more empathic concern, physical pain led to higher ratings of personal distress. Linear mixed-effects modelling analysis further revealed that situational factors, such as the type of pain but also the affect experienced by the participants before the experiment predicted the two empathic responses, whereas dispositional empathic traits had no significant influence. In addition, the more intensely the empathic responses were experienced, the faster were movements initiated, presumably reflecting an effect of arousal. Overall, the present study advances our understanding of empathic responses to people in need and provides novel methodological tools to effectively manipulate and analyze empathic concern and personal distress in future research.

How Well Can We Assess Our Ability to Understand Others' Feelings? Beliefs About Taking Others' Perspectives and Actual Understanding of Others' Emotions

People vary in their beliefs about their tendency to engage in perspective taking and to understand other's feelings. Often, however, those beliefs are suggested to be poor indicators of actual skills and thus provide an inaccurate reflection of performance. Few studies, however, have examined whether people's beliefs accurately predict their performance on emotion recognition tasks using dynamic or spontaneous emotional expressions. We report six studies (N ranges from 186 to 315; N total = 1,347) testing whether individuals' report of their engagement in perspective taking, as measured by the Interpersonal Reactivity Index (IRI; Davis, 1983), is associated with accurate emotion recognition. In Studies 1-3, emotion recognition performance was assessed using three standard tests of nonverbal emotion recognition. To provide a more naturalistic test, we then assessed performance with a new emotion recognition test in Studies 4-6, using videos of real targets that share their emotional experiences. Participants' multi-scalar ratings of the targets' emotions were compared with the targets' own emotion ratings. Across all studies, we found a modest, yet significant positive relationship: people who believe that they take the other's perspective also perform better in tests of emotion recognition (r = 0.20, p < 0.001). Beliefs about taking others' perspective thus reflect interpersonal reality, but only partially.

Antidepressant treatment, not depression, leads to reductions in behavioral and neural responses to pain empathy

Major depressive disorder (MDD) has been hypothesized to lead to impairments in empathy. Previous cross-sectional studies did not disentangle effects of MDD itself and antidepressant treatment. In this first longitudinal neuroimaging study on empathy in depression, 29 patients with MDD participated in two functional magnetic resonance imaging (fMRI) sessions before and after 3 months of antidepressant therapy. We compared their responses to an empathy for pain task to a group of healthy controls (N = 35). All participants provided self-report ratings targeting cognitive (perspective taking) and affective (unpleasant affect) aspects of empathy. To control for general effects on processing of negative affective states, participants additionally underwent an electrical pain task. Before treatment, we found no differences in empathic responses between controls and patients with MDD. After treatment, patients showed significant decreases in both affective empathy and activity of three a priori selected brain regions associated with empathy for pain. Decreases in affective empathy were moreover correlated with symptom improvement. Moreover, functional connectivity during the empathy task between areas associated with affective (anterior insula) and cognitive (precuneus) empathy decreased between sessions in the MDD group. Neither cognitive empathy nor responses to painful electrical shocks were changed after treatment. These findings contradict previous cross-sectional reports of empathy deficits in acute MDD. Rather, they suggest that antidepressant treatment reduces the aversive responses triggered by exposure to the suffering of others. Importantly, this cannot be explained by a general blunting of negative affect, as treatment did not change self-experienced pain.

Empathy at the Heart of Darkness: Empathy Deficits That Bind the Dark Triad and Those That Mediate Indirect Relational Aggression

The dark triad (DT) traits-psychopathy, narcissism and Machiavellianism-have collectively been linked to reduced empathy and increased aggression; however, their association with distinct empathic subtypes remains unclear; and unique links to indirect relational aggression (IRA) have not been delineated. Moreover, whether dark traits should be conceptualized individually, as a dyad or as a triad with a dark core centered around the absence of empathy is debated. The current study examines (i) whether impaired empathy indeed represents a common "dark core" binding Machiavellianism, narcissism, and psychopathy, and (ii) this core explains associations between the dark traits and IRA. Participants (N = 301, 262 F/39 M) completed measures of the DT traits, cognitive and affective empathy components and IRA (Social Exclusion, Malicious Humor and Guilt Induction). The individual traits model without links between narcissism and IRA showed the best fit, suggesting that, at least in the context of IRA, the DT traits are best viewed as three independent personality traits. Distinct cognitive and affective empathy deficits and capacities are seen in the DT. Peripheral responsivity was the only type of empathy deficit associated with all dark traits, but unrelated to IRA. Psychopathy was the strongest indicator of impaired empathy and all IRAs; however, only online simulation, an affect-related cognitive empathy facet, partially mediated the relationships of psychopathy and Machiavellianism with IRA. Whilst the unique pathways for the dark triad traits suggest stronger alignment of psychopathy and Machiavellianism in their empathic deficits and indirect aggression; the data do not support the notion that an unempathic dark core underpinning all three traits drives indirect aggression. This is the first paper delineating the specific empathic deficits involved using a facet approach and their link to indirect forms of aggression. Results therefore inform theoretical models of aggression in the DT and offer some clarity on the debates surrounding the unempathic dark core in the DT.