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Cao Y, Zhang J, He X, Wu C, Liu Z, Zhu B, Miao L. Empathic pain: Exploring the multidimensional impacts of biological and social aspects in pain. Neuropharmacology 2024; 258:110091. [PMID: 39059575 DOI: 10.1016/j.neuropharm.2024.110091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/25/2024] [Accepted: 07/24/2024] [Indexed: 07/28/2024]
Abstract
Empathic pain refers to an individual's perception, judgment, and emotional response to others' pain. This complex social cognitive ability is crucial for healthy interactions in human society. In recent years, with the development of multidisciplinary research in neuroscience, psychology and sociology, empathic pain has become a focal point of widespread attention in these fields. However, the neural mechanism underlying empathic pain remain a controversial and unresolved area. This review aims to comprehensively summarize the history, influencing factors, neural mechanisms and pharmacological interventions of empathic pain. We hope to provide a comprehensive scientific perspective on how humans perceive and respond to others' pain experiences and to provide guidance for future research directions and clinical applications. This article is part of the Special Issue on "Empathic Pain".
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Affiliation(s)
- Yuchun Cao
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Jiahui Zhang
- The Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, 210046, China
| | - Xiaofang He
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Chenye Wu
- Department of Emergency Medicine, Changshu Hospital Affiliated to Soochow University, Changshu, 215500, China
| | - Zeyuan Liu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China.
| | - Liying Miao
- Department of Blood Purification Center, The Third Affiliated Hospital of Soochow University, Changzhou, 213000, Jiangsu, China.
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Thomsen AML, Tayyari N, Duvald I, Kirkegaard H, Obel B, Nielsen CP. Hospital at home for elderly acute patients: a study protocol for a randomised controlled trial. BMJ Open 2024; 14:e083372. [PMID: 38697766 PMCID: PMC11086463 DOI: 10.1136/bmjopen-2023-083372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION The increasing elderly population has led to a growing demand for healthcare services. A hospital at home treatment model offers an alternative to standard hospital admission, with the potential to reduce readmission and healthcare consumption while improving patients' quality of life. However, there is little evidence regarding hospital at home treatment in a Danish setting. This article describes the protocol for a randomised controlled trial (RCT) comparing standard hospital admission to hospital at home treatment. The main aim of the intervention is to reduce 30-day acute readmission after discharge and improve the quality of life of elderly acute patients. METHODS AND ANALYSIS A total of 849 elderly acute patients will be randomised in a 1:2 ratio to either the control or intervention group in the trial. The control group will receive standard hospital treatment in a hospital emergency department while the intervention group will receive treatment at home. The primary outcomes of the trial are the rate of 30-day acute readmission and quality of life, assessed using the European Quality of Life-5 Dimensions-5-Level instrument. Primary analyses are based on the intention-to-treat principle. Secondary outcomes are basic functional mobility, resource use in healthcare, primary and secondary healthcare cost, incremental cost-effectiveness ratio, and the mortality rate 3 months after discharge. ETHICS AND DISSEMINATION The RCT was approved by the Ethical Committee, Central Denmark Region (no. 1-10-72-67-20). Results will be presented at relevant national and international meetings and conferences and will be published in international peer-reviewed journals. Furthermore, we plan to communicate the results to relevant stakeholders in the Danish healthcare system. TRIAL REGISTRATION NUMBER NCT05360914.
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Affiliation(s)
- Anne Marie Ladehoff Thomsen
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Nasrin Tayyari
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Gistrup, Denmark
| | - Iben Duvald
- Interdisciplinary Centre for Organizational Architecture, Department of Management, Aarhus University School of Business and Social Sciences, Aarhus, Denmark
- The Emergency Department, Viborg Regional Hospital, Regional Hospital Central Jutland, Central Denmark Region, Viborg, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Børge Obel
- Interdisciplinary Centre for Organizational Architecture, Department of Management, Aarhus BSS, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Botke JA, van Woerkom M. The effect of self‐leadership training on detached concern and the proactivity of human service professionals. INTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT 2023. [DOI: 10.1111/ijtd.12300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Jolanda A. Botke
- Department of Human Resource Studies Tilburg University Tilburg The Netherlands
| | - Marianne van Woerkom
- Department of Human Resource Studies Tilburg University Tilburg The Netherlands
- Department of Psychology, Education and Child Studies Erasmus University Rotterdam Rotterdam The Netherlands
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Trofimova I. Analytic Background in the Neuroscience of the Potential Project "Hippocrates". Brain Sci 2022; 13:brainsci13010039. [PMID: 36672021 PMCID: PMC9856329 DOI: 10.3390/brainsci13010039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
This paper reviews the principles identified in analytic neuroscience that could be used in the setup of an international project, "Hippocrates" (H-project), named after the author of the endocrine theory of temperaments. The H-project can aim to summarize the findings in functional neurochemistry of consistent behavioural patterns (CBPs) in health (such as temperament traits) and psychopathology (symptoms of psychiatric disorders); to have systematically structured neurochemical investigations; to have an analysis of CBPs that include all ranges of behavioural histories and to have these modules complemented by regional contrasts related to climate, diets and other bio-environmental factors. The review highlights the benefits of constructivism and illustrates the contrast between constructivism and current approaches in terms of analytic and methodological aspects. (1) "Where" the neurochemical biomarkers should be measured: the review expands the range of needed measurements to out-of-brain systems, including environmental factors, and explores the concept of Specialized Extended Phenotype. (2) "What" should be measured but is missing: the review points to the need for measurement of the "Throw & Catch" neurochemical relays; behavioural and neuronal events contributing to the consistency of the CBPs but not documented in measurements. (3) Structuring the H-project's setup: the paper briefly describes a proposed earlier neurochemical framework, Functional Ensemble of Temperament that that accommodates the neurochemical continuum between temperament and symptoms of psychiatric disorders. This framework is in line with documented "Throw & Catch" neurochemical relays and can also be used to organize data about the personal and professional history of an individual.
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Affiliation(s)
- Irina Trofimova
- Laboratory of Collective Intelligence, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 92 Bowman St, Hamilton, ON L8S 2T6, Canada
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Byrd CT, Croft RL, Kelly EM. Improving Clinical Competence Through Simulated Training in Evidence-Based Practice for Stuttering: A Pilot Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2770-2788. [PMID: 36332141 PMCID: PMC9911129 DOI: 10.1044/2022_ajslp-22-00116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this pilot study was to determine the effectiveness and acceptability of an initial module (1.1; active listening skills) of the Simulated Training in Evidence-Based Practice for Stuttering (STEPS) program, a theory-driven, multimodule, content and learning platform designed to advance knowledge and skills in working with culturally and linguistically diverse persons who stutter of all ages. METHOD Fifteen preservice speech-language pathologists (SLPs) were randomly assigned to complete either the STEPS 1.1 module or a control module. In both conditions, all participants engaged in pre- and post-clinical interviews with a standardized patient portraying a parent of a child who stutters. Prior to participation, all participants provided self-ratings on the Jefferson Scale of Physician Empathy-Health Profession Student. Post participation, trained observers rated all participants' active listening behaviors using the Active Listening Observation Scale-Modified. Post participation, the STEPS 1.1 participants also completed an intervention acceptability questionnaire. RESULTS No differences between groups were found in self-perceived clinical empathy prior to participation. Participants who completed the STEPS 1.1 condition utilized paraphrasing and client-directed eye gaze significantly more frequently at posttest than at pretest and significantly more than the control group at posttest. Quantitative and qualitative responses from the participants who completed STEPS 1.1 indicated high acceptability of its content, structure, duration, and perceived impact. CONCLUSION Preliminary data from the present pilot study support use of the STEPS 1.1 module to improve preservice SLPs' use of skills that have been shown to predict perceived clinical empathy and increase assessment and treatment effectiveness.
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Affiliation(s)
- Courtney T. Byrd
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Robyn L. Croft
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Ellen M. Kelly
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
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Croft RL, Byrd CT, Kelly EM. The influence of active listening on parents' perceptions of clinical empathy in a stuttering assessment: A preliminary study. JOURNAL OF COMMUNICATION DISORDERS 2022; 100:106274. [PMID: 36327574 PMCID: PMC9727781 DOI: 10.1016/j.jcomdis.2022.106274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 05/19/2023]
Abstract
PURPOSE The primary purpose of this preliminary study was to explore whether a clinician's use of active listening skills (i.e., client-directed eye gaze and paraphrasing) influenced parents' perceptions of clinical empathy in a stuttering assessment. A secondary purpose was to determine whether parent age, education, or parent concern predicted perceived clinical empathy. METHOD Participants (n = 51 parents/guardians of children who stutter) watched two counter-balanced videos of a clinician demonstrating either high or low frequency use of active listening skills during the clinician's initial assessment with a standardized patient actor portraying a parent of a child who stutters. After each video, parents rated the clinician's empathy and active listening skills via the Jefferson Scale of Physician Empathy for Observers (JSPEO; Hojat et al., 2017) and the Counselor Activity Self-Efficacy Scales - Modified (Victorino & Hinkle, 2018). Participants then completed a demographic questionnaire and rated their concern about their child's stuttering. RESULTS Paired t-tests demonstrated significantly higher ratings of perceived clinical empathy in the high frequency active listening condition compared to the low frequency condition (d = 0.548). Simple linear regression analyses indicated parent age or level of education did not predict perceived clinical empathy. An independent samples t-test indicated that parent concern about stuttering did not predict perceived clinical empathy. CONCLUSIONS Preliminary findings suggest that the clinician was viewed as significantly more understanding, concerned, and caring (i.e., perceived as empathic) when active listening skills were used. Parents' ratings of empathy on the JSPEO, based on high levels of active listening by the clinician, were not associated with parents' ages, education levels, or concern about their children's stuttering. This may reflect the value of active listening in clinical relationships regardless of variables specific to the recipient (e.g., parent of a child who stutters). Given that parents are more apt to share thoughts and emotions about their child's communication with clinicians who demonstrate empathic qualities, this preliminary study suggests that the use of active listening skills warrant emphasis in clinical training.
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Affiliation(s)
- Robyn L Croft
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, United States; 9 University Station A1100, Austin, TX 78759, United States.
| | - Courtney T Byrd
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, United States; 9 University Station A1100, Austin, TX 78759, United States
| | - Ellen M Kelly
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, United States; 9 University Station A1100, Austin, TX 78759, United States
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Chen C, Chen YH, Cheng Y. Meta-analysis of functional neuroimaging and dispositional variables for clinical empathy. Neurosci Biobehav Rev 2022; 142:104874. [PMID: 36116577 DOI: 10.1016/j.neubiorev.2022.104874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
Clinical empathy refers to the ability of healthcare providers (HP) to recognize and understand what patients feel. While neuroimaging investigations have identified a neural network of empathy, activation consistency of brain regions and their specific functions in clinical empathy remains unclear. Herein, we conducted meta-analyses of dispositional assessments using random-effects models and functional neuroimaging using Seed-based d Mapping with Permutation of Subject Images to ascertain the shared neural processes consistently identified as relevant to clinical empathy. The dispositional meta-analysis (n = 15) revealed that HP exhibited higher scores on empathic concern and perspective taking. The HP neuroimaging meta-analysis (n = 11) identified consistent activation of the anterior mid-cingulate cortex, anterior insula, and ventrolateral prefrontal cortex (vlPFC) while HP vs. controls comparison (n = 9) did not yield robust alterations. The vlPFC mediated positive and negative functional connectivity of the insula. We revisited the framework of emotion regulation in clinical empathy. The empathetic agent flexibly shifts between affective regulatory strategies to meet contextual demands, with vlPFC figuring as the key region where this neural mechanism takes place.
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Affiliation(s)
- Chenyi Chen
- Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Research Center of Brain and Consciousness, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Graduate Institute of Mind, Brain and Consciousness, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yu-Hsin Chen
- Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; Institute of Neuroscience and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yawei Cheng
- Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; Institute of Neuroscience and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Rafaqat W, Sami A, Ibrahim MT, Ibad H, Awais S, Memon A, Shahbaz FF, Ahmed D, Zindani S, Leghari AL, Saleem S. Impact of Perfectionism and Resilience on Empathy in Medical Students: A Cross-Sectional Study. J Patient Exp 2022; 9:23743735221106603. [PMID: 35694014 PMCID: PMC9185014 DOI: 10.1177/23743735221106603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Empathy is a cognitive attribute that forms the cornerstone for good
doctor–patient encounters. The formative period for the development of empathy
toward patients begins with clinical encounters within medical school. An
individual medical student's empathy levels may in part be a product of their
resilience and perfectionist attitudes. A cross-sectional study with 320 medical
students across all years of study was conducted to determine the correlation of
perfectionism and resilience with clinical empathy in medical students. The
JSE-S, CD-RISC 10, and APS-R scales were used to assess levels of empathy,
resilience, and perfectionism, respectively. The study found that a positive
correlation exists between resilience (r = 0.174) and academic
year with empathy, and a negative correlation exists between maladaptive
perfectionism and empathy (r = −0.138). The resilience score
declined progressively as the year of study progressed with a statistically
significant. Mean empathy scores were lowest in fifth-year students
(96.8 ± 12.5) and highest in third-year students (107.8 ± 13.2). Further
longitudinal studies are necessary to better understand the impact of resilience
and perfectionism on empathy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sarah Saleem
- Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
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Kanen JW, Robbins TW, Trofimova IN. Harnessing temperament to elucidate the complexities of serotonin function. Curr Opin Behav Sci 2022. [DOI: 10.1016/j.cobeha.2022.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Martingano AJ. Helpful and Hurtful Empathy: How the Interplay of Empathy, Shame, and Anger Predicts Responses to Hypothetical Rape Disclosures. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:1779-1795. [PMID: 32486878 DOI: 10.1177/0886260520922345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Responses to rape victims, although often helpful, can be hurtful and hinder victims' health and recovery. Adopting a multidimensional approach to dispositional empathy, this research investigated how different subfacets of empathy predict responses to hypothetical rape victims. Before reading a sexual assault scenario, 282 participants completed measures of cognitive and emotional empathy. Participants' subsequent emotional arousal was measured by self-report, as were their intentions to help, avoid, or blame the victim. A path model demonstrated that dispositional empathy predicted behavioral intentions toward hypothetical rape victims by altering their vulnerability to experience shame or anger. People who tended to feel personal distress were more likely to mirror rape victims' assumed shame. Due to its antisocial nature, experiencing shame, in turn, led to hurtful behaviors such as blaming or distancing oneself from the victim. On the other hand, people who tended to feel empathic concern were more likely to feel anger on behalf of the victim following a rape disclosure. Anger is a motivating force for action and promotes helping behavior. A second study demonstrated that these results appear unique to rape disclosure, namely, participants reactions to nonsexual assault were unsuccessfully captured by this model. Understanding how empathetic arousal of shame can lead to hurtful intentions toward rape victims has important implications for future interventions: Programs that draw attention to the shame or humiliation experienced by rape victims may do more harm than good. For instance, some anti-rape campaigns portray pictures of women covering their faces. These campaigns, however well intentioned, may discourage people from helping victims because they may evoke feelings of shame in the perceiver. On the other hand, societal movements, such as the #Metoo movement, may be particularly effective by reducing the shame surrounding sexual assault and promote helpful behaviors.
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Daniel Widlöcher (1929–2021). EVOLUTION PSYCHIATRIQUE 2022. [DOI: 10.1016/j.evopsy.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Trofimova IN, Gaykalova AA. Emotionality vs. Other Biobehavioural Traits: A Look at Neurochemical Biomarkers for Their Differentiation. Front Psychol 2021; 12:781631. [PMID: 34987450 PMCID: PMC8720768 DOI: 10.3389/fpsyg.2021.781631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022] Open
Abstract
This review highlights the differential contributions of multiple neurochemical systems to temperament traits related and those that are unrelated to emotionality, even though these systems have a significant overlap. The difference in neurochemical biomarkers of these traits is analysed from the perspective of the neurochemical model, Functional Ensemble of Temperament (FET) that uses multi-marker and constructivism principles. Special attention is given to a differential contribution of hypothalamic-pituitary hormones and opioid neuropeptides implicated in both emotional and non-emotional regulation. The review highlights the role of the mu-opioid receptor system in dispositional emotional valence and the role of the kappa-opioid system in dispositional perceptual and behavioural alertness. These opioid receptor (OR) systems, microbiota and cytokines are produced in three neuroanatomically distinct complexes in the brain and the body, which all together integrate dispositional emotionality. In contrast, hormones could be seen as neurochemical biomarkers of non-emotional aspects of behavioural regulation related to the construction of behaviour in fast-changing and current situations. As examples of the role of hormones, the review summarised their contribution to temperament traits of Sensation Seeking (SS) and Empathy (EMP), which FET considers as non-emotionality traits related to behavioural orientation. SS is presented here as based on (higher) testosterone (fluctuating), adrenaline and (low) cortisol systems, and EMP, as based on (higher) oxytocin, reciprocally coupled with vasopressin and (lower) testosterone. Due to the involvement of gonadal hormones, there are sex and age differences in these traits that could be explained by evolutionary theory. There are, therefore, specific neurochemical biomarkers differentiating (OR-based) dispositional emotionality and (hormones-based) body's regulation in fast-changing events. Here we propose to consider dispositional emotionality associated with OR systems as emotionality in a true sense, whereas to consider hormonal ensembles regulating SS and EMP as systems of behavioural orientation and not emotionality.
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Affiliation(s)
- Irina N. Trofimova
- Laboratory of Collective Intelligence, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Berduzco-Torres N, Medina P, San-Martín M, Delgado Bolton RC, Vivanco L. Non-academic factors influencing the development of empathy in undergraduate nursing students: a cross-sectional study. BMC Nurs 2021; 20:245. [PMID: 34876108 PMCID: PMC8653543 DOI: 10.1186/s12912-021-00773-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Empathy is described as a core competence of nursing. There is abundant research evidence supporting that empathy varies according to personal characteristics and targeted training. The aim of this study was to characterize non-academic factors (personal and environmental) influencing the development of empathy in undergraduate nursing studies who are not receiving a targeted training in empathetic abilities in their nursing schools. METHODS A cross-sectional study was performed in the three nursing schools located in Cusco city, Peru (two private and one public). The Jefferson Scales of Empathy, Attitudes toward Physician-Nurse Collaboration, and Lifelong Learning, the Emotional Loneliness Scale for Adults, and the Scale of Life Satisfaction, were applied as the main measures. Also, information regarding gender, nursing school, and age, were collected. After psychometric properties were assessed, all measures were used in the development of a multivariate regression model to characterize factors of influence in empathy. RESULTS In a sample composed by 700 undergraduate nursing students (72 males and 628 females), a multivariate linear regression model was created. This model explained the 53% of variance of empathy and fitted all conditions necessary for inference estimations. Teamwork abilities, loneliness, age, sex, subjective well-being, and nursing school, appeared as factors influencing the development of empathy in patients' care. CONCLUSIONS Findings have indicated that, in absence of a targeted training, individual characteristics and characteristics associated with social and family environments play an important role of influence in the development of empathy in nursing students. These findings are also in consonance with others previously reported in different cultural settings including high-, middle- and low-income countries.
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Affiliation(s)
- Nancy Berduzco-Torres
- Universidad Nacional San Antonio Abad del Cusco, Av. de La Cultura 773, 08000, Cusco, Peru
| | - Pamela Medina
- Universidad Nacional San Antonio Abad del Cusco, Av. de La Cultura 773, 08000, Cusco, Peru
| | | | - Roberto C Delgado Bolton
- Hospital Universitario San Pedro, C/Piqueras 98, 26006, Logroño, Spain
- Centro Nacional de Documentación en Bioética, C/Piqueras 98, 26006, Logroño, Spain
- Centro de Investigación Biomédica de La Rioja (CIBIR), C/ Piqueras 98, La Rioja, 26006, Logroño, Spain
| | - Luis Vivanco
- Centro Nacional de Documentación en Bioética, C/Piqueras 98, 26006, Logroño, Spain.
- Centro de Investigación Biomédica de La Rioja (CIBIR), C/ Piqueras 98, La Rioja, 26006, Logroño, Spain.
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Benarous X, Iancu C, Guilé JM, Consoli A, Cohen D. Missing the forest for the trees? A high rate of motor and language impairments in Disruptive Mood Dysregulation Disorder in a chart review of inpatient adolescents. Eur Child Adolesc Psychiatry 2021; 30:1579-1590. [PMID: 32918099 DOI: 10.1007/s00787-020-01636-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/29/2020] [Indexed: 11/30/2022]
Abstract
Youths with severe and persistent irritability have a particularly high rate of school failures and learning difficulties. The aim of this study was to determine whether inpatient adolescents with Disruptive Mood Dysregulation Disorder (DMDD) have more motor and/or language impairments compared to patients with other psychiatric disorders. A retrospective chart review of all consecutive cases admitted in two adolescent inpatient units between January 2017 and December 2018 was conducted (N = 191). All patients received multi-disciplinary clinical and developmental assessments. For a subtest of subjects, additional standardized tests were used to document motor and language impairments. In this clinical chart 53 adolescents with a DMDD (mean age 13.6 ± 1.5, min 12, max 16, 70% males) were compared to patients with a major depressive disorder (MDD, n = 64, mean age 15.3 ± 1.6, 52% males) and patients with a non-mood disorder (NMD, n = 61, mean age 14.4 ± 1.55, 59% males). Among inpatients with DMDD, 71% had an associated motor and/or language disorder, with combined forms in around two-thirds of cases. Compared to youths with MDD, participants with DMDD were more likely to have an associated developmental coordination disorder (67% vs. 22%, OR = 4.7) and a written language disorder (35% vs. 10%, OR = 4.6). While 31% of inpatients with DMDD had an associated communication/oral language disorder, this rate was not statistically different from those observed in the MDD group (11%, OR = 3.2). The frequencies of motor and language impairments were not statistically different between participants in the DMDD group and in the NMD group. The high rate of motor and written language disorders found in DMDD patients may partly account for their academic difficulties. Such finding, if confirmed, supports systematic screening of motor and written language impairments in youths with chronic irritability and suggests remediation potential.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054, Amiens, France. .,Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France. .,INSERM U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardie- Jules Verne (UPJV), Amiens, France.
| | - Cosmin Iancu
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Jean-Marc Guilé
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054, Amiens, France.,INSERM U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardie- Jules Verne (UPJV), Amiens, France.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,Group of Clinical Research-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Sorbonne University, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.,UMR 7222, Institute for Intelligent Systems and Robotics, CNRS, Sorbonnes Université, Paris, France
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15
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Anzaldua A, Halpern J. Can Clinical Empathy Survive? Distress, Burnout, and Malignant Duty in the Age of Covid-19. Hastings Cent Rep 2021; 51:22-27. [PMID: 33630324 PMCID: PMC8013970 DOI: 10.1002/hast.1216] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Covid-19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid-19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid-19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid-19 intensification of burnout can serve as a wake-up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.
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16
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Understanding the Links between Inferring Mental States, Empathy, and Burnout in Medical Contexts. Healthcare (Basel) 2021; 9:healthcare9020158. [PMID: 33546199 PMCID: PMC7913277 DOI: 10.3390/healthcare9020158] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/30/2022] Open
Abstract
It is generally accepted that empathy should be the basis of patient care. However, this ideal may be unrealistic if healthcare professionals suffer adverse effects when engaging in empathy. The aim of this study is to explore the effect of inferring mental states and different components of empathy (perspective-taking; empathic concern; personal distress) in burnout dimensions (emotional exhaustion; depersonalization; personal accomplishment). A total of 184 healthcare professionals participated in the study (23% male, Mage = 44.60; SD = 10.46). We measured participants' empathy, the inference of mental states of patients, and burnout. Correlation analyses showed that inferring mental states was positively associated with perspective-taking and with empathic concern, but uncorrelated with personal distress. Furthermore, emotional exhaustion was related to greater levels of personal distress and greater levels of inferences of mental states. Depersonalization was associated with greater levels of personal distress and lower levels of empathic concern. Personal accomplishment was associated with the inference of mental states in patients, lower levels of personal distress, and perspective-taking. These results provide a better understanding of how different components of empathy and mental state inferences may preserve or promote healthcare professionals' burnout.
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17
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Wei H, Hardin SR, Watson J. A unitary caring science resilience-building model: Unifying the human caring theory and research-informed psychology and neuroscience evidence. Int J Nurs Sci 2021; 8:130-135. [PMID: 33575453 PMCID: PMC7859535 DOI: 10.1016/j.ijnss.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/13/2020] [Accepted: 11/18/2020] [Indexed: 11/27/2022] Open
Abstract
Resilience is the psychological capability to recover from difficulties quickly. Healthcare professionals are especially vulnerable to job-related stress and burnout. Unitary Caring Science is the framework for Watson's Human Caring Theory, providing a philosophy of practice in healthcare. With the high rates of clinician burnout and psychological issues, it will be significant to unify the human caring theory with research-informed psychological and neuroscience evidence to develop clinicians' resilience-building strategies. The purpose of this article is to introduce a Unitary Caring Science Resilience Model and explain the science behind the core strategies based on Unitary Caring Science philosophy and the psychological and neuroscience research. This model includes six strategies: Embracing loving-kindness for self and others; Nurturing interpersonal and intersubjective connections/relations; Deepening a creative use of self and sense of belonging; Balancing self-learning, self-awareness, and an evolved self-consciousness; Valuing forgiveness and releasing negativity; Inspiring and maintaining faith-hope. The caring-theory guided resilience-building strategies are proven to alleviate the depletion of clinicians' energy and emotions. Healthcare practices are challenging but rewarding. Clinicians can be emotionally, psychologically, and physically exhausted if they always consider themselves 'giving' and 'doing' institutional tasks without a sense of purpose or fulfillment. The practice can be rewarding if it becomes more aligned with clinicians' value to serve humanity. Through the unitary caring science resilience strategies, clinicians can build resilience as an antidote to clinician burnout and depletion.
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Affiliation(s)
- Holly Wei
- College of Nursing at East Carolina University, Greenville, NC, USA
| | | | - Jean Watson
- Watson Caring Science Institute, Distinguished Professor/Dean Emerita University of Colorado Denver College of Nursing, CO, USA
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18
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Dean S, Halpern J, McAllister M, Lazenby M. Nursing education, virtual reality and empathy? Nurs Open 2020; 7:2056-2059. [PMID: 33072391 PMCID: PMC7544867 DOI: 10.1002/nop2.551] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/12/2022] Open
Abstract
An empathic approach to patient‐centred care is a core of nursing practice. One of the methods to develop empathy, which is gaining currency is the use of virtual reality simulations in education. This paper posits some questions, does it simply reinforce a ‘type’ of patient, neglecting caring for the patient as unique, is empathy what results or is it pity, does it result in a greater distance being created between the patient and the health care provider? Can we ever really know what it is like to walk in a patient's shoes when what we experience through virtual reality provides a small snapshot of the vicissitudes of living with an illness or disability. We suggest that what matters most in simulations using virtual reality is how the student exits the experience and if they leave knowing just what patients ‘like that’ feel, or whether they leave with humility and curiosity.
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Affiliation(s)
- Sue Dean
- Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - Jodi Halpern
- Bioethics and Medical Humanities School of Public Health and Joint Medical Program University of California Berkeley CA USA
| | - Margaret McAllister
- Nursing, Midwifery and Social Sciences/Higher Education CQ University Noosaville Qld Australia
| | - Mark Lazenby
- Nursing and Philosophy UConn School of Nursing Stoors CT USA
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19
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Smith KE, Norman GJ, Decety J. Increases in loneliness during medical school are associated with increases in individuals' likelihood of mislabeling emotions as negative. ACTA ACUST UNITED AC 2020; 22:740-750. [PMID: 32597671 DOI: 10.1037/emo0000773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Expressions of emotion represent an important and unique source of information about the states of others. Being able to effectively understand expressions of emotions to make inferences about others' internal mental states and use these inferences to guide decision-making and behavior is critical to navigating social relationships. Loneliness, the perception that one lacks social connection, has important functional consequences for how individuals attend to signals of emotions in others. However, it is less clear whether loneliness changes how individuals recognize emotions in others. In medical practitioners, being able to accurately recognize emotional cues from patients is critical to effectively diagnosing and reacting with care to those patients. The current study examines the relationship between changes in loneliness during medical school and students' recognition of emotion in others. Measures of loneliness and emotion recognition were collected from 122 medical students during their first 3 years of medical school at the beginning and end of each academic year. Changes in loneliness were related to changes in emotion detection, with increases in loneliness being associated with decreases in the probability of accurately discriminating sad and angry faces from other expressions, decreases in the probability of mislabeling emotion expressions as happy, and increases in the probability of mislabeling other emotional expressions as pained and angry. This study suggests that changes in loneliness during medical school are associated with increases in students' labeling emotional expressions as negative, possibly by shifting attention to cues of negative emotion and away from cues of positive emotion. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Karen E Smith
- Department of Psychology, Integrative Neuroscience Area, University of Chicago
| | | | - Jean Decety
- Department of Psychology, University of Chicago
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20
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Abstract
The concepts of empathy and care are the subject of numerous publications that testify to a surge in interest in the subject. What are the possibilities of teaching empathy to medical and nursing students? A proposed definition and a literature review can be developed to identify the effects of empathy in care and the opportunities for teaching empathy to students and practicing professionals.
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Affiliation(s)
- Éric Maeker
- Association Emp@thies, pour l'humanisation des soins www.empathies.fr, 12 rue Jean-Jaurès Apt B22/23, 62223 Anzin-Saint-Aubin, France.
| | - Bérengère Maeker-Poquet
- Association Emp@thies, pour l'humanisation des soins www.empathies.fr, 12 rue Jean-Jaurès Apt B22/23, 62223 Anzin-Saint-Aubin, France
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21
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Wang W, Zhou Y, Wang J, Xu H, Wei S, Wang D, Wang L, Zhang XY. Prevalence, clinical correlates of suicide attempt and its relationship with empathy in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109863. [PMID: 31931089 DOI: 10.1016/j.pnpbp.2020.109863] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Previous studies have shown that cognitive impairment plays a key role in suicide, an important factor leading to premature death in schizophrenia (SCZ) patients. Empathy has received extensive attention recently; however, the relationship of empathy with suicide in schizophrenia is still unknown. The main aim of this study was to investigate the prevalence of suicide attempts and its association with empathy and other characteristics in Chinese chronic SCZ patients. METHODS The suicide attempt data, together with demographic characteristics and clinical variables were collected from 627 chronic inpatients with schizophrenia. We utilized the Positive and Negative Syndrome Scale (PANSS) for the psychopathological symptoms, and the Interpersonal Reactivity Index (IRI) for affective and cognitive empathy in this study. RESULTS We found a suicide attempt rate of 11.3% in chronic SCZ patients. Compared to non-attempters, suicide attempters were more likely to be women, had younger age and higher education levels, as well as higher positive symptoms and depressive factor score, but lower negative symptoms of PANSS (all p < .05). Moreover, after controlling the confounding factors, suicide attempters scored higher in Personal Distress subscale of IRI (F1, 455 = 5.446, p = .020) than non-attempters. CONCLUSIONS The prevalence of suicide attempt is high in chronic SCZ patients. Its risk factors include some demographic and clinical variables. Moreover, suicide attempters experienced stronger personal distress, suggesting that stronger empathy may be a risk factor of suicide.
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Affiliation(s)
- Wenjia Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hang Xu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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22
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Smith KE, Norman GJ, Decety J. Medical students' empathy positively predicts charitable donation behavior. JOURNAL OF POSITIVE PSYCHOLOGY 2019; 15:734-742. [PMID: 33042206 DOI: 10.1080/17439760.2019.1651889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Empathy is known to motivate prosocial behavior. This relationship, however is complex and influenced by the social context and the type of prosocial behavior. Additionally, empathy is a complex psychological capacity, making it important to examine how different components of empathy influence different prosocial behaviors. The current study uses a unique longitudinal sample to assess how changes in cognitive and affective components of empathy relate to charitable giving. Measures of empathy were collected from medical students in the fall and spring of students' first three years of medical school. After this time, students had the opportunity to donate to charity. Positive changes in students' cognitive empathy predicted their charitable giving, with students who demonstrated greater increases in cognitive empathy giving more money. This study points to an important role for cognitive empathy in certain prosocial behaviors, and suggests that long term changes in empathy influence individual differences in prosocial behavior.
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Affiliation(s)
- Karen E Smith
- Department of Psychology, University of Chicago, 5848 S University Ave, Chicago IL 60615
| | - Greg J Norman
- Department of Psychology, University of Chicago, 5848 S University Ave, Chicago IL 60615
| | - Jean Decety
- Department of Psychology, University of Chicago, 5848 S University Ave, Chicago IL 60615
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23
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FeldmanHall O, Shenhav A. Resolving uncertainty in a social world. Nat Hum Behav 2019; 3:426-435. [PMID: 31011164 PMCID: PMC6594393 DOI: 10.1038/s41562-019-0590-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/15/2019] [Indexed: 01/10/2023]
Abstract
Consider the range of social behaviours we engage in every day. In each case, there are a multitude of unknowns, reflecting the many sources of uncertainty inherent to social inference. We describe how uncertainty manifests in social environments (the thoughts and intentions of others are largely hidden, making it difficult to predict a person's behaviour) and why people are motivated to reduce the aversive feelings generated by uncertainty. We propose a three-part model whereby social uncertainty is initially reduced through automatic modes of inference (such as impression formation) before more control-demanding modes of inference (such as perspective-taking) are deployed to narrow one's predictions even more. Finally, social uncertainty is attenuated further through learning processes that update these predictions based on new information. Our framework integrates research across fields to offer an account of the mechanisms motivating social cognition and action, laying the groundwork for future experiments that can illuminate the impact of uncertainty on social cognition.
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Affiliation(s)
- Oriel FeldmanHall
- Department of Cognitive, Linguistic, Psychological Sciences, Brown University, Providence, Rhode Island, USA.
| | - Amitai Shenhav
- Department of Cognitive, Linguistic, Psychological Sciences, Brown University, Providence, Rhode Island, USA
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24
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Fragkos KC, Sotiropoulos I, Frangos CC. Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016). World J Meta-Anal 2019; 7:1-30. [DOI: 10.13105/wjma.v7.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/16/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.
AIM To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.
METHODS A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I2 statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.
RESULTS Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.
CONCLUSION The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.
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Affiliation(s)
- Konstantinos C Fragkos
- GI Services, University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
- Medical School, University College London, London WC1E 6BT, United Kingdom
| | - Ioannis Sotiropoulos
- Department of Accounting and Finance, University of Ioannina, Psathaki 481 00 Preveza, Greece
| | - Christos C Frangos
- Greek Research Institute for the Study of Quantitative, Social and Biomedical Problems, Athens 141 21, Greece
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25
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Schwan D. Should physicians be empathetic? Rethinking clinical empathy. THEORETICAL MEDICINE AND BIOETHICS 2018; 39:347-360. [PMID: 30238181 DOI: 10.1007/s11017-018-9463-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The role and importance of empathy in clinical practice has been widely discussed. This paper focuses on the ideal of clinical empathy, as involving both cognitive understanding and affective resonance. I argue that this account is subject to a number of objections. Affective resonance may serve more as a liability than as a benefit in clinical settings, and utilizing this capacity is not clearly supported by the relevant empirical literature. Instead, I argue that the ideal account of empathy in medicine remains cognitive, though there is a central role for expressing empathic concern toward patients.
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Affiliation(s)
- David Schwan
- The University of Memphis, Memphis, TN, USA.
- Central Washington University, Ellensburg, WA, USA.
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26
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Impairment of social cognition in neurological diseases. Rev Neurol (Paris) 2018; 174:190-198. [DOI: 10.1016/j.neurol.2018.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/13/2017] [Accepted: 03/02/2018] [Indexed: 12/28/2022]
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27
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Aarthun A, Øymar KA, Akerjordet K. How health professionals facilitate parents' involvement in decision-making at the hospital: A parental perspective. J Child Health Care 2018; 22:108-121. [PMID: 29212362 DOI: 10.1177/1367493517744279] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In many western countries, parents have a legal right to influence and be involved in decision-making (DM) surrounding their children's healthcare. This ensures that the healthcare is customized as far as possible to meet the children's and families' needs and preferences. However, parental involvement in such DM is not sufficiently implemented and the parental role during hospitalizations has become demanding. More knowledge is required to inform health professionals (HPs) about how to improve parental involvement in DM from a health-promoting perspective. The aims of this study were to explore parents' experiences of how HPs facilitate their involvement in the DM surrounding their child's healthcare and to identify how HPs can improve parental involvement at the hospital. This was an explorative, descriptive qualitative study within a constructivist research paradigm, comprising a purposive sample of 12 parents participating in individual semi-structured interviews. Qualitative content analysis was performed. The findings showed that HPs' sensitivity to parents' capacity, resources and needs was essential in order to facilitate the latter's involvement in DM. HPs' sensitivity also seemed to influence the quality of communication and the HP-parent relationship. Moreover, these factors appeared to affect parents' coping ability during their children's hospitalization.
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Affiliation(s)
- Antje Aarthun
- 1 Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,2 Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Knut A Øymar
- 1 Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.,3 Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Kristin Akerjordet
- 2 Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,4 Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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28
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The IMPACT Q framework: teaching medical students how to gather a psychosocial history. Br J Gen Pract 2018; 68:41-42. [DOI: 10.3399/bjgp17x694349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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29
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Coetzee SK, Laschinger HK. Toward a comprehensive, theoretical model of compassion fatigue: An integrative literature review. Nurs Health Sci 2017; 20:4-15. [DOI: 10.1111/nhs.12387] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/13/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Siedine K. Coetzee
- School of Nursing Science; North-West University; Potchefstroom South Africa
| | - Heather K.S. Laschinger
- Arthur Labatt Family School of Nursing; University of Western Ontario; London Ontario Canada
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30
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Smith KE, Norman GJ, Decety J. The complexity of empathy during medical school training: evidence for positive changes. MEDICAL EDUCATION 2017; 51:1146-1159. [PMID: 28884471 PMCID: PMC5657391 DOI: 10.1111/medu.13398] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/16/2017] [Accepted: 06/12/2017] [Indexed: 05/13/2023]
Abstract
CONTEXT Empathy is an essential aspect of clinical care, associated with improved patient satisfaction, increased adherence to treatment, and fewer malpractice complaints. Previous studies suggest that empathy declines during medical training. However, past research relied on a single narrowly operationalised, self-report measure of empathy. As empathy is a complex socio-emotional construct, it is critical to assess changes across its distinct components using multiple measures in order to better understand how it is influenced by medical training. METHODS In a longitudinal study, medical students completed a series of self-report and behavioural measures twice per year during the first 3 years of their study (2012-2015). These included the previously used Jefferson Scale of Physician Empathy (JSPE), designed to assess empathy in the clinical context, the Questionnaire of Cognitive and Affective Empathy (QCAE), designed to assess overall empathy and its main components, and behavioural measures of sensitivity to others' pain and understanding of others' emotions, both of which are important aspects of empathy. The employment of multiple measures allowed for a more complete assessment of medical students' empathy and related processes. RESULTS In reflection of findings in previous work, students' empathy assessed by the JSPE decreased over training. However, on the QCAE, aspects of students' empathy, specifically overall cognitive empathy and its subcomponent perspective taking, and the emotion contagion subcomponent of affective empathy improved, whereas the remaining subcomponents remained stable. During medical school, students also exhibited comparable growth in their understanding of others' emotions and increased sensitivity to others' pain. CONCLUSIONS Changes in empathy during medical school cannot be simply characterised as representing an overall decline. Indeed, aspects of empathy thought to be valuable in positive physician-patient interactions improve during training. Overall, this study points to the importance of assessing the distinct components of empathy using multiple forms of measurement in order to better understand the mechanisms involved in empathy changes in medical practice.
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Affiliation(s)
- Karen E Smith
- Department of Psychology, University of Chicago, Chicago, Illinois, USA
| | - Greg J Norman
- Grossman Institute for Neuroscience, University of Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioural Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Jean Decety
- Department of Psychology, University of Chicago, Chicago, Illinois, USA
- Grossman Institute for Neuroscience, University of Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioural Neuroscience, University of Chicago, Chicago, Illinois, USA
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31
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Martingano AJ, Martingano D. Measuring Multidimensional Empathy: Theoretical and Practical Considerations for Osteopathic Medical Researchers. J Osteopath Med 2017; 117:697-704. [DOI: 10.7556/jaoa.2017.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Osteopathic physicians are increasingly recognizing the importance of empathy for improving patient satisfaction and clinical outcomes. This review advocates for a multidimensional perspective of empathy, encompassing both affective and cognitive empathy, and highlights situational and dispositional factors relevant to the curtailment of empathy. A review of the utility of self-report, behavioral, and physiological measures that researchers may use to quantify empathy in further research is also provided. The authors encourage members of the osteopathic medical profession to embrace a fuller understanding of empathy.
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32
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Cheng Y, Chen C, Decety J. How Situational Context Impacts Empathic Responses and Brain Activation Patterns. Front Behav Neurosci 2017; 11:165. [PMID: 28928643 PMCID: PMC5591329 DOI: 10.3389/fnbeh.2017.00165] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/21/2017] [Indexed: 01/10/2023] Open
Abstract
Clinical empathy, which is defined as the ability to understand the patient’s experience and feelings from the patient’s perspective, is acknowledged to be an important aspect of quality healthcare. However, how work experience modulates the empathic responses and brain activation patterns in medical professions remains elusive. This fMRI study recruited one hundred female nurses, who varied the length of work experience, and examined how their neural response, functional connectivity, and subjective evaluations of valence and arousal to perceiving another individual in physical pain are modulated by the situational context in which they occur (i.e., in a hospital or at home). Participants with longer hospital terms evaluated pain as less negative in valence and arousal when occurring in a hospital context, but not in a home context. Physical pain perceived in a hospital compared to a home context produced stronger activity in the right temporoparietal junction (rTPJ). The reverse comparison resulted in an increased activity in the insula and anterior midcingulate cortex (aMCC). Mediation analysis indicated that reduced personal accomplishment, a symptom of burnout, breaks down the mediation effect of the putamen on context-dependent valence ratings. Overall, the study demonstrates how situational contexts significantly influence individuals’ empathic processing, and that perceiving reward from patient care protects them from burnout. HighlightsDifferences in behavior ratings and brain activations between medical practitioners perceiving others’ pain in a hospital and at home. Situational contexts significantly influence individual’s empathic processing. Perceiving rewards from patient care protects medical practitioners from burnout. Empathy is a flexible phenomenon.
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Affiliation(s)
- Yawei Cheng
- Institute of Neuroscience, National Yang-Ming UniversityTaipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Yang-Ming University HospitalYilan, Taiwan
| | - Chenyi Chen
- Institute of Neuroscience, National Yang-Ming UniversityTaipei, Taiwan
| | - Jean Decety
- Department of Psychology and Department of Psychiatry and Behavioral Neuroscience, University of ChicagoChicago, IL, United States
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Roche J, Harmon D. Exploring the Facets of Empathy and Pain in Clinical Practice: A Review. Pain Pract 2017; 17:1089-1096. [PMID: 28160400 DOI: 10.1111/papr.12563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 08/29/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Empathy is an essential element in providing quality patient care. The significance of empathy is even more striking in pain medicine, as chronic pain is notorious for the way it can compromise an individual, leaving him or her isolated and feeling misconceived. This review examines the role of empathy in pain medicine practice. METHODS Current and past literature focusing on empathy and pain was searched for in PubMed, Science Direct, MEDLINE (Ovid), MEDLINE (Ebsco), Research Gate, and Google Scholar in July 2015. Search dates were not limited and languages included English only. Search terms were "empathy and pain," "empathy and chronic pain," "physician empathy and pain," "neural mechanisms and empathy," "empathy in clinical practice," "empathy and stigma," and "empathy and medical students". To select relevant publications, the title and abstract of every publication were examined, and when in doubt, the rest of the publication was read. RESULTS Four major themes were identified: (1) the neural basis for empathy and pain; (2) the value and challenges of practicing empathy pain medicine; (3) stigma and empathy for pain; and (4) empathy and physician education and training. CONCLUSION The review reveals that empathy deserves an unchallenged place in medical care, especially in pain medicine and medical education. It highlights the need to nurture empathy at all levels of professional expertise from medical student to senior doctors.
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Affiliation(s)
| | - Dominic Harmon
- Anesthesia, Intensive Care and Pain Medicine, University Hospital Limerick, Limerick, Ireland
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Abstract
Empathy is a multifaceted skill and asset for health care providers. This paper uses current neuroscience literature of empathy to generate nuanced theory of how empathy can be blocked by personal stress and aversion among health care professionals. Current training approaches for educating sustainable empathy are reviewed in depth. The final part of the paper provides suggestions on how to spread empathy education farther and wider across medical education.
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Affiliation(s)
- Eve Ekman
- a Osher Center of Integrative Medicine, University of California San Francisco , San Francisco , CA , USA
| | - Michael Krasner
- b School of Medicine, University of Rochester , Rochester , NY , USA
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Oliver LD, Neufeld RW, Dziobek I, Mitchell DG. Distinguishing the relationship between different aspects of empathic responding as a function of psychopathic, autistic, and anxious traits. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.04.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
The importance of emotions is supported by many authors of the ethics of care in contrast to the rationalistic paradigm of justice. However, the reference to the emotions remains generic. By focusing on three paradigmatic typologies (care out of love, care work, and care of the distant other), I propose to investigate this aspect further, and distinguish between the different emotions that motivate care (such as love, compassion, and generosity). I will try, first, to offer a reflection on which emotions are likely to motivate ethical action within an ethics of care; second, to survey different potential obstacles to these emotions and propose how they might be overcome to more successfully achieve good care and ethical action.
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Affiliation(s)
- Elena Pulcini
- Department of Political and Social Science, University of Florence, Italy
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Díaz-Narváez VP, Núñez AC, Carrasco D, Bustos A, Zamorano A, Silva H, Tagle EL, Hubermann J, Utsman R, Reyes AR. Levels of Empathy among Dental Students in Five Chilean Universities. Health (London) 2016. [DOI: 10.4236/health.2016.81005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Galderisi S, Heinz A, Kastrup M, Beezhold J, Sartorius N. Toward a new definition of mental health. World Psychiatry 2015; 14:231-3. [PMID: 26043341 PMCID: PMC4471980 DOI: 10.1002/wps.20231] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Berlin, Germany
| | - Marianne Kastrup
- Competence Center for Transcultural Psychiatry, Psychiatric Center Ballerup, Hellerup, Denmark
| | - Julian Beezhold
- Hellesdon Hospital and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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Maj M. Technical and non-technical aspects of psychiatric care: the need for a balanced view. World Psychiatry 2014; 13:209-10. [PMID: 25273284 PMCID: PMC4219052 DOI: 10.1002/wps.20168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Mario Maj
- Department of Psychiatry; University of Naples SUN; Naples Italy
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