Empathy for the Stressed

Is your stress my stress? A standardized, randomized-controlled paradigm to study physiological stress contagion based on direct stress observation

BACKGROUND & OBJECTIVES

Existing research indicates that not only own stress leads to physiological stress reactions, but also observing stress in others. So far, a standardized paradigm to reliably induce physiological stress contagion based on direct face-to-face stress observation compared to an active placebo-stress observing control condition is lacking. Here, we tested a standardized randomized placebo-controlled experimental paradigm to investigate physiological reactivity to direct stress observation and characterized the stress contagion response of the major endocrine stress systems, including full reactivity kinetics.

METHODS

Healthy young male participants were randomly assigned to (1) undergo an adapted version of the Trier Social Stress Test ("TSST participants", n = 20), (2) observe it ("stress observers", n = 36), or (3) observe a corresponding placebo-stress control condition ("placebo-stress observers", n = 30). We repeatedly assessed heart rate, salivary alpha-amylase, salivary cortisol, and salivary aldosterone.

RESULTS

Stress observers exhibited greater physiological reactivity to stress observation as compared to placebo-stress observers to placebo-stress observation in heart rate, salivary alpha-amylase, and cortisol (p's ≤ .027), but not in aldosterone. We observed similar reactivity kinetics in TSST participants and stress observers but less pronounced in stress observers.

DISCUSSION

Extending previous literature, our findings indicate that independent of secondary effects of the observation setting, direct observation of stress in other individuals induces activation of the hypothalamus-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis. Moreover, the physiological stress contagion response resembles the physiological reactivity to first-hand stress but is less pronounced. Potential implications of physiological stress contagion regarding health, cognition, or behavior, as well as modulating factors need to be further elucidated.

Chronic stress and stressful emotional contagion affect the empathy-like behavior of rats

Empathy is a potential motivation for prosocial behaviors that is related to many psychiatric diseases, such as major depressive disorder; however, its neural mechanisms remain unclear. To elucidate the relationship between empathy and stress, we established a chronic stress contagion (SC) procedure combined with chronic unpredictable mild stress (CUMS) to investigate (1) whether depressive rats show impaired empathy-like behavior toward fearful conspecifics, (2) whether frequent social contact with normal familiar conspecifics (social support) alleviates the negative effects of CUMS, and (3) the effect of long-term exposure to a depressed partner on emotional and empathic responses in normal rats. We found that the CUMS group showed less empathy-like behavior in the social transfer of fear model (STFM), as indicated by less social interaction with the demonstrator and reduced freezing behavior in the fear-expression test. Social contact partially alleviated depression-like behaviors and the negative effect of CUMS in the fear-transfer test. The normal rats who experienced stress contagion from daily exposure to a depressed partner for 3 weeks showed lower anxiety and increased social response in the fear-transfer test than the control group. We concluded that chronic stress impairs empathy-like behaviors, while social contact partially buffers the effect of CUMS. Thus, social contact or contagion of stress is mutually beneficial to both stressed individuals and nonstressed partners. Higher dopamine and lower norepinephrine levels in the basolateral amygdala probably contributed to these beneficial effects.

History Repeats Itself: The Relevance of Historical Pandemics to the Medical School Curriculum

Introduction

The dramatic global impact of the coronavirus pandemic has increased consideration on epidemiological progressions of pandemics. Measures implemented to reduce viral transmission have been largely historical, comparable in nature with the 1918 and 2009 influenza pandemics, demonstrating the importance of clinicians' awareness on historical pandemics. Despite this, literature suggests medical students' knowledge on previous pandemics is poor.

Objectives

This study aims to gather stakeholder information from UK medical students on the importance of including the history of pandemics in the medical school curriculum.

Methods

A cross-sectional cohort study conducted via a mixed question type online survey was distributed to all UK medical schools to explore stakeholder views. Grounded theory emergent coding was used to generate themes to free-text answers and SPSS and Excel were used to analyse quantitative data using pivot tables and Fishers exact tests.

Results

Two hundred and forty-one students consented to take part from eight medical schools in the UK with 98% of these students completing the questionnaire. 34% of students reported having teaching on pandemics with 78% of students stating it would be beneficial. Knowledge was poor with 5.7% of students achieving 100% on knowledge-based questions. 72% of students believed that learning about the history of medicine would be beneficial with 87% of these students referring to 'benefiting (the) future' in their answers. Additionally, 79% of students thought it would be beneficial to learn about historical pandemics with reference to the current COVID-19 pandemic.

Conclusion

To date, this is the only UK based study assessing stakeholders' views on including the history of pandemics in the medical school curriculum. Our findings demonstrate that medical students wish to have more historical content included in their degree to better prepare tomorrow's doctors for situations that may occur when history repeats itself.

The association between acute stress & empathy: A systematic literature review

Empathy is a fundamental component of our social-emotional experience. Over the last decade, there has been increased interest in understanding the effects of acute stress on empathy. We provide a first comprehensive-and systematic-overview identifying emerging patterns and gaps in this literature. Regarding affective empathy, there is abundant evidence for stress contagion-the 'spillover' of stress from a stressed target to an unstressed perceiver. We highlight contextual factors that can facilitate and/or undermine these effects. Fewer studies have investigated the effects of acute stress on affective empathy, revealing a nuanced picture, some evidence suggests acute stress can block contagion of other's emotions; but again contextual differences need to be considered. Regarding cognitive empathy, most studies find no conclusive effects for simplistic measures of emotion recognition; however, studies using more complex empathy tasks find that acute stress might affect cognitive empathy differentially for men and women. This review provides an important first step towards understanding how acute stress can impact social-togetherness, and aims to aid future research by highlighting (in)congruencies and outstanding questions.

Neural basis of prosocial behavior

The ability to behave in ways that benefit other individuals' well-being is among the most celebrated human characteristics crucial for social cohesiveness. Across mammalian species, animals display various forms of prosocial behaviors - comforting, helping, and resource sharing - to support others' emotions, goals, and/or material needs. In this review, we provide a cross-species view of the behavioral manifestations, proximate and ultimate drives, and neural mechanisms of prosocial behaviors. We summarize key findings from recent studies in humans and rodents that have shed light on the neural mechanisms underlying different processes essential for prosocial interactions, from perception and empathic sharing of others' states to prosocial decisions and actions.

Relational teletherapy experiences of couple and family therapy trainees: "Reading the room," exhaustion, and the comforts of home

Couple and family therapists are increasingly using telehealth platforms to deliver services. Unfortunately, the literature on relational teletherapy is not well developed. This study sought to understand experiences of teletherapy with couples and families as it contrasts with individual clients and in-person therapy. We utilized a hermeneutic phenomenological approach to qualitative inquiry from data collected through open-ended questions on a web-based survey of graduate student trainees (n = 66) in COAMFTE-accredited couple and family therapy programs. Thematic analysis identified the body-of-the-therapist and client as they exist (and are obstructed) due to technology for creating barriers and opportunities in translating CFT intervention to telehealth platforms. Relational teletherapy cultivated therapist creativity and exhaustion. It also made plain the need for systemic interventions with children and adolescents that engages their parents and home environments. Implications for CFT practice, training, and intervention research are outlined.

Physiological Resonance in Empathic Stress: Insights from Nonlinear Dynamics of Heart Rate Variability

Because most humans live and work in populated environments, researchers recently took into account that people may not only experience first-hand stress, but also second-hand stress related to the ability to empathically share another person’s stress response. Recently, researchers have begun to more closely examine the existence of such empathic stress and highlighted the human propensity to physiologically resonate with the stress responses of others. As in case of first-hand stress, empathic stress could be deleterious for health if people experience exacerbated activation of hypothalamic–pituitary–adrenal and autonomic nervous systems. Thus, exploring empathic stress in an observer watching someone else experiencing stress is critical to gain a better understanding of physiological resonance and conduct strategies for health prevention. In the current study, we investigated the influence of empathic stress responses on heart rate variability (HRV) with a specific focus on nonlinear dynamics. Classic and nonlinear markers of HRV time series were computed in both targets and observers during a modified Trier social stress test (TSST). We capitalized on multiscale entropy, a reliable marker of complexity for depicting neurovisceral interactions (brain-to-heart and heart-to-brain) and their role in physiological resonance. State anxiety and affect were evaluated as well. While classic markers of HRV were not impacted by empathic stress, we showed that the complexity marker reflected the existence of empathic stress in observers. More specifically, a linear model highlighted a physiological resonance phenomenon. We conclude on the relevance of entropy in HRV dynamics, as a marker of complexity in neurovisceral interactions reflecting physiological resonance in empathic stress.

The social curse: Evidence for a moderating effect of shared social identity on contagious stress reactions

Contagious stress describes the transmission of a stress response from a distressed individual (target) to an uninvolved observer. Building on social identity theory, we hypothesize that a shared social identity between the observer and the target as compared to a personal identity increases the likelihood of contagious endocrine and psychological stress responses. Participants underwent the experiment in groups of four or five individuals. After experimentally inducing either a shared social identity or a personal identity, one participant in each group (N_target = 27) was randomly chosen to undergo the Trier Social Stress Test (TSST), while being observed by the rest of the group (N_observer = 89). Salivary cortisol and psychological stress responses were assessed repeatedly during the experiment. As predicted, the likelihood of cortisol stress reactions was significantly higher in the social identity condition (25 %) as compared to the personal identity condition (7 %). No effect of our manipulation on psychological stress responses was found. We also tested whether observers' trait empathy moderates contagious stress and found no support for this moderation.

The potential role of cortisol as a biomarker of physiological interdependence in romantic couples: A systematic review

Significant evidence supports the link between relationships and health including the potential for interpartner regulation of intrapersonal physical and mental homeostasis. Physiological interdependence is proposed as a term to summarize the adaptive process in which partners demonstrate physiological contagion that evolves with repetition to create a new homeostatic state regulating individual physiological functioning. Through a systematic review consistent with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), the present study reviewed the literature examining the interdependent role of diurnal cortisol with romantic couples. The literature search yielded thirteen articles that included statistical modeling testing interdependence between partners in a couple and at the individual level. Five themes emerged from the literature including cortisol synchrony, cortisol and health, cortisol and emotions, cortisol and internal relationship factors, and cortisol and factors external to the romantic relationship. Findings suggest a potential for romantic partners to regulate one another's emotional and physiological states, but this process may not be present in both partners. More research is needed to substantiate a regulatory role as the current literature supports correlations.

No Words for Feelings? Not Only for My Own: Diminished Emotional Empathic Ability in Alexithymia

The present study has been designed to disentangle cognitive and emotional dimensions of empathy in a group of mentally healthy and highly alexithymic individuals (ALEX, n = 24) and well-matched controls (n = 26) through questionnaire Interpersonal Reactivity Index (IRI) and Multifaceted Empathy Task (MET) used during the fMRI and after the fMRI. Simultaneously, Skin Conductance Response (SCR) has been acquired as an implicit measure of emotional reaction. Results show an impaired emotional empathic ability in alexithymic individuals, with lower levels of SCR and higher activation in prefrontal brain regions such as the ventrolateral prefrontal cortex (VLPFC) and inferior frontal gyrus (IFG). Cognitive empathy was not impaired in the alexithymic group and the results were accompanied by a higher activation left IFG. The study leads to the conclusion that alexithymia does not only involve a diminished ability to identify and describe one's own emotions. Furthermore, it is related to a deeper disability of emotion regulation, which becomes visible through impaired emotional concern for others and higher levels of personal distress.

Embodied stress: The physiological resonance of psychosocial stress

Psychosocial stress is a ubiquitous phenomenon in our society. While acute stress responses are necessary and adaptive, excessive activation of neurobiological stress systems can predispose an individual to far-reaching adverse health outcomes. Living in a complex social environment, experiencing stress is not limited to challenges humans face individually. Possibly linked with our capacity for empathy, we also display the tendency to physiologically resonate with others' stress responses. This recently identified source of stress raises many interesting questions. In comparison to the wealth of studies that have advanced our understanding of sharing others' affective states, the physiological resonance of stress has only recently begun to be more closely investigated. The aim of the current paper is to review the existing literature surrounding the emerging area of "stress contagion", "empathic stress" or "stress resonance", as it has been variably called. After a brief introduction of the concepts of stress and empathy, we discuss several key studies that paved the way for the merging of empathy with the concept of physiological resonance. We then delineate recent empirical studies specifically focusing on the physiological resonance of stress. In the final section of this review, we highlight differences between these studies and discuss the variability in terminology used for what seems to be the same phenomenon. Lastly, potential health implications of chronic empathic stress are presented and possible mechanisms of physiological stress transmission are discussed.

Social identification and contagious stress reactions

Contagious stress describes the transmission of stress from a stressed person to an observer, which we examined at the neuroendocrine and the affective level. We tested whether a shared social identity moderates contagious stress. Ninety-four participants participated in groups of four. After inducing either a shared social or a personal identity, participants observed a confederate undergoing the Trier Social Stress Test (TSST), a standardized social-evaluative stressor. Salivary cortisol and affective stress were assessed multiple times before and after the observation of the TSST. We found a physiologically significant contagious stress reaction on a neuroendocrine level for 17% of all participants. Additionally, we found an increase in observers' self-reported stress. Contrary to our expectations, the manipulation of social identity had no effect on contagious stress. Our variation of the TSST is a viable methodological strategy to increase standardization as well as experimental economy in studies examining contagious stress.