Disgust, Empathy, and Care of the Sick: an Evolutionary Perspective

The identification of the relationship between nursing students' disgust sensitivity and willingness to care for the elderly: The case of a university

OBJECTIVES

In clinical learning environments, nursing students frequently encounter situations that cause physical disgust. It is believed that a high sensitivity to disgust among students can negatively affect their academic performance and caregiving behavior. This study was conducted to identify the relationship between nursing students' disgust sensitivity and willingness to care for older adults.

METHOD

This descriptive and cross-sectional research was conducted with 807 volunteer participants studying at the Department of Nursing of a university in southeast Turkey. The research data were collected by using the Personal Information Form, the Disgust Sensitivity Scale - Revised Form (DS-R), and the Willingness to Care for the Elderly Scale (WCES) . Descriptive statistics, the Student's t-test, the Mann-Whitney U test, the One-Way Analysis of Variance, and Pearson's correlation were used in the analysis of research data.

RESULTS

In the research, nursing students' mean DS-R and WCES scores were calculated respectively as 77.93 ± 16.40 and 34.16 ± 5.98 points. A statistically significant negative relationship was found between nursing students' DS-R and WCES scores (p < 0.05). In the research, there were statistically significant differences in nursing students' mean DS-R scores as per the variables of student gender and class year. Also, it was found that, as per the variables of student nationality and the status of assuming responsibility for the care of a sick or old relative, there were statistically significant differences in both nursing students' mean DS-R scores and their mean WCES scores (p < 0.05).

CONCLUSION

It was concluded that nursing students had high-level disgust sensitivity and medium-level willingness to care for an older adult. As the disgust sensitivity of the nursing students increased, their willingness to care for an older adult was negatively affected. Therefore, it is important that nurse educators evaluate nursing students' disgust sensitivity and help nursing students define and eliminate their disgust emotions.

Moderate similarity leads to empathic concern, but high similarity can also induce personal distress towards others' pain

Empathic concern and personal distress are common vicarious emotional responses that arise when witnessing someone else's pain. However, the influence of perceived similarity on these responses remains unclear. In this study, we examined how perceived similarity with an injured target impacts vicarious emotional responses. A total of 87 participants watched a video of an athlete in pain preceded by a clip describing the athlete's trajectory, which indicated either high, moderate, or low similarity to the participants. Emotional self-reports, facial expressions, gaze behavior, and pupil diameter were measured as indicators of the participants' emotional responses. Participants in the moderate- and high-similarity groups exhibited greater empathic concern, as evidenced by their display of more sadness compared with those in the low-similarity group. Furthermore, those in the moderate-similarity group exhibited less avoidance by displaying reduced disgust, indicating lower personal distress compared with those in the low-similarity condition. Nevertheless, the high-similarity group displayed just as much disgust as the low-similarity group. These findings suggest that perceived similarity enhances empathic concern to others' suffering, but that high similarity can also lead to personal distress. Future studies on empathy should explore distinct vicarious states using multimodal measurements to further advance our understanding of these processes.

Brain-to-brain mechanisms underlying pain empathy and social modulation of pain in the patient-clinician interaction

Social interactions such as the patient-clinician encounter can influence pain, but the underlying dynamic interbrain processes are unclear. Here, we investigated the dynamic brain processes supporting social modulation of pain by assessing simultaneous brain activity (fMRI hyperscanning) from chronic pain patients and clinicians during video-based live interaction. Patients received painful and nonpainful pressure stimuli either with a supportive clinician present (Dyadic) or in isolation (Solo). In half of the dyads, clinicians performed a clinical consultation and intake with the patient prior to hyperscanning (Clinical Interaction), which increased self-reported therapeutic alliance. For the other half, patient-clinician hyperscanning was completed without prior clinical interaction (No Interaction). Patients reported lower pain intensity in the Dyadic, relative to the Solo, condition. In Clinical Interaction dyads relative to No Interaction, patients evaluated their clinicians as better able to understand their pain, and clinicians were more accurate when estimating patients' pain levels. In Clinical Interaction dyads, compared to No Interaction, patients showed stronger activation of the dorsolateral and ventrolateral prefrontal cortex (dlPFC and vlPFC) and primary (S1) and secondary (S2) somatosensory areas (Dyadic-Solo contrast), and clinicians showed increased dynamic dlPFC concordance with patients' S2 activity during pain. Furthermore, the strength of S2-dlPFC concordance was positively correlated with self-reported therapeutic alliance. These findings support that empathy and supportive care can reduce pain intensity and shed light on the brain processes underpinning social modulation of pain in patient-clinician interactions. Our findings further suggest that clinicians' dlPFC concordance with patients' somatosensory processing during pain can be boosted by increasing therapeutic alliance.

The suffering ape hypothesis

The "fearful ape hypothesis" could be regarded as one aspect of a more general "suffering ape hypothesis": Humans are more likely to experience negative emotions (e.g., fear, sadness), aversive symptoms (e.g., pain, fever), and to engage in self-harming behavior (e.g., cutting, suicide attempts) because these might motivate affiliative, consolatory, and supportive behavior from their prosocial environment thereby enhancing evolutionary fitness.

Patient-clinician brain concordance underlies causal dynamics in nonverbal communication and negative affective expressivity

Patient-clinician concordance in behavior and brain activity has been proposed as a potential key mediator of mutual empathy and clinical rapport in the therapeutic encounter. However, the specific elements of patient-clinician communication that may support brain-to-brain concordance and therapeutic alliance are unknown. Here, we investigated how pain-related, directional facial communication between patients and clinicians is associated with brain-to-brain concordance. Patient-clinician dyads interacted in a pain-treatment context, during synchronous assessment of brain activity (fMRI hyperscanning) and online video transfer, enabling face-to-face social interaction. In-scanner videos were used for automated individual facial action unit (AU) time-series extraction. First, an interpretable machine-learning classifier of patients' facial expressions, from an independent fMRI experiment, significantly distinguished moderately painful leg pressure from innocuous pressure stimuli. Next, we estimated neural-network causality of patient-to-clinician directional information flow of facial expressions during clinician-initiated treatment of patients' evoked pain. We identified a leader-follower relationship in which patients predominantly led the facial communication while clinicians responded to patients' expressions. Finally, analyses of dynamic brain-to-brain concordance showed that patients' mid/posterior insular concordance with the clinicians' anterior insula cortex, a region identified in previously published data from this study¹, was associated with therapeutic alliance, and self-reported and objective (patient-to-clinician-directed causal influence) markers of negative-affect expressivity. These results suggest a role of patient-clinician concordance of the insula, a social-mirroring and salience-processing brain node, in mediating directional dynamics of pain-directed facial communication during therapeutic encounters.

Strangers look sicker (with implications in times of COVID-19)

We animals have evolved a variety of mechanisms to avoid conspecifics who might be infected. It is currently unclear whether and why this "behavioral immune system" targets unfamiliar individuals more than familiar ones. Here I answer this question in humans, using publicly available data of a recent study on 1969 participants from India and 1615 from the USA. The apparent health of a male stranger, as estimated from his face, and the comfort with contact with him were a direct function of his similarity to the men in the local community. This held true regardless of whether the face carried overt signs of infection. I conclude that our behavioral immune system is finely tuned to degrees of outgroupness - and that cues of outgroupness are partly processed as cues of infectiousness. These findings, which were consistent across the two cultures, support the notion that the pathogens of strangers are perceived as more dangerous.

Disgust and political attitudes Guest Editors' Introduction to the Special Issue

We introduce the Politics and the Life Sciences Special Issue on Disgust and Political Attitudes discussing the importance of understanding state and trait disgust, the innovative and transparent process by which registered reports and preregistered studies were chosen and funded, and the manuscripts that make up this special issue. This essay concludes by discussing future research directions in disgust and political attitudes, as well as the benefits of a transparent review process that avoids the "file drawer problem" of unpublished null findings.

Healthy Out-Group Members Are Represented Psychologically as Infected In-Group Members

A range of studies have demonstrated that people implicitly treat out-groups as the carriers of pathogens and that considerable prejudice against out-groups is driven by concerns about pathogens. Yet the psychological categories that are involved and the selection pressures that underlie these categories remain unclear. A common view is that human pathogen-avoidance psychology is specifically adapted to avoid out-groups because of their potentially different pathogens. However, the series of studies reported here shows that there is no dedicated category for reasoning about out-groups in terms of pathogens. Specifically, a memory-confusion experiment conducted with two large-scale samples of Americans (one nationally representative) yielded strong, replicable evidence that healthy out-group members are represented using the same psychological category that is used to represent manifestly infected in-group members. This suggests that the link between out-group prejudice and pathogen concerns is a by-product of general mechanisms for treating any unfamiliar appearance as an infection cue.