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

TSST-OL: Comparison between online and laboratory application and effects on empathy

Online test protocols are increasingly popular in psychological and neuroscientific research. Despite its relevance to the social functioning, the influence of acute stress on cognitive and affective state empathy is not clearly understood. Recently, a remote online version (TSST-OL) of the Trier Social Stress Test (TSST) was established for use in research with both children and adults. In general, the TSST-OL offers the opportunity for context-independent application (e.g., at the participants' home or in field contexts). However, in order to exploit this opportunity, it seems crucial to validate the TSST-OL across different settings and contextual variables. We compared stress reactivity in response to the TSST-OL at home and in the laboratory. In a 2 ×2 factorial design, N=120 participants (n=60 women) underwent the TSST-OL and an online adaption of the friendly TSST (fTSST-OL) either at home (n=60) or at the laboratory (n=60). Stress induction was evaluated in terms of physiological (cortisol and salivary alpha-amylase, sAA) and subjective stress and affect measures. Participants also completed an empathy performance task after stress and control exposure. Results confirmed that the TSST-OL successfully induced stress both when conducted at participants' homes and in the laboratory. Still, cortisol levels were higher during laboratory participation compared to application at home, likely due to anticipatory stress. Consequently, the TSST-OL in a home-based application seems to buffer anticipatory stress thus making it an attractive tool to study experimentally induced stress reactivity. Concerning empathy, positive emotions were generally better identified (cognitive empathy) and empathized (affective empathy) than negative emotions. For the latter, this difference was absent after stress, indicated by decreased affective empathy for positive emotions. Overall, this study indicates that the TSST-OL induces stress and validates the tool using a rigorous study design with sufficient participants and relevant stress parameters. Thus, future studies may apply the TSST-OL in different contexts and diverse samples. The findings on empathy under stress align with mixed results in existing research, highlighting the necessity for further investigations into empathy, considering various measurements, stimulus valence, and sex of the participant.

Reduced threat avoidance but increased stress induced approach bias in women taking oral contraceptives

Recent research has increasingly acknowledged the impact of oral contraceptives on affective behavior and stress responses; however, the underlying mechanisms are still not well understood. Studies have previously shown that steroid hormones modulate automatic approach and avoidance behavior. Here, we thus investigated the effects of oral contraceptives on approach and avoidance behavior and whether these effects are modulated by stress. The study comprised 130 female participants, half of whom were using oral contraceptives, while the other half were not using any hormonal contraception (NC). The participants completed the Approach Avoidance Task (AAT), which measures automatic approach and avoidance behavior to socio-affective signals. The AAT was run once before and once after a stress manipulation using the Socially Evaluated Cold Pressor Test. OC users showed absent avoidance behavior to social threat signals and a stress-induced increase in approach behavior to positive social signals. The latter was found in particular in women taking androgenic acting OC, demonstrating that different OC preparations need to be taken into account in research on OC effects. However, OC and NC group did not differ in their cortisol stress response. Overall, the results suggest that OC usage impacts on approach and avoidance behavior to social signals, which might also contribute to the development of affective side effects.

Attachment styles and empathy in trainee nurses: the mediating and moderating roles of attitudes toward death

Aim

A growing body of evidence has shown that attachment styles and death attitudes have a significant impact on empathy. This study aimed to explore the precise role of death attitudes in the relationship between attachment styles and empathy levels among trainee nurses.

Methods

A total of 626 Chinese trainee nurses with different attachment types were enrolled, and their attachment styles, death attitudes, and empathy levels were assessed using the Revised Adult Attachment Scale, the Death Attitude Profile-Revised, and the Jefferson Scale of Empathy-Healthy Professionals, and finally, data from 566 participants were included for statistical analysis.

Results

We found that among trainee nurses with secure attachment type, fear of death, approach acceptance, escape acceptance, and neutral acceptance (-) mediated the relationships between attachment-related avoidance/anxiety and their overall empathy levels and all its dimensions; in the preoccupied type, only neutral acceptance (-) mediated the relationships between attachment-related avoidance and their overall empathy levels and compassionate care; and in the fearful type, only fear of death mediated the relationship between attachment-related avoidance and compassionate care. Furthermore, in the secure type, neutral acceptance attenuated the negative predictions of attachment-related avoidance on overall empathy level and perspective taking.

Conclusion

Attitudes toward death played different mediating and moderating roles in the relationship between attachment styles and empathy among trainee nurses with different attachment types. In addition to acculturated empathy-specific training, targeted education related to death for trainee nurses with different attachment types is needed to prevent their compassion fatigue.

Issues and Perspectives for the Study of Disruptive Clinician Behavior

This article discusses issues and perspectives related to the study of disruptive clinician behavior (DCB) to improve patient safety and healthcare professionals' work environments. Multiple terminologies and ambiguous definitions have resulted in conceptual confusion in studies on DCB. In addition, subjective classifications have led the attributes of DCB to overlap and fluctuate. Therefore, we share Rosenberg's definition of DCB as "any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse to physical and sexual harassment." It is recommended that DCB be understood as a hierarchical structure identified through statistical analysis of field survey data. Furthermore, a recurring list of items is duplicated across existing studies on DCB triggers, contributing factors, and influences. These items can be organized into separate path models based on their mutual relationships. Given these assumed models, we believe that further studies on DCB can shift toward elucidating the mechanisms of occurrence and impact. Finally, based on the path models, we recommend improving healthcare professionals' psychological and social states through a policy shift from "zero-tolerance" to "to err is human" as a priority issue for DCB prevention and countermeasures.

Early life conditions reduce similarity between reproductive partners in HPA axis response to stress

Social environments modulate endocrine function, yet it is unclear whether individuals can become like their social partners in how they physiologically respond to stressors. This social transmission of hypothalamic-pituitary-adrenal (HPA) axis reactivity could have long-term consequences for health and lifespan of individuals if their social partners react to stressors with an exaggerated HPA axis response. We tested whether glucocorticoid levels in response to stress of breeding partners changes after breeding depending on whether partners had similar or dissimilar postnatal conditions. We manipulated postnatal conditions by mimicking early life stress in zebra finch chicks (Taeniopygia guttata) via postnatal corticosterone exposure. When they reached adulthood, we created breeding pairs where the female and male had experienced either the same or different early life hormonal treatment (corticosterone or control). Before and after breeding, we obtained blood samples within 3 min and after 10 min or 30 min of restraint stress (baseline, cort10, cort30). We found that corticosterone levels of individuals in response to restraint were affected by their own and their partner's early life conditions, but did not change after breeding. However, across all pairs, partners became more similar in cort30 levels after breeding, although differences between partners in cort10 remained greater in pairs with a corticosterone-treated female. Thus, we show that HPA axis response to stressors in adulthood can be modulated by reproductive partners and that similarity between partners is reduced when females are postnatally exposed to elevated glucocorticoids.

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.

Risk factors for internalizing symptoms: The influence of empathy, theory of mind, and negative thinking processes

Internalizing symptoms such as elevated stress and sustained negative affect can be important warning signs for developing mental disorders. A recent theoretical framework suggests a complex interplay of empathy, theory of mind (ToM), and negative thinking processes as a crucial risk combination for internalizing symptoms. To disentangle these relationships, this study utilizes neural, behavioral, and self-report data to examine how the interplay between empathy, ToM, and negative thinking processes relates to stress and negative affect. We reanalyzed the baseline data of N = 302 healthy participants (57% female, Mage  = 40.52, SDage  = 9.30) who participated in a large-scale mental training study, the ReSource project. Empathy and ToM were assessed using a validated fMRI paradigm featuring naturalistic video stimuli and via self-report. Additional self-report scales were employed to measure internalizing symptoms (perceived stress, negative affect) and negative thinking processes (rumination and self-blame). Our results revealed linear associations of self-reported ToM and empathic distress with stress and negative affect. Also, both lower and higher, compared to average, activation in the anterior insula during empathic processing and in the middle temporal gyrus during ToM performance was significantly associated with internalizing symptoms. These associations were dependent on rumination and self-blame. Our findings indicate specific risk constellations for internalizing symptoms. Especially people with lower self-reported ToM and higher empathic distress may be at risk for more internalizing symptoms. Quadratic associations of empathy- and ToM-related brain activation with internalizing symptoms depended on negative thinking processes, suggesting differential effects of cognitive and affective functioning on internalizing symptoms. Using a multi-method approach, these findings advance current research by shedding light on which complex risk combinations of cognitive and affective functioning are relevant for internalizing symptoms.

Mood congruency affects physiological synchrony but not empathic accuracy in a naturalistic empathy task

Empathy is a crucial aspect of our daily lives, as it enhances our wellbeing and is a proxy for prosocial behavior. It encompasses two related but partially distinct components: cognitive and affective empathy. Both are susceptible to context, biases and an individual's physiological state. Few studies have explored the effects of a person's mood on these empathy components, and results are mixed. The current study takes advantage of an ecological, naturalistic empathy task - the empathic accuracy (EA) task - in combination with physiological measurements to examine and differentiate between the effects of one's mood on both empathy components. Participants were induced with positive or negative mood and presented videos of targets narrating autobiographical negative stories, selected from a Chinese empathy dataset that we developed (now publicly available). The stories were conveyed in audio-only, visual-only and full-video formats. Participants rated the target's emotional state while watching or listening to their stories, and physiological measures were taken throughout the process. Importantly, similar measures were taken from the targets when they narrated the stories, allowing a comparison between participants' and targets' measures. We found that in audio-only and visual-only conditions, participants whose moods were congruent with the target showed higher physiological synchrony than those with incongruent mood, implying a mood-congruency effect on affective empathy. However, there was no mood effect on empathic accuracy (reflecting cognitive empathy), suggesting a different influence of mood on the two empathy components.

The acute effects of stress on dishonesty are moderated by individual differences in moral default

In daily life we regularly must decide whether to act dishonestly for personal gain or to be honest and maintain a positive image of ourselves. While evidence suggests that acute stress influences moral decisions, it is unclear whether stress increases or decreases immoral behavior. Here, we hypothesize that stress, through its effects on cognitive control, has different effects on moral decision making for different individuals, depending on their moral default. We test this hypothesis by combining a task which allows for inconspicuously measuring spontaneous cheating with a well-established stress induction task. Our findings confirm our hypothesis, revealing that effects of stress on dishonesty are not uniform, but instead depend on the individual: for those who are relatively dishonest, stress increases dishonesty, whereas for participants who are relatively honest stress makes them more honest. These findings go a long way in resolving the conflicting findings in the literature on the effects of stress on moral decisions, suggesting that stress affects dishonesty differently for different individuals, depending on their moral default.