Empathy present and future

Empathy for wildlife: The importance of the individual

Because climate change and the biodiversity crisis are driven by human actions, determining psychological mechanisms underpinning support for environmental action is an urgent priority. Here, we experimentally tested for mechanisms promoting conservation-related motivation and behavior toward a flagship species, wild Tamanend's bottlenose dolphins. Following evidence that empathy increases prosocial motivations and behavior, and that the ability to identify individual humans promotes empathy, we tested whether this relationship applied to the ability to identify individual dolphins. Participants identified dolphins from their dorsal fins at above chance levels, and better individuation correlated with higher empathy for dolphins and higher willingness to pledge environmental behaviors. Pairing a narrative with an image of an injured dolphin leads to higher donations relative to a narrative alone. Our novel finding that the ability to individually identify dolphins relates to empathy and conservation-related behavior suggests pathways for strengthening environmental attitudes and behavior.

Which clinician responses to emotion are associated with more positive patient experiences of communication?

OBJECTIVES

To identify communication strategies that may improve clinician-patient interactions, we assessed the association between clinician response to emotion and patient ratings of communication.

METHODS

From a cohort of 1817 clinician-patient encounters, we designed a retrospective case-control study by identifying 69 patients who rated their interpersonal care as low-quality and 69 patients who rated their care as high-quality. We used the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to identify patient emotional expressions and clinician responses. Using mixed-effects logistic regression, we evaluated the association between clinician responses to patients' emotions and patient ratings of their interpersonal care.

RESULTS

In adjusted analyses, explicit responses that reduced space for further emotional communication were associated with high ratings of care (OR 1.94, 95% CI 1.25, 2.99); non-explicit responses providing additional space were associated with low ratings (OR 0.54, 95% CI 0.36-0.82). In terms of specific response types, neutral/passive responses were associated with low ratings (OR 0.59, 95% CI 0.39-0.90), whereas giving information/advice was associated with high ratings (OR, 95% 1.91 CI 1.17-3.1).

CONCLUSIONS

Patients may prefer responses to their expressed emotions that demonstrate clinician engagement, with or without expressions of empathy.

PRACTICE IMPLICATIONS

These findings may inform educational interventions to improve clinician-patient communication.

Expanding the empirical study of virtual reality beyond empathy to compassion, moral reasoning, and moral foundations

This study utilizes a controlled experimental design to investigate the influence of a virtual reality experience on empathy, compassion, moral reasoning, and moral foundations. With continued debate and mixed results from previous studies attempting to show relationships between virtual reality and empathy, this study takes advantage of the technology for its ability to provide a consistent, repeatable experience, broadening the scope of analysis beyond empathy. A systematic literature review identified the most widely used and validated moral psychology assessments for the constructs, and these assessments were administered before and after the virtual reality experience. The study is comprised of two pre-post experiments with student participants from a university in the United States. The first experiment investigated change in empathy and moral foundations among 44 participants, and the second investigated change in compassion and moral reasoning among 69 participants. The results showed no significant change in empathy nor compassion, but significant change in moral reasoning from personal interest to post-conventional stages, and significant increase in the Care/harm factor of moral foundations. By testing four of the primary constructs of moral psychology with the most widely used and validated assessments in controlled experiments, this study attempts to advance our understanding of virtual reality and its potential to influence human morality. It also raises questions about our self-reported assessment tools and provides possible new insights for the constructs examined.

The pattern theory of compassion

Concepts of empathy, sympathy and compassion are often confused in a variety of literatures. This article proposes a pattern-theoretic approach to distinguishing compassion from empathy and sympathy. Drawing on psychology, Western philosophy, affective neuroscience, and contemplative science, we clarify the nature of compassion as a specific pattern of dynamically related factors that include physiological, cognitive, and affective processes, relational/intersubjective processes, and motivational/action tendencies. We also show that the dynamic nature of the compassion pattern is reflected in neuroscientific findings, as well as in compassion practice. The pattern theory of compassion allows us to make several clear distinctions between compassion, empathy, and sympathy.

Beyond physical sensations: investigating empathy and prosocial behavior in vicarious pain responders

Empathy, the capacity to share others' emotional experiences, has been proposed as a key motivation for altruistic behavior in both humans and animals. Sharing another's emotional experience may generate a self-embodied simulation of their emotional state, fostering understanding and promoting prosocial behavior. Vicarious pain responders report sensing physical pain when observing others in pain. Whether this ability extends to emotional experiences remains unexplored. Using both questionnaires and ecologically valid behavioral tasks, we explored whether vicarious pain responders differ from nonresponders in empathic abilities and prosocial behavior. Participants watched video clips of people describing a negative emotional life event. We operationalized several empathic abilities and responses (empathic accuracy, affective synchrony, emotional reaction, and empathic motivation) based on participants' and targets' responses during and after watching the videos. Participants were also engaged in a donation task measuring tendency for prosocial behavior. Findings reveal that compared to nonresponders, vicarious pain responders exhibit enhanced empathic accuracy, intensified emotional reactions to others' emotional pain, and a greater motivation to communicate with the target. This study marks the first behavioral evidence showcasing vicarious pain responders' empathic abilities, reactions, and motivation in response to nonphysical pain of others, expanding our knowledge of this phenomenon and its association with broader empathic abilities.

Neuronal Correlates of Empathy: A Systematic Review of Event-Related Potentials Studies in Perceptual Tasks

Empathy is a crucial component to infer and understand others' emotions. However, a synthesis of studies regarding empathy and its neuronal correlates in perceptual tasks using event-related potentials (ERPs) has yet to occur. The current systematic review aimed to provide that overview. Upon bibliographic research, 30 studies featuring empathy assessments and at least one perceptual task measuring ERP components in healthy participants were included. Four main focus categories were identified, as follows: Affective Pictures, Facial Stimuli, Mental States, and Social Language. The Late Positive Potential was the most analyzed in Affective Pictures and was reported to be positively correlated with cognitive and affective empathy, along with other late components. In contrast, for Facial Stimuli, early components presented significant correlations with empathy scales. Particularly, the N170 presented negative correlations with cognitive and affective empathy. Finally, augmented N400 was suggested to be associated with higher empathy scores in the Mental States and Social Language categories. These findings highlight the relevance of early perceptual stages of empathic processing and how different EEG/ERP methodologies provide relevant information.

Susceptibility to positive versus negative emotional contagion: First evidence on their distinction using a balanced self-report measure

Susceptibility to emotional contagion is defined as the disposition of how susceptible someone is to catch others' emotions and it has long been studied in research on mental health, well-being, and social interaction. Given that existing self-report measures of susceptibility to emotional contagion have focused almost exclusively on negative emotions, we developed a self-report measure to assess the susceptibility to emotional contagion of both positive and negative emotions (2 scales). In two studies, we examined their factor structure, validity, and reliability using exploratory factor analysis (Study 1, N = 257), confirmatory factor analysis (Study 2, N = 247) and correlations. Our results confirmed the two-factor structure and demonstrated good internal consistencies. Regarding external validity, our scales showed diverging correlational patterns: While susceptibility to negative emotional contagion was linked to mental health problems and negative emotions, susceptibility to positive emotional contagion was linked to interpersonal functioning and prosocial tendencies. In conclusion, our scales appear to be internally/externally valid and a promising tool for future research.

Thwarted belongingness and empathy's relation with organizational culture change

Introduction

In response to several high-profile cases of senior leaders in the Canadian Armed Forces (CAF) being accused of various forms of sexual and professional misconduct, the organization has committed to culture change. Drawing on the group engagement model and empirical evidence, we propose that CAF members' experience of thwarted belongingness reduces their capacity to show empathy, which in turn affects their support for culture change.

Method

Participants were 139 Naval and Officer Cadets from the Royal Military College of Canada who were predominantly male (61%), between 18 and 21 years old (80%), and not members of a visible minority group (68%). Data was collected via an online self-report survey assessing thwarted belongingness, empathy, and attitudes toward culture change.

Results

Whether participants experienced thwarted belongingness was not directly related to their level of support for culture change. Individuals' thwarted belongingness was indirectly and negatively associated with support for culture change, through its impact on empathy.

Discussion

Taken together, the results demonstrate that cadets' experience of belongingness contributed to their level of empathy, which together predicted their support for culture change initiatives. Efforts to change the culture of the CAF may need to consider improving members' levels of belongingness and, by extension, their levels of empathy. Implications for inclusion efforts are discussed.

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.

Moral disengagement and empathy in cyberbullying: how they are related in reflection activities about a serious game

Cyberbullying is a complex phenomenon with multiple factors involved, both contextual and individual factors, such as moral disengagement and empathy. This study investigated how moral disengagement and empathy could be related, longitudinally in cyberbullying events. Specifically, two gamified tasks (one for empathy and other for moral disengagement) were analyzed. These tasks were developed attending to the specificities of the cyberbullying scenarios presented in a serious game. To accomplish this goal, data from gamified tasks (N = 208), from 4 different moments, were analyzed through multilevel linear modeling. Results suggested that there was a change in adolescents' moral disengagement over time. Participants with greater empathy revealed lower moral disengagement overall. Over time, adolescents with greater empathy revealed lower moral disengagement within their own growth rate. Overall, our results provide important information about the dynamic relationship between moral disengagement, empathy and cyberbullying, which informs future studies and interventions.

Analyzing the Factor Structure of the Toronto Empathy Questionnaire: Dimensionality, Reliability, Validity, Measurement Invariance and One-Year Stability of the German Version

In the face of heterogeneity in the measurement of empathy, the Toronto Empathy Questionnaire (TEQ; Spreng et al., Journal of Personality Assessment, 91(1), 62-71 (2009)) was developed as a brief unidimensional tool by statistically forming a consensus from existing measures of the construct. The present study aimed to (1) validate a German version of the TEQ, and (2) contribute empirical evidence to the ongoing debate regarding a singular versus multidimensional factor structure of the TEQ. One cross-sectional and two longitudinal studies were performed, with a total of 1,075 participants. Our initial exploratory factor analyses suggested either a one- or a two-factor structure (with the two-factors clustering straight and reverse-scored items); the two-factor model outperformed the one-factor model using confirmatory factor analyses. However, after negated items were replaced by positively reworded alternatives, both models fit the data equally well. A comparison of the correlation patterns with numerous external measures indicated that a second factor of the TEQ is a methodological artifact of item wording. Finally, a unidimensional TEQ scale showed sufficient internal consistency, two-week test-retest reliability, one-year stability, as well as convergent and discriminant validity with measures of empathy, emotion recognition, emotion regulation, altruism, social desirability, and the Big Five personality traits.

Social anxiety is associated with personal distress and disrupted recognition of negative emotions

Past research investigating the relation between social anxiety (SA), empathy and emotion recognition is marked by conceptual and methodological issues. In the present study, we aim to overcome these limitations by examining whether individuals with high (n = 40) vs. low (n = 43) social anxiety differed across these two facets of empathy and whether this could be related to their recognition of emotions. We employed a naturalistic emotion recognition paradigm in which participants watched short videos of individuals (targets) sharing authentic emotional experiences. After each video, we measured self-reported empathic concern and distress, as well as their ability to recognize the emotions expressed by the targets in the videos. Our results show that individuals with high social anxiety recognized the targets' emotions less accurately. Furthermore, high socially anxious individuals reported more personal distress than low socially anxious individuals, whereas no significant difference was found for empathic concern. The findings suggest that reduced recognition of emotions among SA individuals can be better explained by the negative effects of social stress than by a general deficit in empathy.

On the proliferation of the empathy concept in healthcare and medical education research

OBJECTIVE

To offer a critique of empathy concept usage in healthcare and medical education research.

METHODS

Analysis of current usage and suggestions for authors and researchers.

RESULTS

Empathy is often undefined or inconsistently defined, and "empathy" as represented in research covers an unmanageably wide and varied range of intentions, attitudes, emotions, and behaviors. The ubiquitous use of "empathy" as a vague and often undefined umbrella term hinders comprehension and, therefore, scientific progress. Patients are rarely asked directly about empathy; instead, measures of so-called perceived empathy contain descriptive items that could as well be called quality of care, patient-centeredness, or patient satisfaction.

CONCLUSIONS

Although "empathy" in medical care is widely valued by researchers, educators, and practitioners, the empathy concept as used in the published literature is overused and unclear, and potentially damaging to scholarship, medical education, and ultimately healthcare. The vague term empathy should be replaced as much as possible with concrete descriptions of what is actually measured, experimentally manipulated, or taught.

PRACTICE IMPLICATIONS

Identifying patients' own empathy definitions will improve medical education and medical care through clarifying what clinical behaviors will best fulfill patients' needs and desires. This approach allows for greater specificity and personalized care delivery.

An investigation of the modulatory effects of empathic and autistic traits on emotional and facial motor responses during live social interactions

A close relationship between emotional contagion and spontaneous facial mimicry has been theoretically proposed and is supported by empirical data. Facial expressions are essential in terms of both emotional and motor synchrony. Previous studies have demonstrated that trait emotional empathy enhanced spontaneous facial mimicry, but the relationship between autistic traits and spontaneous mimicry remained controversial. Moreover, previous studies presented faces that were static or videotaped, which may lack the "liveliness" of real-life social interactions. We addressed this limitation by using an image relay system to present live performances and pre-recorded videos of smiling or frowning dynamic facial expressions to 94 healthy female participants. We assessed their subjective experiential valence and arousal ratings to infer the amplitude of emotional contagion. We measured the electromyographic activities of the zygomaticus major and corrugator supercilii muscles to estimate spontaneous facial mimicry. Individual differences measures included trait emotional empathy (empathic concern) and the autism-spectrum quotient. We did not find that live performances enhanced the modulatory effect of trait differences on emotional contagion or spontaneous facial mimicry. However, we found that a high trait empathic concern was associated with stronger emotional contagion and corrugator mimicry. We found no two-way interaction between the autism spectrum quotient and emotional condition, suggesting that autistic traits did not modulate emotional contagion or spontaneous facial mimicry. Our findings imply that previous findings regarding the relationship between emotional empathy and emotional contagion/spontaneous facial mimicry using videos and photos could be generalized to real-life interactions.

A meta-analytic review of the relations between anxiety and empathy

Although theory suggests that empathy may signal a risk for anxiety (Tone & Tully, 2014), the relation between these constructs remains unclear due to the lack of a quantitative synthesis of empirical findings. We addressed this question by conducting three meta-analyses assessing anxiety and general, cognitive, and affective empathy (k's = 70-102 samples; N's = 19,410-25,102 participants). Results suggest that anxiety has a small and significant association with general empathy (r = .08). The relation of clinical anxiety with cognitive empathy was significant but very weak (r = -.03), and small for affective empathy (r = .16). Geographic region and the type of cognitive (e.g., perspective taking, fantasy) and affective empathy (e.g., affective resonance, empathic concern) emerged as moderators. Results suggest that anxiety has a weaker association with general empathy but a stronger association with affective empathy in participants from predominantly collectivistic geographic regions. Further, greater anxiety was weakly associated with less perspective-taking and greater fantasy, and anxiety had a more modest association with empathic concern than other types of affective empathy. Targeting affective empathy (e.g., promoting coping strategies when faced with others' distress) in interventions for anxiety may be beneficial.

The Role of Empathic Communication in the Relationship between Servant Leadership and Workplace Loneliness: A Serial Mediation Model

Researchers have increasingly concentrated on loneliness in the workplace as a crucial factor influencing the mental health of employees and the viability of telework. In contrast, the current understanding of the strategies mitigating workplace loneliness and how leaders utilize their behaviors to impact followers' loneliness remains limited. Since servant leadership values the emotional needs of followers and displays a high level of empathy, this study investigated the direct and indirect effects of servant leadership on workplace loneliness. In this study, 267 employees (mean age = 31.5 years) from 28 provinces in China were recruited to participate in this survey. We proposed that servant leaders motivate their own empathic communication and other followers' empathic communication to reduce lonely followers' workplace loneliness. This research further examined the relationship between the leader's and colleagues' empathic communication, and the two jointly mediate the connection between servant leadership and followers' workplace loneliness. We constructed a serial mediation model to examine the relationships between servant leadership, leader's empathic communication, colleagues' empathic communication, and workplace loneliness. The results indicate that servant leadership creates a cycle of empathy and provides insights into building a culture of empathy to improve employee well-being.

Shared Hearts and Minds: Physiological Synchrony During Empathy

Empathy is a multidimensional construct that includes changes in cognitive, affective, and physiological processes. However, the physiological processes that contribute to empathic responding have received far less empirical attention. Here, we investigated whether physiological synchrony emerged during an empathy-inducing activity in which individuals disclosed a time of suffering while their romantic partner listened and responded (N = 111 couples). Further, we examined the extent to which trait and state measures of cognitive and affective empathy were associated with each other and with physiological synchrony during this activity. We found evidence for physiological synchrony in skin conductance reactivity and also in interbeat interval reactivity, though only when disclosers were women, but not for respiratory sinus arrhythmia reactivity. Physiological synchrony was not consistently associated with other well-established trait and state measures of empathy. These findings identify the nuanced role of physiological synchrony in empathic responding to others' suffering.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00210-4.

Social identification, identity integration and wellbeing in people who hear voices

OBJECTIVES

Hearing voices is associated with public stigma and this can influence readiness to identify as a voice hearer (VH) and psychological wellbeing. In this study, we investigated the relationships between a VH social identity, the integration of that identity with other important social identities and wellbeing.

DESIGN

Cross-sectional study, with a subset of longitudinal data across three time points.

METHODS

People who self-identified as voice hearers completed questionnaires (VH social identity, identity integration, wellbeing and perceptions of in-group and out-group empathy) at three time points, spaced at 3-monthly intervals. The final sample comprised 182 participants at T1, 91 at T2 and 75 at T3. Hierarchical linear multiple regression analyses were used to test all hypotheses.

RESULTS

The integration of a VH social identity was strongly associated with better psychological wellbeing at T1. Identity integration was also associated with static wellbeing scores at 6 months. Effects on wellbeing were not accounted for by either severity of voice-hearing or paranoia. Whilst perceptions of in-group empathy were associated with VH social identification, perceptions of outgroup empathy were important for identity integration.

CONCLUSIONS

Integrating a VH social identity with other important identities into a coherent sense of self is important for wellbeing in voice hearers; perceived in-group and outgroup empathy are important in this process.

Embracing the Emotion in Emotional Intelligence Measurement: Insights from Emotion Theory and Research

Emotional intelligence (EI) has gained significant popularity as a scientific construct over the past three decades, yet its conceptualization and measurement still face limitations. Applied EI research often overlooks its components, treating it as a global characteristic, and there are few widely used performance-based tests for assessing ability EI. The present paper proposes avenues for advancing ability EI measurement by connecting the main EI components to models and theories from the emotion science literature and related fields. For emotion understanding and emotion recognition, we discuss the implications of basic emotion theory, dimensional models, and appraisal models of emotion for creating stimuli, scenarios, and response options. For the regulation and management of one's own and others' emotions, we discuss how the process model of emotion regulation and its extensions to interpersonal processes can inform the creation of situational judgment items. In addition, we emphasize the importance of incorporating context, cross-cultural variability, and attentional and motivational factors into future models and measures of ability EI. We hope this article will foster exchange among scholars in the fields of ability EI, basic emotion science, social cognition, and emotion regulation, leading to an enhanced understanding of the individual differences in successful emotional functioning and communication.

Impairments in Cognitive and Emotional Empathy as Markers of General versus Specific Personality Pathology

INTRODUCTION

The alternative model for personality disorders (AMPD) of the Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-5) considers impairments in empathy a basic feature of personality disorders (PDs). In contrast, the AMPD pathological personality trait model and the categorical DSM-5 Section II PD model associate deficits in empathy to specific forms of personality pathology. The present study investigated to what extent impairments in cognitive and emotional empathy are markers of general versus specific personality pathology.

METHODS

In a clinical sample (n = 119), the Multifaceted Empathy Test was used to assess cognitive empathy, emotional empathy for positive emotions, and emotional empathy for negative emotions. Personality functioning, pathological personality traits, and DSM-5 Section II PDs were assessed via interviews and self-reports. Confirmatory factor analyses were applied to associate the three empathy facets with the three personality pathology approaches, each modeled with general personality pathology (common factor) and specific personality pathology (residuals of indicators).

RESULTS

Impairments in cognitive empathy and emotional empathy for positive emotions were significantly correlated with general personality pathology. All three empathy facets were also correlated to specific personality pathology when controlling for general personality pathology, respectively. Impairments in cognitive empathy were incrementally associated with identity and empathy (personality functioning), psychoticism (pathological personality traits), and paranoid and dependent PD (DSM-5 Section II PDs). Deficits in emotional empathy for positive emotions were incrementally associated with self-direction and intimacy (personality functioning) and detachment (pathological personality traits). Impairments in emotional empathy for negative emotions were incrementally associated with antagonism (pathological personality traits) and antisocial PD (DSM-5 Section II PDs).

CONCLUSION

The results suggest that impairments in cognitive empathy and emotional empathy for positive emotions, but not for negative emotions, are markers of general personality pathology, while deficits in the three empathy facets are also markers for specific personality pathology.

Cognitive dependencies and psychological health correlates of coherence in autobiographical reasoning

Autobiographical reasoning is a process by which an individual creates a coherent life account. The degree of coherence in autobiographical reasoning has been related to psychological health correlates such as depression and self-esteem in previous studies, but with inconsistent findings. Similarly, the basic psychological processes required to achieve coherence have been previously studied with regard to intelligence, but infrequently, and also with mixed findings. In the present study, we first developed and evaluated a German version of the Awareness of Narrative Identity Questionnaire (ANIQ) as an established measure of self-reported coherence. Second, we tested for cognitive dependencies on intelligence and memory indices. Third, we analysed its associations with psychological health correlates. We assessed a sample of 272 participants and thereof 189 participants again two-weeks later. Results supported the assumptions of the German ANIQ's psychometric qualities (factor structure, test-retest reliability, invariance) and validity (with regard to self-consciousness, self-concept clarity, and written accounts of personal turning points). We found coherence to be independent of intelligence and verbal memory, but partially dependent on figural memory. Coherence was related to depression, positivity, self-esteem, and self-esteem stability, but not to anxiety, substantiating its salutogenic effects.

Measuring Empathy Across the Adult Lifespan: A Comparison of Three Assessment Types

Empathy is a core component of social cognition that can be indexed via behavioral, informant-report, or self-report methods of assessment. However, concerns have been raised regarding the lack of convergence between these assessment approaches for cognitive empathy. Here, we provided the first comparison of all three measurement approaches for cognitive and affective empathy in a large adult sample (N = 371) aged 18 to 101 years. We found that poor convergence was more of a problem for cognitive empathy than affective empathy. While none of the cognitive empathy measures correlated with each other, for affective empathy, self-report was significantly associated with both behavioral and informant-report assessments. However, for both cognitive and affective empathy, there was evidence for poor discriminant validity within the measures. Out of the three assessment approaches, only the informant-report measures were consistently associated with indices of social functioning. Importantly, age did not moderate any of the tested relationships, indicating that both the strengths and the limitations of these different types of assessment do not appear to vary as a function of age. These findings highlight the variation that exists among empathy measures and are discussed in relation to their practical implications for the assessment of empathy.

Do Bad People Deserve Empathy? Selective Empathy Based on Targets' Moral Characteristics

The relation between empathy and morality is a widely discussed topic. However, previous discussions mainly focused on whether and how empathy influences moral cognition and moral behaviors, with limited attention to the reverse influence of morality on empathy. This review summarized how morality influences empathy by drawing together a number of hitherto scattered studies illustrating the influence of targets' moral characteristics on empathy. To explain why empathy is morally selective, we discuss its ultimate cause, to increase survival rates, and five proximate causes based on similarity, affective bonds, the appraisal of deservingness, dehumanization, and potential group membership. To explain how empathy becomes morally selective, we consider three different pathways (automatic, regulative, and mixed) based on previous findings. Finally, we discuss future directions, including the reverse influence of selective empathy on moral cognition, the moral selectivity of positive empathy, and the role of selective empathy in selective helping and third-party punishment.

The role of empathy in shared intentionality: Contributions from Inter-Processual Self theory

Research in psychology related to the conceptualization of empathy has been on the rise in the last decades. However, we argue that there is still space for further research to help capture the important notion of empathy and its theoretical and conceptual depth. Following a critical review of the current state of the research that conceptualizes and measures empathy, we focus on works that highlight the importance of a shared vision and its relevance in psychology and neuroscience. Considering the state of the art of current neuroscientific and psychological approaches to empathy, we argue for the relevance of shared intention and shared vision in empathy-related actions. Upon review of different models that emphasize a shared vision for informing research on empathy, we suggest that a newly developed theory of self, human growth and action–the so-called Inter-Processual Self theory (IPS)–can significantly and novelly inform the theorization on empathy beyond what the literature has stated to date. Then, we show how an understanding of integrity as a relational act that requires empathy is an essential mechanism for current key research on empathy and its related concepts and models. Ultimately, we aim to present IPS as a distinctive proposal to expand upon the conceptualization of empathy.

The Little Black Box: Contextualizing Empathy

In the last century since the word “empathy” was first introduced to the English vernacular, it has gained wide attention within academia and society more broadly. However, empathy has proven particularly challenging to define. We suggest that persistent disagreements about its conceptualization partially result from the tendency of researchers to simplify, remove, or ignore the context in which empathy is experienced. But context matters. For instance, we experience empathy when we encounter a grieving friend, but also when our partner expresses frustration with our past behavior. We illustrate how context shapes the experience of empathy by focusing on the diversity of emotional contexts that give rise to empathy and presenting a case study of context-specific empathy in response to another’s pain versus sadness. We conclude with recommendations for academics and those in the public arena who are interested in understanding empathy.

Physician empathy in Korean clinical contexts: developing a conceptual framework and exploring influencing factors

PURPOSE

Despite its well-known clinical importance, physician empathy (PE) has been variably defined and its concepts among cultures are yet to be studied. This study aimed to develop a conceptual framework of PE and explore influencing factors on physicians' empathetic behavior in the Korean clinical context.

METHODS

Forty-two faculty members and 67 residents participated in the two-round Delphi survey to arrive at a consensus regarding the conceptual framework of PE in 2019. To explore individual and external factors affecting physicians' empathetic behavior, a Likert scale questionnaire based on an initial free-text response was administered to the same participants.

RESULTS

The conceptual framework of PE among Korean doctors consisted of basic communication skills and attitudes, cognitively understanding of patients' thoughts and emotions, and communicating the doctors' understandings to patients. Individual attributes and system- and patient-factors were revealed as influencing factors for PE in real practice. The former included communication ability, self-awareness and management, humanism, clinical competence, and good personality traits. Excessive workload, time constraints, aggressive attitudes, and negative preconceptions towards doctors were perceived as inhibiting or hindering empathy in patient care.

CONCLUSION

PE in the Korean clinical context comprised behavioral and cognitive components. Individual attributes, as well as external factors including system- and patient-factors were identified to affect PE in clinical settings. Further studies are needed to enhance the conceptual clarity of PE and identify how to promote doctors' empathetic practice even in less favorable healthcare environments.

Empathy, impulsiveness, and sensation seeking as mediators between primary psychopathic traits and driving behaviors in French driving offenders

OBJECTIVE

The aim of this study was to examine the links between primary psychopathic traits and driving behavior on the one hand, and driving anger expression on the other hand, through the specific contribution of empathy, impulsiveness, and sensation seeking, in a sample of French driving offenders.

METHODS

One thousand six hundred and eighty-six driving offenders completed a paper-and-pencil questionnaire during 110 drivers' rehabilitation programs.

RESULTS

Primary psychopathic traits were positively associated with violations and aggressive driving anger expression, and negatively associated with prosocial driving behaviors. These associations were partially mediated by empathy, impulsiveness, and sensation seeking. In addition, the negative relation between primary psychopathic traits and adaptive anger expression was fully mediated by these three personal dispositions.

CONCLUSION

Low empathy, high impulsiveness and sensation seeking are important characteristics of driving offenders with high psychopathic traits. Our results provide a better understanding of French driving offenders' risky behaviors and the role of primary psychopathic traits.

Differential associations of the two higher-order factors of mindfulness with trait empathy and the mediating role of emotional awareness

Empathy enables us to understand the emotions of others and is an important determinant of prosocial behavior. Investigating the relationship between mindfulness and empathy could therefore provide important insights into factors that promote interpersonal understanding and pathways that contribute to prosocial behavior. As prior studies have yielded only inconsistent results, this study extended previous findings and investigated for the first time the associations of two important factors of mindfulness (Self-regulated Attention [SRA] and Orientation to Experience [OTE]) with two commonly proposed components of empathy (cognitive empathy and affective empathy). Using a community sample of N = 552 German-speaking adults, the two mindfulness factors were differentially associated with cognitive and affective empathy. SRA correlated positively with cognitive empathy (r = 0.44; OTE: r = 0.09), but OTE correlated negatively with affective empathy (r = - 0.27; SRA: r = 0.11). This negative association was strongest for one specific aspect of affective empathy, emotional contagion. Revisiting previously reported mediating effects of emotion regulation, we found that emotional awareness mediated the associations with both components of empathy, but only for SRA. Together, these findings imply that mindfulness benefits the cognitive understanding of others' emotions via two distinct pathways: by promoting emotional awareness (SRA) and by limiting the undue impact of others' emotions on oneself (OTE).

What is the Link Between Different Components of Empathy and Burnout in Healthcare Professionals? A Systematic Review and Meta-Analysis

Research on healthcare shows that the relationship between empathy and burnout is complex. The aim of this systematic review and meta-analysis is to clarify the link between different empathic components and burnout components in healthcare professionals. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. The search strategy was applied in PubMed, PsycINFO, CINAHL, Scopus, and Medline, from January 1990 to January 2021. Population included nurses and doctors. Key inclusion criteria were articles addressing the relationship between different components of empathy and professional performance and wellbeing or burn out, or studies using burnout and empathy measures with validity support from commonly accepted sources of evidence. Risk of bias was assessed using the Mixed Methods Appraisal Tool. From 1159 references identified, 22 studies were included in the systematic review, and 5 studies in the meta-analysis. Empathic Concern was significantly correlated with Depersonalization and Personal Accomplishment. Moreover, the links between Perspective Taking, Depersonalization and Personal Accomplishment were statistically significant. In conclusion, exploring and understanding the complex links between empathy and burnout could help healthcare professionals as well as institutions to reduce the risk of suffering burnout.

Testing the social mindfulness paradigm: Longitudinal evidence of its unidimensionality, reliability, validity, and replicability in a sample of health care providers

OBJECTIVES

Social mindfulness is a relatively new concept in psychological research and is attracting increasing attention. Recent studies have provided evidence of its relevance with regard to prosocial behavior and empathy, but also concerning individual well-being and psychological health. In such studies, social mindfulness has been assessed using the social mindfulness paradigm by Van Doesum and colleagues, which is the standard measure of social mindfulness to date. However, evidence is scarce or lacking with regard to whether this measurement approach is unidimensional, whether it produces (test-retest) reliable and valid measurements, and whether its associations with personality and empathy are replicable.

METHODS

To test these assumptions, we assessed a sample of 265 participants currently working in health care professions on social mindfulness, several concepts of empathy, and the HEXACO personality dimensions longitudinally at two measurement occasions.

RESULTS

The results supported the assumption of unidimensionality of the measure. Partial support was found for its reliability, validity, and replicability. Test-retest reliability was acceptable, but the associations with personality and empathy turned out weaker than expected.

CONCLUSIONS

The social mindfulness paradigm is an interesting approach toward understanding social mindfulness, meaning mindfulness of other people's needs. Potential directions for the further development of the social mindfulness paradigm and its network of relations, especially to empathy, are discussed.

"I am feeling tension in my whole body": An experimental phenomenological study of empathy for pain

Introduction

Traditionally, empathy has been studied from two main perspectives: the theory-theory approach and the simulation theory approach. These theories claim that social emotions are fundamentally constituted by mind states in the brain. In contrast, classical phenomenology and recent research based on the enactive theories consider empathy as the basic process of contacting others' emotional experiences through direct bodily perception and sensation.

Objective

This study aims to enrich the knowledge of the empathic experience of pain using an experimental phenomenological method.

Materials and methods

Implementing an experimental paradigm used in affective neuroscience, we exposed 28 healthy adults to a video of sportspersons suffering physical accidents while practicing extreme sports. Immediately after watching the video, each participant underwent a phenomenological interview to gather data on embodied, multi-layered dimensions (bodily sensations, emotions, and motivations) and temporal aspects of empathic experience. We also performed quantitative analyses of the phenomenological categories.

Results

Experiential access to the other person's painful experience involves four main themes. Bodily resonance: participants felt a multiplicity of bodily, affective, and kinesthetic sensations in coordination with the sportsperson's bodily actions. Attentional focus: some participants centered their attention more on their own personal discomfort and sensations of rejection, while others on the pain and suffering experienced by the sportspersons. Kinesthetic motivation: some participants experienced the feeling in their bodies to avoid or escape from watching the video, while others experienced the need to help the sportspersons avoid suffering any injury while practicing extreme sports. The temporality of experience: participants witnessed temporal fluctuations in their experiences, bringing intensity changes in their bodily resonance, attentional focus, and kinesthetic motivation. Finally, two experiential structures were found: one structure is self-centered empathic experience, characterized by bodily resonance, attentional focus centered on the participant's own experience of seeing the sportsperson suffering, and self-protective kinesthetic motivation; the other structure is other-centered empathic experience, characterized by bodily resonance, attentional focus centered on the sportsperson, and prosocial kinesthetic motivation to help them.

Discussion

We show how phenomenological data may contribute to comprehending empathy for pain in social neuroscience. In addition, we address the phenomenological aspect of the enactive approach to the three dimensions of an embodiment of human consciousness, especially the intersubjective dimension. Also, based on our results, we suggest an extension of the enactive theory of non-interactive social experience.

Measuring empathy online and moral disengagement in cyberbullying

This investigation intends to explore how adolescents report empathy in online contexts and moral disengagement in cyberbullying incidents, and how these two constructs are related. To accomplish this goal, three studies were conducted considering the need to develop new instruments to uncover this new approach of measuring empathy and moral disengagement. In the first study, we adapted the Portuguese version of the Empathy Quotient-short form to online contexts, which resulted in the Empathy Quotient in Virtual Contexts (EQVC). We also developed the Process Moral Disengagement in Cyberbullying Inventory (PMDCI), in order to assess moral disengagement in these specific situations. In the second study we conducted exploratory factor analyses (N = 234) of these instruments. Finally, in the third study, we conducted confirmatory factor analyses (N = 345) of both instruments. These results showed how adolescents reported empathy in online contexts and moral disengagement in cyberbullying incidents. Specifically, empathy revealed a bi-dimensional structure including difficulty and self-efficacy in empathizing (Cronbach's α = 0.44, 0.83, respectively), whereas process moral disengagement revealed four unidimensional questionnaires including locus of behavior, agency, outcome, and recipient (Cronbach's α = 0.76, 0.65, 0.77, 0.69, respectively). Furthermore, a correlational analysis was also performed of both constructs, and we also considered the variable sex. Results showed that difficulty in empathizing was negatively associated with sex (with girls revealing more difficulty than boys) and all moral disengagement mechanisms except for behavior. Moral disengagement was positively correlated with sex, suggesting boys morally disengaged more from cyberbullying. The instruments provided new insights on how empathy and moral disengagement can be specific to online contexts and cyberbullying situations, and how they can be used in educational programs to promote empathy and gain insight on moral disengagement within this phenomenon.

Police interviews with adult reporters of historical child sexual abuse: Exploring the link between verbal rapport and information obtained

BACKGROUND

Police officers and academics agree that rapport is important when interviewing victims and witnesses, although previous research has found that officers do not always engage in rapport-building behaviours during interviews. Interviews with complainants reporting historical child sexual abuse may be key to police investigations, as physical or corroborating evidence is often not available.

OBJECTIVE

This research explored the possible effect of verbal rapport-building behaviour on the elicitation of investigation-relevant details in historical child sexual abuse victim interviews.

PARTICIPANTS AND SETTING

A sample of interviews (N = 44) with adults reporting historical child sexual abuse in a northern Canadian territory with a large Indigenous population was examined.

METHODS

Interviews were evaluated for interviewer verbal rapport-building behaviours, using a framework derived from Tickle-Degnen and Rosenthal's three domain model of rapport. Interviews were also coded for details given by the interviewee.

RESULTS

Results showed that verbal rapport was significantly positively correlated with both total details (r = 0.621, p < .001) and abuse relevant details (r = 0.518, p < .001). Chronological Rapport Maps were piloted, to show the use of rapport behaviours over the course of interviews, and the possible effect over time of these behaviours on information yield.

CONCLUSIONS

The results show that information yield is higher when more rapport behaviours are demonstrated and both parties work together harmoniously, even after a long delay. Further research is needed on the experience of police interviews for Indigenous complainants.

Psychometric validation of teacher empathy scale: Measurement invariance in gender

Result from Wang et al. study described the development and validation of an empathy scale for teachers (EST) and suggested that the EST could be an effective tool to assess the empathy of primary, middle and high school teachers in relation to their students. This study examines the factorial structure and factorial invariance of the EST in an Iranian sample. Confirmatory factor analysis was conducted to explore dimensionality and test for measurement invariance in factor structure, factor loadings and intercepts across gender in a sample (N = 462), of Iranian high-school male and female teachers (24-55 years). The data supported the multidimensional structure in both male and female samples. Accordingly, all factor loadings were significant and scale structure confirmed like the original scale. The results indicated that the EST includes three dimensions: cognitive empathy, negative affective empathy and positive affective empathy, and the internal consistency reliability of the three subscales are satisfactory in total sample and both sexes. Furthermore, the results revealed that invariance of the measure according to gender was confirmed. In addition, as the validity evidence, the EST is positively correlated with empathic concern scale scores. The study suggests that the EST could be an effective tool to measure the empathy of high school teachers in relation to their students in Iranian sample.

Do positive emotions prompt people to be more authentic? The mediation effect of gratitude and empathy dimensions on the relationship between humility state and perceived false self

Background

Gratitude, empathy and humility have been defined as personality dispositions, as complex interpersonal emotions, and as states that prompt people to be more pro-social. However, studies on the associations between these emotions and authen-ticity are scarce. The main purpose of this study was to analyze the mediation effect of gratitude and empathy on the asso-ciation between humility and perceived false identity.

Participants and procedure

The number of participants who took part in the survey was equal to 220 university students (91% female). Students com-pleted questionnaires concerning humility (BSHS scale), gratitude (GQ scale), empathy (QCAE inventory), and perceived false self (POFS scale).

Results

The results confirmed significant correlations between gratitude, empathy and authenticity, but not with humility. Further analysis revealed that gratitude and affective and cognitive empathy explain 9% of the perceived false identity level. The findings confirmed the mediation effect of gratitude on the associations between (1) humility and false self, (2) affective empathy and false self, but not between cognitive empathy and false self. The results also indicated that humility may in-fluence authenticity indirectly via gratitude, but not via dimensions of empathy.

Conclusions

The findings confirm the significance of gratitude and cognitive empathy as dispositions that promote a feeling of being authentic. On the other hand, the relationship between affective empathy and false self was positive.

Empathy arousal and emotional reactions to victims of the gender pay gap

Men and women are well aware of the gender pay gap. The present study involved four experiments (N = 341, student sample, N = 203 general population sample) in which we indirectly measured empathy by asking participants to rate the non-complex and complex emotions they felt when reading a scenario in which a woman described her pay situation. Experiments 1 (equal pay vs. unequal pay) and 2, 3 & 4 (angry vs. depressed reaction to pay inequality) investigate differences in empathy arousal between men and women by assessing their emotions. Globally, both men and women identified correctly emotions expressed by the women victim of pay inequity. On complex emotions, women express more other suffering emotions than men, only in Experiment 4. Coupled with expression of guilt/shame for men only, these results are discussed in the perspective of future research.

The missing construct: Impathy

This article is about impathy (introversive empathy), understood as the ability to share in and understand one’s own feelings, which is considered a critical psychological construct relevant for the recovery and maintenance of mental health. However, while the ability to empathize with oneself has received considerable attention from the clinical community, this has not been paralleled by the same scientific scrutiny, which was subject to the ability to empathize with others. Impathy has not yet been operationally defined and thus has remained relatively unexplored, both conceptually and empirically. This work describes an operational definition of impathy with four dimensions: Perceiving, Meta-Position, Accepting Attitude, and Understanding. Issues of differentiation from related constructs are discussed and avenues of clinical applicability are explored, suggesting that impathy exists as a distinct human capacity, which can be assessed and which has important clinical implications. The paper closes with future directions, including the assessment of impathy and possible research questions.

Social Frailty in Late Adulthood: Social Cognitive and Psychological Well-Being Correlates

OBJECTIVES

Social frailty poses a major threat to successful aging, but its social cognitive and psychological well-being correlates remain poorly understood. This cross-sectional study provides initial insights into whether social cognitive difficulties in older age are associated with social frailty, as well as how social frailty is linked to psychological characteristics known to be important for health and well-being.

METHOD

Ninety community-dwelling older adults completed measures of social frailty and social cognition (social perception, theory of mind, affective empathy, and informant-rated social behavior) as well as measures of psychological function known to be important for health and well-being, both positively (resilience and life satisfaction) and negatively (demoralization, social anxiety, and apathy). Measures of cognitive frailty, physical frailty, and depression were also administered to test the specificity of any observed relationships with social frailty.

RESULTS

Both affective empathy and social behavior were predictive of increased social frailty, but social behavior emerged as the only unique predictor after controlling for covariates. Social frailty also predicted unique variance in all five measures of psychological well-being, and for three of these measures (demoralization, resilience, and life satisfaction), the effects remained significant even after adjusting for covariates.

DISCUSSION

Findings are discussed in relation to models of socioemotional aging and frailty. Potential mechanisms linking social behavior to social capital in older age are identified, as well as how loss of social resources might both directly and indirectly impact well-being.

Doctors, Patients, and Interpreters' Views on the Co-Construction of Empathic Communication in Interpreter-Mediated Consultations: A Qualitative Content Analysis of Video Stimulated Recall Interviews

Doctors and patients rely on verbal and nonverbal resources to co-construct clinical empathy. In language-discordant consultations, interpreters' communicative actions might compromise this process. We aim to explore doctors, patients, and professional interpreters' perspectives on their own and others' actions during their empathic interaction in interpreter-mediated consultations (IMCs). We analyzed 20 video stimulated recall interviews with doctors, patients, and interpreters using qualitative content analysis. Doctors and patients found ways to connect with each other on the level of empathic communication (EC) that is not limited by interpreters' alterations or disengaged demeanor. Some aspects of doctors and interpreters' professional practices might jeopardize the co-construction of EC in IMCs. The co-construction of EC in IMCs is not only subject to participants' communicative (inter)actions, but also to organizational and subjective factors. These results provide evidence of the transactional process between the behavioral, cognitive, and affective components of clinical empathy in the context of IMCs.

The empathy level and caring behaviors perceptions of nursing students: A cross-sectional and correlational study

PURPOSE

The aim of the study was to investigate the empathy level and caring behaviors perceptions of nursing students.

METHOD

This cross-sectional and correlational study was conducted with 276 nursing students.

RESULTS

The mean Empathic Tendency Scale score was 62.71 ± 5.10 (min. 20 to max. 100), indicating a low level of empathy. The mean of the Caring Assessment Questionnaire was 5.42 ± 0.80 (min. 1 to max. 7), showing a good perception of caring behaviors. There was a positive, low, and significant relationship between empathy and caring behaviors (r = 0.286, p < 0.001).

CONCLUSION

This study revealed that nursing students have low-level empathy and high-level caring behaviors.

PRACTICE IMPLICATIONS

Throughout the educational process, the students' caring competencies, which include empathy and caring behaviors, developed. It is suggested that humanistic and value-oriented pedagogical approaches be incorporated into nursing curricula.

Understanding of empathetic communication in acute hospital settings: a scoping review

OBJECTIVE

Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of 'empathetic communication' remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented.

DESIGN

Scoping review.

DATA SOURCES

Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted.

STUDY SELECTION

All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers.

DATA EXTRACTION

Data were assessed through the use of a pre-set analysis tool.

RESULTS

After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term 'empathetic communication'; however, 33 unique definitions of 'empathy' were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process.

CONCLUSION

Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures.

PRACTICE IMPLICATIONS

Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.

Effects of emotional valence and intensity on cognitive and affective empathy after insula lesions

The insula plays a central role in empathy. However, the complex structure of cognitive (CE) and affective empathy (AE) deficits following insular damage is not fully understood. In the present study, patients with insular lesions (n = 20) and demographically matched healthy controls (n = 24) viewed ecologically valid videos that varied in terms of valence and emotional intensity. The videos showed a person (target) narrating a personal life event. In CE conditions, subjects continuously rated the affective state of the target, while in AE conditions, they continuously rated their own affect. Mean squared error (MSE) assessed deviations between subject and target ratings. Patients differed from controls only in negative, low-intensity AE, rating their own affective state less negative than the target. This deficit was not related to trait empathy, neuropsychological or clinical parameters, or laterality of lesion. Empathic functions may be widely spared after insular damage in a naturalistic, dynamic setting, potentially due to the intact interpretation of social context by residual networks outside the lesion. The particular role of the insula in AE for negative states may evolve specifically in situations that bear higher uncertainty pointing to a threshold role of the insula in online ratings of AE.

Introspective self-narrative modulates the neuronal response during the emphatic process: an event-related potentials (ERPs) study

Empathy is the ability to perceive and understand others' emotional states generating a similar mental state in the self. Previous behavioural studies have shown that self-reflection can enhance the empathic process. The present event-related potentials' study aims to investigate whether self-reflection, elicited by an introspective self-narrative task, modulates the neuronal response to eye expressions and improves the accuracy of empathic process. The 29 participants included in the final sample were divided into two groups: an introspection group (IG) (n = 15), who received an introspective writing task, and a control group (CG) (n = 14), who completed a not-introspective writing task. For both groups, the electroencephalographic and behavioural responses to images depicting eye expressions taken from the "Reading the Mind in the Eyes" Theory of Mind test were recorded pre- (T0) and post- (T1) 7 days of writing. The main result showed that only the IG presented a different P300 amplitude in response to eye expressions at T1 compared to T0 on the left centre-frontal montage. No significant results on accuracy at T1 compared to T0 were found. These findings seem to suggest that the introspective writing task modulates attention and implicit evaluation of the socio-emotional stimuli. Results are discussed with reference to the hypothesis that such neuronal modulation is linked to an increase in the embodied simulation process underlying affective empathy.

A Scoping Review on the Concept of Physician Caring

BACKGROUND

Physicians' interest in the health and well-being of their patients is a tenet of medical practice. Physicians' ability to act upon this interest by caring for and about their patients is central to high-quality clinical medicine and may affect burnout. To date, a strong theoretical and empirical understanding of physician caring does not exist. To establish a practical, evidence-based approach to improve health care delivery and potentially address physician burnout, we sought to identify and synthesize existing conceptual models, frameworks, and definitions of physician caring.

METHODS

We performed a scoping review on physician caring. In November 2019 and September 2020, we searched PubMed MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL Register of Controlled Trials to identify conceptual models, frameworks, and definitions of physician caring. Eligible articles involved discussion or study of care or caring among medical practitioners. We created a content summary and performed thematic analysis of extracted data.

RESULTS

Of 11,776 articles, we reviewed the full text of 297 articles; 61 articles met inclusion criteria. Commonly identified concepts referenced Peabody's "secret of care" and the ethics of care. In bioethics, caring is described as a virtue. Contradictions exist among concepts of caring, such as whether caring is an attitude, emotion, or behavior, and the role of relationship development. Thematic analysis of all concepts and definitions identified six aspects of physician caring: (1) relational aspects, (2) technical aspects, (3) physician attitudes and characteristics, (4) agency, (5) reciprocity, and (6) physician self-care.

DISCUSSION

Caring is instrumental to clinical medicine. However, scientific understanding of what constitutes caring from physicians is limited by contradictions across concepts. A unifying concept of physician caring does not yet exist. This review proposes six aspects of physician caring which can be used to develop evidence-based approaches to improve health care delivery and potentially mitigate physician burnout.

Consistency Analysis in Medical Empathy Intervention Research

Various studies have examined the effectiveness of interventions to increase empathy in medical professionals. However, inconsistencies may exist in the definitions, interventions, and assessments of empathy. Inconsistencies jeopardize the internal validity and generalization of the research findings. The main purpose of this study was to examine the internal consistency among the definitions, interventions, and assessments of empathy in medical empathy intervention studies. We also examined the interventions and assessments in terms of the knowledge-attitude-behavior aspects. We conducted a literature search for medical empathy intervention studies with a design of randomized controlled trials and categorized each study according to the dimensions of empathy and knowledge-attitude-behavior aspects. The consistencies among the definitions, interventions, and assessments were calculated. A total of 13 studies were included in this study. No studies were fully consistent in their definitions, interventions, and assessments of empathy. Only four studies were partially consistent. In terms of knowledge-attitude-behavior aspects, four studies were fully consistent, two studies were partially consistent, and seven studies were inconsistent. Most medical empathy intervention studies are inconsistent in their definitions, interventions, and assessments of empathy, as well as the knowledge-attitude-behavior aspects between interventions and assessments. These inconsistencies may have affected the internal validity and generalization of the research results.

Listen to my feelings! How prosody and accent drive the empathic relevance of complaining speech

Interpersonal communication often involves sharing our feelings with others; complaining, for example, aims to elicit empathy in listeners by vocally expressing a speaker's suffering. Despite the growing neuroscientific interest in the phenomenon of empathy, few have investigated how it is elicited in real time by vocal signals (prosody), and how this might be affected by interpersonal factors, such as a speaker's cultural background (based on their accent). To investigate the neural processes at play when hearing spoken complaints, twenty-six French participants listened to complaining and neutral utterances produced by in-group French and out-group Québécois (i.e., French-Canadian) speakers. Participants rated how hurt the speaker felt while their cerebral activity was monitored with electroencephalography (EEG). Principal Component Analysis of Event-Related Potentials (ERPs) taken at utterance onset showed culture-dependent time courses of emotive prosody processing. The high motivational relevance of ingroup complaints increased the P200 response compared to all other utterance types; in contrast, outgroup complaints selectively elicited an early posterior negativity in the same time window, followed by an increased N400 (due to ongoing effort to derive affective meaning from outgroup voices). Ingroup neutral utterances evoked a late negativity which may reflect re-analysis of emotively less salient, but culturally relevant ingroup speech. Results highlight the time-course of neurocognitive responses that contribute to emotive speech processing for complaints, establishing the critical role of prosody as well as social-relational factors (i.e., cultural identity) on how listeners are likely to "empathize" with a speaker.