Empathy: Assessment Instruments and Psychometric Quality - A Systematic Literature Review With a Meta-Analysis of the Past Ten Years

Measurement of Empathy in Virtual Reality with Head-Mounted Displays: A Systematic Review

We present a systematic review of 111 papers that measure the impact of virtual experiences created through head-mounted displays (HMDs) on empathy. Our goal was to analyze the conditions and the extent to which virtual reality (VR) enhances empathy. To achieve this, we categorized the relevant literature according to measurement methods, correlated human factors, viewing experiences, topics, and participants. Meta-analysis was performed based on categorized themes, and under specified conditions, we found that VR can improve empathy. Emotional empathy increased temporarily after the VR experience and returned to its original level over time, whereas cognitive empathy remained enhanced. Furthermore, while VR did not surpass 2D video in improving emotional empathy, it did enhance cognitive empathy, which is associated with embodiment. Our results are consistent with existing research suggesting differentiation between cognitive empathy (influenced by environmental factors and learnable) and emotional empathy (highly heritable and less variable). Interactivity, target of empathy, and point of view were not found to significantly affect empathy, but participants' age and nationality were found to influence empathy levels. It can be concluded that VR enhances cognitive empathy by immersing individuals in the perspective of others and that storytelling and personal characteristics are more important than the composition of the VR scene. Our findings provide guiding information for creating empathy content in VR and designing experiments to measure empathy.

Measuring dispositional empathy in South African children

OBJECTIVE

Empathy is a key factor to examine in development, because of its predictive associations with both aggression and successful prosocial behaviour. However, established measures of empathy for Low-to-Middle Income Countries, including South Africa, are lacking. In children, parent-report measures are key. However, a local study examining empathy and aggression (Malcolm-Smith et al., 2015) found poor psychometric performance for a widely used parent-report measure of dispositional empathy, the Griffith Empathy Measure (GEM). We thus investigated which of two questionnaires measuring dispositional cognitive and affective empathy perform better in this context.

METHOD

We contrasted internal consistency reliability of a simplified version of the GEM (SGEM; n = 160) and a parent-report version of the Questionnaire of Cognitive and Affective Empathy (QCAE; n = 440) in a low-mid socio-economic status sample. Convergence between the measures and factor structure were also assessed.

RESULTS

The parent-report version of the QCAE performed well as a measure of child dispositional cognitive and affective empathy, with good reliability (overall α = 0.90 vs. SGEM α = .63), and confirmatory factor analysis supporting the two-factor structure. The SGEM's reliability and failure to correlate with QCAE indicated poor psychometric performance.

CONCLUSION

This is the first psychometric evaluation of the QCAE as a parent-report measure, and our results indicate that it should prove useful for future assessments of dispositional empathy in children across a variety of contexts.

Proposed Specifiers for Conduct Disorder (PSCD) scale: A Latent Profile Analysis with At-Risk Adolescents

The Proposed Specifiers for Conduct Disorder (PSCD; Salekin in Pers Disord: Theory Res Treat 7:180-191, 2016) scale was designed to assess interrelated psychopathic trait domains in conjunction with symptoms of Conduct Disorder (CD) in children and adolescents (i.e., grandiose-manipulative, callous-unemotional, daring-impulsive). Variable-centered studies have provided support for a four-factor PSCD structure (Salekin et al. in Psychol Assess 34(10):985-992, 2022) in line with other adolescent and adult studies. The current person-centered study used latent profile analysis of the PSCD domains to examine whether theoretically meaningful and empirically robust PSCD subtypes emerged from a diverse sample (70.9% White, 20.1% Black, 3.6% Hispanic, and 5.4% other) of adolescents (modal age = 17) in a military style residential facility (N = 409; Males = 80.6%). As hypothesized, a four-class solution was best, consistent with adult psychopathy subtyping research (Hare et al. in Handbook of Psychopathy 39-79, 2018; Roy et al. in Pers Disord: Theory Res Treat, in press). The PSCD subtype profiles were uniform across sex and race/ethnicity. Adolescents evincing a psychopathic trait propensity profile (elevated on all four PSCD domains) displayed the greatest number of arrests and higher overall externalizing psychopathology, compared to the other three latent classes, as well as higher internalizing psychopathology compared to adolescents with general delinquency. The PSCD provides a sound measure of psychopathic trait propensities in youth and our results offer investigators and clinicians a means for understanding person-centered psychopathic traits versus antisocial profiles among at-risk adolescents. Taken together, the current results may offer a viable approach for examining specific treatment targets based on PSCD subtype profiles.

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.

Cross-cultural adaptation and clinical application of the Perth Empathy Scale

OBJECTIVE

Alterations of empathy have been observed in patients with various mental disorders. The Perth Empathy Scale (PES) was recently developed to measure a multidimensional construct of empathy across positive and negative emotions. However, its psychometric properties and clinical applications have not been examined in the Chinese context.

METHODS

The Chinese version of the PES was developed and administered to a large Chinese sample (n = 1090). Factor structure, internal consistency, test-retest reliability, and convergent, discriminant, as well as concurrent validity were examined. Moreover, 50 patients with major depressive disorder (MDD) and 50 healthy controls were recruited to explore the clinical utility of the PES.

RESULTS

Confirmatory factor analyses supported a theoretically congruent three-factor structure of empathy, namely Cognitive Empathy, Negative Affective Empathy and Positive Affective Empathy. The PES showed good to excellent internal consistency reliability, good convergent and discriminant validity, acceptable concurrent validity, and moderate to high test-retest reliability. Patients with MDD had significantly lower PES scores compared to healthy controls. Linear discriminant function comprised of the three factors correctly differentiated 71% of participants, which further verified the clinical utility of the PES.

CONCLUSIONS

Our findings indicated that the Chinese version of the PES is a reliable and valid instrument to measure cognitive and affective empathy across negative and positive emotions, and could therefore be used in both research and clinical practice.

Empathy Modulates the Activity of the Sensorimotor Mirror Neuron System during Pain Observation

AIM

The aim of this study is to analyze the brain activity patterns during the observation of painful expressions and to establish the relationship between this activity and the scores obtained on the Interpersonal Reactivity Index (IRI).

METHODS

The study included twenty healthy, right-handed subjects (10 women). We conducted a task-based and resting-state functional magnetic resonance imaging (fMRI) study. The task involved observing pictures displaying painful expressions. We performed a region of interest (ROI) analysis focusing on the core regions of the sensorimotor mirror neuron system (MNS). Resting-state fMRI was utilized to assess the functional connectivity of the sensorimotor MNS regions with the rest of the cortex using a seed-to-voxel approach. Additionally, we conducted a regression analysis to examine the relationship between brain activity and scores from the IRI subtests.

RESULTS

Observing painful expressions led to increased activity in specific regions of the frontal, temporal, and parietal lobes. The largest cluster of activation was observed in the left inferior parietal lobule (IPL). However, the ROI analysis did not reveal any significant activity in the remaining core regions of the sensorimotor MNS. The regression analysis demonstrated a positive correlation between brain activity during the observation of pain and the "empathic concern" subtest scores of the IRI in both the cingulate gyri and bilateral IPL. Finally, we identified a positive relationship between the "empathic concern" subtest of the IRI and the functional connectivity (FC) of bilateral IPLs with the bilateral prefrontal cortex and the right IFG.

CONCLUSION

Observing expressions of pain triggers activation in the sensorimotor MNS, and this activation is influenced by the individual's level of empathy.

Multifaceted Empathy Test (MET): Validity evidence for the Brazilian population concerning the computer-based (face-to-face) and online versions

BACKGROUND

The lack of empathy is associated with several psychological and behavioral disorders, and it is important to assess this construct broadly, through multi-methods.

OBJECTIVE

To conduct a psychometric analysis of the Brazilian version of the Multifaceted Empathy Test (MET), a computerized task that assesses emotional and cognitive empathy.

METHODS

The samples were recruited from the community using the snowball method (phase 1: face-to-face; N = 142) and through social media (phase 2: online; N = 519). The participants completed the MET and the Interpersonal Reactivity Index (IRI) to assess the convergent validity between the instruments. To assess validity with correlated constructs (resilient coping and stress), the Brief Resilient Coping Scale and Perceived Stress Scale were used. A task was also implemented in the face-to-face application to assess facial emotions. The retest was applied 25 days later to a portion of the sample (face-to-face: N = 31; online: N = 102).

RESULTS

It was observed adequate test-retest reliability for most items (ICC = 0.49-0.98), satisfactory infit and outfit indexes, discriminatory ability between sexes, weak convergent validity with empathy measures (r = 0.17-0.36), and correlate constructs (r = 0.12-0.46). MET presented good psychometric indicators, confirming its use in face-to-face/computer-based and online formats in clinical and research contexts. However, weaknesses were found regarding the cognitive subscale, demanding future studies to address larger samples to enable more robust conclusions concerning its adequacy. Further research on the instrument's internal structure can also contribute to its improvement.

Virtual reality stimulation and organizational neuroscience for the assessment of empathy

This study aimed to evaluate the viability of a new procedure based on machine learning (ML), virtual reality (VR), and implicit measures to discriminate empathy. Specifically, eye-tracking and decision-making patterns were used to classify individuals according to their level in each of the empathy dimensions, while they were immersed in virtual environments that represented social workplace situations. The virtual environments were designed using an evidence-centered design approach. Interaction and gaze patterns were recorded for 82 participants, who were classified as having high or low empathy on each of the following empathy dimensions: perspective-taking, emotional understanding, empathetic stress, and empathetic joy. The dimensions were assessed using the Cognitive and Affective Empathy Test. An ML-based model that combined behavioral outputs and eye-gaze patterns was developed to predict the empathy dimension level of the participants (high or low). The analysis indicated that the different dimensions could be differentiated by eye-gaze patterns and behaviors during immersive VR. The eye-tracking measures contributed more significantly to this differentiation than did the behavioral metrics. In summary, this study illustrates the potential of a novel VR organizational environment coupled with ML to discriminate the empathy dimensions. However, the results should be interpreted with caution, as the small sample does not allow general conclusions to be drawn. Further studies with a larger sample are required to support the results obtained in this study.

The association between empathy and the physiotherapy-patient therapeutic alliance: A cross-sectional study

BACKGROUND

The central component of person-centred care is in having a therapeutic realtionship. Furthermore, the empathy of the physiotherapist is one of the most important attributes in achieving a successful therapeutic alliance.

OBJECTIVE

The aim of the research was to determine the association between the constructs of empathy and therapeutic alliance in Spanish physical therapists and the possible influence of socio-professional variables on them.

DESIGN

Cross-sectional research.

METHODS

An electronic survey including the Working Alliance Inventory-Short Form, the Interpersonal Reactivity Index and sociodemographic data with 473 Spanish physiotherapists. A descriptive, bivariate and simple lineal regression analysis was carried out.

RESULTS

Work experience has a positive influence on bonding and the agreement on objectives and tasks (0.04 < B > 0.06; p < 0.01). The perspective taking dimensions and empathic concern positively influence the agreement on achievement (0.14 < B > 0.19; p < 0.001). Personal distress inversely influences bonding and the agreement on achievements and tasks (-0.13 < B > -0.09; p < 0.01).

CONCLUSIONS

The dimensions of perspective taking and empathic concern seem to facilitate successful shared decision making in terms of treating objectives. Furthermore, the physiotherapist's personal distress acts as an obstacle to the development of the three subcomponents of the therapeutic alliance analysed.