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PubMed1992

Empathy: the importance of recognizing two types.

1. Empathy has been a consistent topic in nursing literature. Although authors attest to the importance of empathy for quality nursing care, an understanding of empathy and its role in the nurse-patient relationship remains elusive. 2. The study of empathy in nursing has been hampered by a lack of theoretical and methodological clarity, a factor that has contributed to the inexplicable findings in empathy studies. 3. The recognition of two distinct types--basic empathy, a human developmental trait, and trained empathy, a clinical skill state--is set forth as a possible solution to methodological problems.

Clinical Competence↗

PubMed1996

Art: an occupation with promise for developing empathy.

Empathy is central to the interactions of occupational therapists who value personal dignity. Persons from various sectors of the behavioral sciences and the medical humanities have proposed that engagement with the arts can develop empathy, an assumption that prompted this inquiry. The observations of artists and art philosophers suggest that the assumption that art may develop empathy is grounded in the kindred natures of the two practices and in the actions that occur when a person engages with a work of art. The assumption that art may develop empathy is grounded in the kinship of the actions common to both practices: response, emotion, and connection. Artists and art philosophers' observations of human practices have uncovered three rules of art that may dispose one toward empathy: reliance on bodily senses, use of metaphor, and occupation by virtual worlds. Analysis of art's potential suggests that a person who would derive empathy from art must (a) use the senses to grasp feeling, (b) stretch the imagination to see a new perspective, and (c) invite an occupation that enhances understanding. Persons who hope to develop empathy must pursue an experience that evokes the fellow feeling that inspires it. Art can offer this experience.

Art Therapy↗

PubMed1994

[Self object and interpersonal emotions. Identification of own mirror image, empathy and prosocial behavior in the 2nd year of life].

This paper deals with the development of empathy during the second year of life. Empathy is defined as understanding another person's emotional state by vicariously sharing this state. In contemporary discussion, empathy is not clearly distinguished from emotional contagion, in which the Subject is indistinctly incorporated into the other person's mood. Most authors must therefore stipulate additional cognitive mechanisms, such as perspective taking, or even a theory of mind, to supply the empathic observer with the insight that it is, and remains, another person's emotional state which he shares. Contrary to this notion, the present paper proposes that insight is mediated by the particular quality of the empathical response itself and that self-objectification is the only relevant precondition of empathy, since it allows drawing a clearcut distinction between the emotional domains of self and other. Since self-objectification is also responsible for recognizing oneself in a mirror, empathy should emerge simultaneously with self-recognition. This was tested in an investigation on 36 girls and boys aged 14 to 22 months. In two separate sessions the subjects underwent a "rouge test" for self-recognition and were confronted with a person in need, who demonstrated grief. Empathy was operationalized by prosocial interventions. The study replicates the results of a previous investigation (Bischof-Köhler, 1988, 1991) with a modified empathy-eliciting situation. In both experiments, only those Subjects who recognized themselves tried to help, whereas non-recognizers stayed indifferent.

Body Image↗

PubMed2026

Empathic Accuracy and Behavioral Empathy After a Moderate Dose of Beer.

OBJECTIVES: Empathic accuracy (EA) represents a person's ability to correctly infer the emotions of another person. One past study in men found lower EA for positive emotions after a moderate dose of hard liquor compared to after placebo, particularly among non-hazardous drinkers. The present study aimed to replicate this finding, using a moderate dose of beer and a mixed design. Moreover, we added a novel measure of behavioral empathy. METHODS: Participants (62% men) completed the Alcohol Use Disorders Identification Test, Empathy Quotient, and Revised Drinking Motives Questionnaire. Before and after drinking either beer (6.6% alcohol, n = 28) or its 0.0% equivalent (placebo, n = 38), they watched videoclips of targets talking about emotional autobiographical events and rated how targets felt while talking. Behavioral empathy was assessed by presenting participants with painful scenarios and asking whether they would help the people in pain. RESULTS: The previous finding of lower EA for positive emotions after alcohol was not replicated. Nonetheless, after alcohol non-hazardous drinkers were less willing to help people in pain. Trait affective empathy (i.e., a person's long-term disposition to experience emotional responses congruent to another's feelings) and the drinking to cope motive did not significantly moderate the findings. CONCLUSIONS: Although alcohol may alter empathy, its effects are not consistent and may depend on the dose and type of alcohol consumed. The moderating roles of trait empathy and trait aggressivity deserves further study.

Humans↗

PubMed1991

Staff burnout in dementia care--relations to empathy and attitudes.

Sixty nursing staff in geriatric and psychogeriatric care (RNs, LPNs and nurse's aides) were selected to be studied on two occasions with an interval of one year regarding the relationships between their experience of burnout, empathy and attitudes towards demented patients. A semistructured interview was performed on the second occasion to learn more about their work experience and to relate the ratings of burnout, empathy and attitudes to their experience at work. The staff's experience of burnout changed from a mean score of 2.7 in 1987 to 2.5 in 1988. Their empathic ability was moderately high and increased from 398 (m) in (1987) to 450 (m) in 1988. The attitudes of staff remained unchanged from 1987 to 1988 and no differences were found regarding the staff's age, place of work or time at present place of work. As for the staff's empathy, there was no difference with respect to sex, category of staff or place of work. RN's showed the most positive attitudes towards demented patients both in 1987 and 1988 and differed compared to the nurse's aides and LPN's. Burnout correlated with lower empathy and less positive attitudes in the staff. Regression analysis showed that 'experience of feed-back at work' and 'time spent at present place of work' were the most important factors when explaining burnout among the staff. Staff with high empathy experienced "a close contact with the patient" as the most stimulating factor at work while staff with low empathy experienced "improvement of the patient's health" and "contact with colleagues" as the most stimulating factors. The importance of counteracting burnout in the care of demented patients is stressed.

Adolescent↗

PubMed1995

Parental levels of empathy as related to risk assessment in child protective services.

Much attention has been paid to empathy as a concept necessary to the therapeutic relationship and successful outcome with clients. Less attention has been paid to the importance of empathy in the parent-child relationship. Even less attention has been paid to empathy as it relates to the presence or absence of child abuse in the parent-child relationship. While early literature on child abuse eluded to the parents' ability or inability to empathize with the child, recent emphasis on risk assessment and studies of variables used as factors to predict risk of abuse do not include parental empathy. Research presented in this article suggests that a complete assessment of risk of child physical abuse must include a measure of parental empathy. The article also suggests that a measure of parental empathy be added to each of the risk assessment tools used by child protective service specialists.

Adult↗

PubMed2005

Prefrontal substrates of empathy: psychometric evidence in a community sample.

Empathy is a vicarious experience of others' emotions, and is crucial to many forms of adaptive social interaction. Clinical, experimental, and functional neuroimaging studies convergently suggest a role for prefrontal-limbic circuits in mediating empathy. This study examined the prefrontal basis of empathy in a community sample using self-report measures: the frontal systems behavior scale (FrSBe), Barratt impulsiveness scale (BIS), and the interpersonal reactivity index (IRI). Multiple correlations emerged supporting an inverse relationship between prefrontal system dysfunction and empathy, particularly emotional empathy and perspective taking. Many of these relationships persisted after controlling for age, sex, and education. However, FrSBe scales did not correlate with one's identification with fictional characters, and motor impulsivity correlated positively, presumably due to the different cognitive and emotional context (i.e. real versus fictional individuals). These studies parallel others using objective methodologies and suggest a graded relationship between prefrontal function and empathy and likely reflect normal variations in prefrontal-limbic function.

Adolescent↗

PubMed2005

Neuronal correlates of theory of mind and empathy: a functional magnetic resonance imaging study in a nonverbal task.

Theory of Mind (ToM), the ability to attribute mental states to others, and empathy, the ability to infer emotional experiences, are important processes in social cognition. Brain imaging studies in healthy subjects have described a brain system involving medial prefrontal cortex, superior temporal sulcus and temporal pole in ToM processing. Studies investigating networks associated with empathic responding also suggest involvement of temporal and frontal lobe regions. In this fMRI study, we used a cartoon task derived from Sarfati et al. (1997) [Sarfati, Y., Hardy-Bayle, M.C., Besche, C., Widlocher, D. 1997. Attribution of intentions to others in people with schizophrenia: a non-verbal exploration with comic strips. Schizophrenia Research 25, 199-209.]with both ToM and empathy stimuli in order to allow comparison of brain activations in these two processes. Results of 13 right-handed, healthy, male volunteers were included. Functional images were acquired using a 1.5 T Phillips Gyroscan. Our results confirmed that ToM and empathy stimuli are associated with overlapping but distinct neuronal networks. Common areas of activation included the medial prefrontal cortex, temporoparietal junction and temporal poles. Compared to the empathy condition, ToM stimuli revealed increased activations in lateral orbitofrontal cortex, middle frontal gyrus, cuneus and superior temporal gyrus. Empathy, on the other hand, was associated with enhanced activations of paracingulate, anterior and posterior cingulate and amygdala. We therefore suggest that ToM and empathy both rely on networks associated with making inferences about mental states of others. However, empathic responding requires the additional recruitment of networks involved in emotional processing. These results have implications for our understanding of disorders characterized by impairments of social cognition, such as autism and psychopathy.

Adult↗

PubMed2006

Practitioner empathy, patient enablement and health outcomes: a prospective study of acupuncture patients.

OBJECTIVE: To measure acupuncture patients' perceptions of practitioner empathy at the initial consultation and its relationship with patient enablement, and prospectively reported changes in symptoms. METHODS: Fifteen acupuncturists asked consecutive new patients to complete a questionnaire within 2 days of the first consultation. The questionnaire included the Consultation and Relational Empathy (CARE) measure (a consultation process measure), the Patient Enablement Instrument (PEI, a consultation outcome measure) and the Measure Yourself Medical Outcome Profile (MYMOP), a patient-centred symptom, well-being and activity outcome measure. A postal follow-up questionnaire was completed at 8 weeks, which repeated these measures. RESULTS: Fifty-two patients (58% of all new patients) completed the initial questionnaire. Of these, 41 (79%) completed the follow-up questionnaire. From a multiple regression analysis, which controlled for known confounders, empathy was found to be associated with enablement at the initial consultation (Beta coefficient=0.16, 95% CI: 0.02-0.31, p=0.03) and empathy-predicted changes in health outcome (MYMOP) at 8 weeks (Beta=0.07, 95% CI: 0.004-0.13, p=0.04). CONCLUSION: Patients' perception of practitioner empathy was associated with patient enablement at initial consultation and predicted changes in health outcome at 8 weeks. PRACTICE IMPLICATIONS: The empathy of practitioners, as perceived by patients, has a direct impact on patient enablement and health outcome.

Acupuncture Therapy↗

PubMed2003

Dispositional empathy in high- and low-risk parents for child physical abuse.

OBJECTIVE: The present study was designed to investigate dispositional empathy in high-risk parents for child physical abuse, using self-report instruments. More specifically, the objective was to know if high-risk parents for child physical abuse, in comparison with low-risk parents, show deficits on main dimensions of dispositional empathy: empathic concern, role-taking, and personal distress. METHOD: Based on their scores on the Abuse Scale of the CAP Inventory (Milner, 1986), 36 high-risk and 38 low-risk for child physical abuse participants were selected from a total sample of 440 Basque Country (Spain) general population parents. Both groups were statistically matched on sociodemographic variables. The Interpersonal Reactivity Index (IRI, Davis, 1980), the Hogan Empathy Scale (HES, Hogan, 1969) and the Questionnaire Measure of Emotional Empathy (QMEE, Mehrabian & Epstein, 1972) were used to assess dispositional empathy. RESULTS: As expected, high-risk, relative to low-risk, parents showed lower total scores on the HES and QMEE measures and lower scores on the IRI "Empathic concern" dimension. Moreover, high-risk, relative to low-risk, parents showed higher scores on the IRI "Personal distress" dimension. No differences between groups were observed for the IRI "Perspective-taking" dimension. CONCLUSIONS: Findings of the present study supported the hypothesis that high-risk parents for child physical abuse show a deficit in dispositional empathy. High-risk parents reported less feelings of warmth, compassion and concern for others and more feelings of anxiety and discomfort that result from observing another's negative experience.

Adult↗

PubMed1997

Approaching child abuse treatment from the perspective of empathy.

Research identifies empathy as a moderating variable in the display of aggression. Research further suggests that empathy is a significant variable in the effective parenting of children. Studies in child abuse show that abusive parents score significantly lower on empathy measures as compared to their nonabusive counterparts. The purpose of this theoretical article is (1) to suggest based on the literature that empathy training should be a core component in treatment strategies with abusive parents. A variety of approaches to empathy training will be suggested; (2) to encourage the implementation of empathy training in interventions with abusive parents and the measurement through research of the effectiveness of this approach to treatment on a short and long-term basis.

Child↗

PubMed1986

Social evaluation and the empathy-altruism hypothesis.

Archer, Diaz-Loving, Gollwitzer, Davis, and Foushee (1981) suggested that feeling empathy for a person in need may lead to increased helping because the empathic individual wants to avoid negative social evaluation. As support for this suggestion, they claimed that empathy leads to increased helping only under socially evaluative circumstances. We conducted two studies to test this claim. In Study 1 subjects were led to believe that no one--including the person in need--would ever know if they declined to help. In this situation, which was designed to be totally devoid of the potential for negative social evaluation for not helping, there was still a positive relationship between self-reported empathic emotion and offering help. In Study 2 empathy (low versus high) and social evaluation (low versus high) were manipulated in a 2 X 2 design. Once again there was a positive relationship between empathy and offering help when the potential for social evaluation was low as well as high. Results of both studies, then, suggest that the motivation to help evoked by empathy is not egoistic motivation to avoid negative social evaluation. Instead, the observed pattern was what would be expected if empathy evokes altruistic motivation to reduce the victim's need.

Adult↗

PubMed1987

Emotional reactions to dramatic film stimuli: the influence of cognitive and emotional empathy.

The idea that empathy may best be considered a multidimensional construct, consisting of both cognitive and emotional facets, has recently been gaining in popularity. To date, however, little research explicitly based on such a view has been carried out. We conducted the present experiment to explore the different influences of cognitive and emotional empathy on two types of responses to dramatic stimuli: positive and negative emotional reactions. Consistent with a multidimensional view of empathy, the two types of empathy exhibited different effects; positive emotional reactions were affected primarily by cognitive empathy, and negative emotional reactions were most heavily influenced by emotional empathy. The results are discussed in terms of their relevance to a multidimensional approach to the study of empathic responding.

Cognition↗

PubMed2003

The moderating effects of dispositional empathy on alcohol-related aggression in men and women.

The author investigated the influence of dispositional empathy on alcohol-related aggression in men and women. Participants were 204 (111 men, 93 women) healthy social drinkers, 21-35 years old. Dispositional empathy was measured with the Interpersonal Reactivity Index. Following the consumption of either an alcoholic or a placebo beverage, participants were tested on a modified version of the Taylor Aggression Paradigm in which mild electric shocks were received from, and administered to, a fictitious opponent during a competitive task. Alcohol increased aggression for persons (particularly men) with lower, as opposed to higher, levels of empathy. Men with lower empathy levels exhibited the most aggression followed by men with higher empathy levels. Women displayed the least aggression regardless of their empathy levels.

Adult↗

PubMed1999

Empathy: a crucial component of the helping relationship.

The literature reviewed in this paper substantiates the widely held view that empathy is crucial to all forms of helping relationships. While most studies cited are more than a decade old, the relationship between empathy and helping remains unchallenged in the 1990s. Additionally, while there is confusion about whether empathy is a personality dimension, an experienced emotion, or an observable skill, it is shown that empathy involves an ability to communicate an understanding of a client's world. Finally, a definition of empathy considered to be relevant to clinical nursing is introduced, which includes the need to understand client's distress, and to provide supportive interpersonal communication. It is argued that there is a need to revisit the role of empathy in the context of current health care delivery.

Attitude of Health Personnel↗

PubMed2001

Work of art dialogues: an educational technique by which students discover personal knowledge of empathy.

The visual art programme was an approach used to facilitate students' discovery of personal knowledge of empathy. The research programme constituted the first phase of an existing theory course in empathy. It involved a visual-verbal-writing process in which a reproduction of Edvard Munch's The Sick Child was studied and interpreted with a focus on personal knowledge of empathy. Data were collected from two university colleges of health sciences in Sweden during a period of 4 years (1995-1998). Student nurses (n = 428) in the undergraduate programme served as the study population. In the first stage, the students worked alone on written reports. Then, in small-groups, they discussed whether the picture facilitated the discovery of a personal knowledge of empathy. The results showed that the visual art programme stimulated the students to discuss and write about empathy. The ambiguity in the painting and the relaxed study situation was favourable to the students' discovery of their personal knowledge of empathy.

Child↗

PubMed2004

Teaching empathy to first year medical students: evaluation of an elective literature and medicine course.

BACKGROUND: Empathy is critical to the development of professionalism in medical students, and the humanities-particularly literature-have been touted as an effective tool for increasing student empathy. This quantitative/qualitative study was undertaken to assess whether reading and discussing poetry and prose related to patients and doctors could significantly increase medical student empathy and appreciation of the relevance of the humanities for their own professional development. METHOD: In 2000-2001, first year students (n=22) volunteered for an eight-session literature and medicine elective and were randomly assigned to either immediate participation in the class or a wait-list group, who participated in the same class 6 months later. Complete pre- and post-intervention data for 16 students from both groups were obtained for two quantitative measures of empathy and an attitudes-toward-the-humanities scale. Students also participated in a qualitative group interview pre- and post-intervention. RESULTS: Empathy and attitudes toward the humanities improved significantly (p<0.01) after participation in the class when both groups of students were combined. The scaled treatment effect size was in the moderate range (> or =0.60 standard deviation units) for both measures that had statistically significant pre-to-post changes. Furthermore, student understanding of the patient's perspective became more detailed and complex after the intervention. Students were also more likely post-intervention to note ways reading literature could help them cope with training-related stress. CONCLUSION: A brief literature-based course can contribute to greater student empathy and appreciation for the value of humanities in medical education.

Adult↗

PubMed2004

Impairment in cognitive and affective empathy in patients with brain lesions: anatomical and cognitive correlates.

The present study was designed to examine the degree of impairment in cognitive and affective empathy among patients with focal brain lesions, and the contribution of specific cognitive abilities (such as cognitive flexibility and processing of emotional information), to empathy. The cognitive and affective empathic response of patients with localized prefrontal lesions (n=36) was compared to responses of patients with parietal lesions (n=15) and healthy control subjects (n=19). Results indicate that patients with prefrontal lesions (especially those with lesions involving the orbitoprefrontal and medial regions) were significantly impaired in both cognitive and affective empathy as compared to parietal patients and healthy controls. When the damage was restricted to the prefrontal cortex, either left- or right-hemisphere lesions resulted in impaired empathy. However, when the lesion involved the right hemisphere, patients with parietal lesions were also impaired. The pattern of relationships between cognitive performance and empathy suggested dissociation between the cognitive correlates of affective and cognitive empathy.

Adult↗