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PubMed2002

Empathy and quality of care.

Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting.

Empathy↗

PubMed1976

Empathy. We know what we mean, but what do we measure?

In recent years, quantitative researches on the empathic process in psychotherapy have resulted in definite recommendations for the technique of psychotherapy and the training of psychotherapists. What is not always observed, however, is that the methods employed for studying empathy have been based on brief segments of patient-therapist interaction in which judgments of empathy do not depend on hearing the patient's communications, and are in several ways discordant with what is meant by empathy according to clinical theory. Evidence suggests that it is the rater's impression of the "goodness of psychotherapy" rather than empathy that is being captured by these methods.

Empathy↗

PubMed2002

Variation of mood and empathy during internship.

CONTEXT: Internship is a time of great transition, during which mood disturbances are common. However, variations in mood and empathy levels throughout the internship year have not been investigated. OBJECTIVE: To examine mood patterns and changes in empathy among internal medicine residents over the course of the internship year. DESIGN: Cohort study of interns involving completion of survey instruments at 4 points: time 1 (June 2000; Profile of Mood States [POMS] and Interpersonal Reactivity Index [IRI]), times 2 and 3 (November 2000 and February 2001; POMS), and time 4 (June 2001; POMS and IRI). SETTING: Internal medicine residency program at a university-based medical center. PARTICIPANTS: Sixty-one interns. MAIN OUTCOME MEASURES: Baseline scores of mood states and empathy; trends in mood states and empathy over the internship year. RESULTS: Response rates for time 1 were 98%; for time 2, 72%; for time 3, 79%; and for time 4, 79%. Results of the POMS revealed that physicians starting their internship exhibit less tension, depression, anger, fatigue, and confusion and have more vigor than general adult and college student populations (P<.001 for all). Results of the IRI showed better baseline scores for perspective taking (P<.001) and empathic concern (P =.007) and lower scores for personal distress (P<.001) among interns compared with norms. Five months into internship, however, POMS scores revealed significant increases in the depression-dejection (P<.001), anger-hostility (P<.001), and fatigue-inertia (P<.001) scales, as well as an increase in IRI personal distress level (P<.001). These increases corresponded with decreases in the POMS vigor-activity scores (P<.001) and IRI empathic concern measures (P =.005). Changes persisted throughout the internship period. CONCLUSIONS: We found that, in this sample, enthusiasm at the beginning of internship soon gave way to depression, anger, and fatigue. Future research should be aimed at determining whether these changes persist beyond internship.

Adult↗

PubMed2005

Clinical empathy as emotional labor in the patient-physician relationship.

Empathy should characterize all health care professions. Despite advancement in medical technology, the healing relationship between physicians and patients remains essential to quality care. We propose that physicians consider empathy as emotional labor (ie, management of experienced and displayed emotions to present a certain image). Since the publication of Hochschild's The Managed Heart in 1983, researchers in management and organization behavior have been studying emotional labor by service workers, such as flight attendants and bill collectors. In this article, we focus on physicians as professionals who are expected to be empathic caregivers. They engage in such emotional labor through deep acting (ie, generating empathy-consistent emotional and cognitive reactions before and during empathic interactions with the patient, similar to the method-acting tradition used by some stage and screen actors), surface acting (ie, forging empathic behaviors toward the patient, absent of consistent emotional and cognitive reactions), or both. Although deep acting is preferred, physicians may rely on surface acting when immediate emotional and cognitive understanding of patients is impossible. Overall, we contend that physicians are more effective healers--and enjoy more professional satisfaction--when they engage in the process of empathy. We urge physicians first to recognize that their work has an element of emotional labor and, second, to consciously practice deep and surface acting to empathize with their patients. Medical students and residents can benefit from long-term regular training that includes conscious efforts to develop their empathic abilities. This will be valuable for both physicians and patients facing the increasingly fragmented and technological world of modern medicine.

Empathy↗

PubMed2007

Dissociable systems for empathy.

Empathy is a lay term that is becoming increasingly used in the field of cognitive neuroscience. In this paper, it is argued that empathy is a loose collection of partially dissociable neurocognitive systems. Two forms of 'emotional' empathy were considered: First, responding to emotional expressions, particularly angry expressions, leading to response reversal. Secondly, responding to emotional expressions, particularly fearful and sad expressions, leading to stimulus-reinforcement learning. The implications of these forms of empathy for understanding specific psychiatric conditions are briefly considered.

Affect↗

PubMed1981

Construct validity of an empathy instrument.

The purpose of the study was to determine the construct validity of the Empathy Construct Rating Scale (ECRS), developed as part of a larger investigation. Two procedures were used: (a) Campbell and Fiske's (1959) multitrait- multimethod approach and (b) factor analysis. The results suggest that the ECRS is a valid and a reliable instrument for measuring empathy. It was shown to have high internal consistency, content validity, and discriminant validity. Results of the factor analysis placed the rating scale in the primary factor, sharing that factor with no other measured trait. The results further suggest that empathy cannot be divided meaningfully into subscales; empathy exists as a whole and all elements must be present in the relationship for it to exist.

Adult↗

PubMed1995

Verbal and facial measures of children's emotion and empathy.

The purpose of this study was to assess the relationship between two theoretically distinct aspects of children's emotional responses (Lewis & Michalson, 1983), their emotional experience (via verbal report) and emotional state (via nonverbal expression), in response to emotion-evoking stimuli. A related objective was to assess the concordance of these two verbal and nonverbal measures as indices of empathy, i.e., affective responses consistent with those of stimulus persons. Facial expressions of 60 10-year-old girls were unobtrusively videotaped while they individually viewed six stimulus vignettes. Half of these children pressed a button to indicate awareness of emotional arousal while viewing stimuli; half served as controls. Results indicated that emotional and empathic responses were not affected by the button press procedure, or by a social desirability response set. Expressive responses at button presses were microanalytically analyzed using AFFEX. Postviewing interviews assessed children's reported emotions and the affect match (empathy) between children's reported emotion for themselves and stimulus characters. Results indicated modest associations between the emotions children reported and those facially displayed and similar associations between children's verbal and facial empathy scores. Results address the concurrent validity of different measures of children's emotions, and contribute to the small number of extant multimethod studies on children's emotional responses and empathy.

Awareness↗

PubMed1988

Interrelations of empathy, cognition, and moral reasoning with dimensions of juvenile delinquency.

The interrelations of a variety of indices of sociocognitive development (empathy, role-taking, logical cognition, and moral reasoning) were studied in delinquent and nondelinquent adolescents. Delinquent males (grouped into psychopathic, neurotic, and subcultural subgroups) and a matched nondelinquent comparison group were administered individually two empathy scales (the Davis Interpersonal Reactivity Index and the Mehrabian and Epstein Questionnaire Measure of Emotional Empathy), an adaptation of Byrne's and Flavell's role-taking tasks, two Piagetian cognitive tasks, and two of Kohlberg's structured moral dilemmas. Delinquents as a group displayed significantly more immature modes of role-taking, logical cognition, and moral reasoning than did nondelinquents. The delinquent subgroups, however, did not significantly differ from one another on these dimensions. Role-taking, logical cognition, and moral reasoning were significantly related to one another. Anticipated differences in level of empathy between the delinquent and nondelinquent adolescents failed to occur. A number of interpretations for this unexpected finding are offered.

Adolescent↗

PubMed1977

Empathy and socialization in first and repeat juvenile offenders and normals.

The present study examined empathy and socialization in delinquent and nondelinquent juveniles. From 32 first offenders, 16 repeat offenders, and 19 normals who were administered Hogan's empathy scale and the socialization scale of the California Psychological Inventory, groups of 16 subjects matched on age and race were compared. Results indicated that the three groups did not differ on empathy but that each of the three groups differed on socialization. Results are discussed in terms of potentially identifying recidivists and the efficacy of therapist-trained empathy.

Adolescent↗

PubMed2006

The effect of emotional distance on psychophysiologic concordance and perceived empathy between patient and interviewer.

This preliminary study investigated the effect of emotional distance on psychophysiologic concordance and perceived empathy in a clinical population. Participants included 20 adult outpatients from a mental health clinic that underwent a brief semi-structured interview with a trained psychiatrist in either an emotionally neutral or an emotionally distant condition. Simultaneous skin conductance (SC) levels of the patient and interviewer were recorded and used to calculate a measure of psychophysiologic concordance. Interviewer gaze was rated by an independent observer and used as a proxy indicator of emotional distance. Observer ratings of interviewer gaze, SC concordance, and patient ratings of perceived interviewer empathy were significantly lower in the emotionally distant condition compared with the emotionally neutral condition (p < 0.05). Results suggest that increased emotional distance is associated with decreased psychophysiologic concordance and reduced subjective ratings of perceived empathy. The observed differences in psychophysiologic concordance support the use of this measure as a potential marker of empathy in a clinical population in an interview setting.

Adult↗

PubMed2005

The moral contours of empathy.

Morally contoured empathy is a form of "reasonable partiality" essential to the healthy care of dependents. It is critical as an epistemic aid in determining proper moral responsiveness; it is also, within certain richly normative roles and relationships, itself a crucial constitutive mode of moral connection. Yet the achievement of empathy is no easy feat. Patterns of incuriosity imperil connection, impeding empathic engagement; inappropriate "empathic" engagement, on the other hand, can result in self-effacement. Impartial moral principles and constraints offer at best meager protection against these perils, and hence serve poorly in securing morally contoured empathy. More nuanced and practical guidance should be sought in normatively substantive conceptions of our roles and relationships and their defining moral stakes. These, joined with more abstract moral tools, can facilitate rich, narratively textured interpretations of morality's demands. While the content of our normative conceptions must be continually debated, engaging in this debate is vital to the achievement of proper empathy, and thus to effective, respectful, morally healthy care of dependents.

Empathy↗

PubMed2006

Understanding prosocial behavior: the impact of empathy and gender among African American adolescents.

Although prosocial behavior in adolescence is associated with many positive outcomes, few studies have examined the factors that contribute to the development of prosocial behaviors. This study examines empathy and gender as predictors of prosocial behavior among African American early adolescents. Results revealed a significant main effect for empathy, as well as an interaction between empathy and gender in predicting prosocial behavior. In general, youth with more empathy reported more prosocial behavior, and this effect was more pronounced for males than females. These findings suggest that the ability to understand another's perspective may be important in the development and expression of prosocial behaviors, particularly among males.

Adolescent↗

PubMed2006

The neuronal basis and ontogeny of empathy and mind reading: review of literature and implications for future research.

Social neuro-science has recently started to investigate the neuronal mechanisms underlying our ability to understand the mental and emotional states of others. In this review, imaging research conducted on theory of mind (ToM or mentalizing) and empathy is selectively reviewed. It is proposed that even though these abilities are often used as synonyms in the literature these capacities represent different abilities that rely on different neuronal circuitry. ToM refers to our ability to understand mental states such as intentions, goals and beliefs, and relies on structures of the temporal lobe and the pre-frontal cortex. In contrast, empathy refers to our ability to share the feelings (emotions and sensations) of others and relies on sensorimotor cortices as well as limbic and para-limbic structures. It is further argued that the concept of empathy as used in lay terms refers to a multi-level construct extending from simple forms of emotion contagion to complex forms of cognitive perspective taking. Future research should investigate the relative contribution of empathizing and mentalizing abilities in the understanding of other people's states. Finally, it is suggested that the abilities to understand other people's thoughts and to share their affects display different ontogenetic trajectories reflecting the different developmental paths of their underlying neural structures. In particular, empathy develops much earlier than mentalizing abilities, because the former relys on limbic structures which develop early in ontogeny, whereas the latter rely on lateral temporal lobe and pre-frontal structures which are among the last to fully mature.

Brain↗

PubMedDate not supplied

On the nature and place of empathy in clinical nursing practice.

Empathy has long been thought of as a fundamental component of nurse-patient interactions. Despite the central role empathy has been accorded, understanding how the concept is operationalized in practice is difficult. A review of nursing literature on empathy is presented to help clarify the concept, and an analysis is given concerning the relationship of empathy to recent findings on expert caring in nursing. Vignettes are presented as illustrations of the concepts discussed.

Clinical Competence↗

PubMed2000

Empathy and jurors' decisions in patricide trials involving child sexual assault allegations.

In a mock-trial paradigm, 205 participants considered a patricide trial in which a child defendant claimed the patricide was done in self-defense after years of sexual abuse. Participants in an empathy-induction condition were asked to take the perspective of the defendant and to detail how they would be thinking and feeling if they were the defendant. Control condition participants received no such instructions. Results indicated that, compared to jurors in the control condition, jurors who were asked to take the defendant's perspective had more empathy for the defendant (without feeling more similar to or more sympathy for the defendant), found the defendant less guilty and less responsible for the murder, and were more likely to consider abuse to be a mitigating factor in the killing. Overall, compared to men, women were more likely to believe the defendant's abuse allegations, find the defendant credible, and consider the defendant to be less responsible for the murder. Women in the empathy condition found the defendant less guilty than did all other jurors. Finally, child defendant gender was also varied, but this had few effects on case judgments overall. Jurors, however, were more likely to believe that the girl defendant was sexually abused than the boy defendant. We discuss theoretical implications for understanding the social psychological construct of empathy as well as implications for understanding jurors' decisions in cases involving child sexual assault allegations.

Adolescent↗

PubMed1992

Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model.

This study demonstrated that therapeutic empathy has a moderate-to-large causal effect on recovery from depression in a group of 185 patients treated with cognitive-behavioral therapy (CBT). The authors simultaneously estimated the reciprocal effect of depression severity on therapeutic empathy and found that this effect was quite small. In addition, homework compliance had a separate effect on clinical recovery, over and above the effect of therapeutic empathy. The patients of novice therapists improved significantly less than did the patients of more experienced therapists, when controlling for therapeutic empathy and homework compliance. Ss who terminated therapy prematurely were less likely to complete the self-help assignments between sessions, rated their therapists as significantly less empathic, and improved significantly less. Ss with borderline personality disorder improved significantly less, but they rated their therapists as just as empathic and caring as other patients. The significance of these findings for psychotherapy research, treatment, and clinical training is discussed.

Adolescent↗

PubMed1997

Empathy and attitudes: can feeling for a member of a stigmatized group improve feelings toward the group?

Results of 3 experiments suggest that feeling empathy for a member of a stigmatized group can improve attitudes toward the group as a whole. In Experiments 1 and 2, inducing empathy for a young woman with AIDS (Experiment 1) or a homeless man (Experiment 2) led to more positive attitudes toward people with AIDS or toward the homeless, respectively. Experiment 3 tested possible limits of the empathy-attitude effect by inducing empathy toward a member of a highly stigmatized group, convicted murderers, and measuring attitudes toward this group immediately and then 1-2 weeks later. Results provided only weak evidence of improved attitudes toward murderers immediately but strong evidence of improved attitudes 1-2 weeks later.

Analysis of Variance↗

PubMed2002

Children's internal representations, empathy, and fantasy play: a validity study of the SCORS-Q.

The authors investigated relationships among internal representations, empathy, and affective and cognitive processes in fantasy play to test the validity of the Social Cognition and Object Relations Scale Q-Sort (SCORS-Q; D. Westen, 1995) with children. Eighty-six 8-10-year-olds were administered 8 Thematic Apperception Test cards, a standardized play task, and a self-report empathy measure. Teachers rated children's empathy and helpfulness. As predicted, internal representations were related to empathy, helpfulness, and quality of fantasy play. Developmental differences on the SCORS-Q were consistent with object relations theory and with results from the original SCORS. The findings support the value of internal representations as a means of understanding children's interpersonal functioning and contribute to the validity of the SCORS-Q for use with children.

Child↗