The Role of Cognitive and Affective Empathy in Spouses' Support Interactions: An Observational Study

The present study examined how support providers’ empathic dispositions (dispositional perspective taking, empathic concern, and personal distress) as well as their situational empathic reactions (interaction-based perspective taking, empathic concern, and personal distress) relate to the provision of spousal support during observed support interactions. Forty-five committed couples provided questionnaire data and participated in two ten-minute social support interactions designed to assess behaviors when partners are offering and soliciting social support. A video-review task was used to assess situational forms of perspective taking (e.g., empathic accuracy), empathic concern and personal distress. Data were analyzed by means of the multi-level Actor-Partner Interdependence Model. Results revealed that providers scoring higher on affective empathy (i.e., dispositional empathic concern), provided lower levels of negative support. In addition, for male partners, scoring higher on cognitive empathy (i.e., situational perspective taking) was related to lower levels of negative support provision. For both partners, higher scores on cognitive empathy (i.e., situational perspective taking) correlated with more instrumental support provision. Male providers scoring higher on affective empathy (i.e., situational personal distress) provided higher levels of instrumental support. Dispositional perspective taking was related to higher scores on emotional support provision for male providers. The current study furthers our insight into the empathy-support link, by revealing differential effects (a) for men and women, (b) of both cognitive and affective empathy, and (c) of dispositional as well as situational empathy, on different types of support provision.     

Low Levels of Empathic Concern Predict Utilitarian Moral Judgment

Is it permissible to harm one to save many? Classic moral dilemmas are often defined by the conflict between a putatively rational response to maximize aggregate welfare (i.e., the utilitarian judgment) and an emotional aversion to harm (i.e., the non-utilitarian judgment). Here, we address two questions. First, what specific aspect of emotional responding is relevant for these judgments? Second, is this aspect of emotional responding selectively reduced in utilitarians or enhanced in non-utilitarians? The results reveal a key relationship between moral judgment and empathic concern in particular (i.e., feelings of warmth and compassion in response to someone in distress). Utilitarian participants showed significantly reduced empathic concern on an independent empathy measure. These findings therefore reveal diminished empathic concern in utilitarian moral judges.     

The Role of Compassion in Altruistic Helping and Punishment Behavior

Compassion, the emotional response of caring for another who is suffering and that results in motivation to relieve suffering, is thought to be an emotional antecedent to altruistic behavior. However, it remains unclear whether compassion enhances altruistic behavior in a uniform way or is specific to sub-types of behavior such as altruistic helping of a victim or altruistic punishment of a transgressor. We investigated the relationship between compassion and subtypes of altruistic behavior using third-party paradigms where participants 1) witnessed an unfair economic exchange between a transgressor and a victim, and 2) had the opportunity to either spend personal funds to either economically a) help the victim or b) punish the transgressor. In Study 1, we examined whether individual differences in self-reported empathic concern (the emotional component of compassion) was associated with greater altruistic helping or punishment behavior in two independent samples. For participants who witnessed an unfair transaction, trait empathic concern was associated with greater helping of a victim and had no relationship to punishment. However, in those who decided to punish the transgressor, participants who reported greater empathic concern decided to punish less. In Study 2, we directly enhanced compassion using short-term online compassion meditation training to examine whether altruistic helping and punishment were increased after two weeks of training. Compared to an active reappraisal training control group, the compassion training group gave more to help the victim and did not differ in punishment of the transgressor. Together, these two studies suggest that compassion is related to greater altruistic helping of victims and is not associated with or may mitigate altruistic punishment of transgressors.     

Chronobiological factors for compassion satisfaction and fatigue among ambulatory oncology caregivers

Primary caregivers for victims of chronic illness and or trauma experience both positive and negative emotional consequences. These are broadly classified as compassion satisfaction (CS) and compassion fatigue (CF). Because one of the components of CF, burnout, varies with chronotype and sleep quality, we assessed the influence of chronobiological features on the broader constructs of CS and CF. Responses from primary ambulatory care oncology staff working dayshifts were assessed for potential relationships of chronotype and sleep quality with CS and CF using the professional quality of life scale. These were analyzed further in a multivariate model that included personality and job satisfaction as cofactors. We found that sleep quality was a key contributor to CS development and CF reduction. Morningness was positively linked to CS, but the univariate association was masked in the multivariate model. Job satisfaction (contingent rewards, nature of work and operating procedures) heavily influenced CS and CF development. Agreeableness and openness showed positive correlations with CS and negative with burnout, while emotional stability was linked to reduced CF. While job satisfaction and personality predictably played roles in the development of CS and CF, sleep quality and chronotype contributed significantly to benefits and negative consequences of providing care.     

Responding Empathically: A Question of Heart,not a Question of Skin

Empathy entails the capacities to resonate with another person’s emotions, understand his/her thoughts and feelings, separate our own thoughts and emotions from those of the observed and responding with the appropriate prosocial and helpful behavior. While there is abundant research on the neurobiological mechanisms of some components of empathy (e.g., emotional contagion), few studies have considered the neurobiological mechanisms underlying the empathic response. The present study explores psychophysiological correlates (skin conductance level and the interbeat interval) as a function of the empathic response while participants watch and respond to actors portraying emotionally laden vignettes. Forty undergraduate psychology students were each presented with 40 emotional vignettes of positive or negative valence and asked to choose among three different empathic responses while their electrodermal and cardiac responses were measured. Overall, the study shows that higher levels of additive empathy are associated with increased cardiac activity (i.e., decreased Interbeat Interval) but not electrodermal activity.     

The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review

Background

Working in the stressful environment of the Intensive Care Unit (ICU) is an emotionally charged challenge that might affect the emotional stability of medical staff. The quality of care for ICU patients and their relatives might be threatened through long-term absenteeism or a brain and skill drain if the healthcare professionals leave their jobs prematurely in order to preserve their own health.

Purpose

The purpose of this review is to evaluate the literature related to emotional distress among healthcare professionals in the ICU, with an emphasis on the prevalence of burnout and compassion fatigue and the available preventive strategies.

Methods

A systematic literature review was conducted, using Embase, Medline OvidSP, Cinahl, Web-of-science, PsychINFO, PubMed publisher, Cochrane and Google Scholar for articles published between 1992 and June, 2014. Studies reporting the prevalence of burnout, compassion fatigue, secondary traumatic stress and vicarious trauma in ICU healthcare professionals were included, as well as related intervention studies.

Results

Forty of the 1623 identified publications, which included 14,770 respondents, met the selection criteria. Two studies reported the prevalence of compassion fatigue as 7.3% and 40%; five studies described the prevalence of secondary traumatic stress ranging from 0% to 38.5%. The reported prevalence of burnout in the ICU varied from 0% to 70.1%. A wide range of intervention strategies emerged from the recent literature search, such as different intensivist work schedules, educational programs on coping with emotional distress, improving communication skills, and relaxation methods.

Conclusions

The true prevalence of burnout, compassion fatigue, secondary traumatic stress and vicarious trauma in ICU healthcare professionals remains open for discussion. A thorough exploration of emotional distress in relation to communication skills, ethical rounds, and mindfulness might provide an appropriate starting point for the development of further preventive strategies.     

Emotional face recognition, empathic trait (BEES), and cortical contribution in response to positive and negative cues. The effect of rTMS on dorsal medial prefrontal cortex

The present study investigated the relationship between three different measures related to the affective empathy: facial expression detection in response to different emotional patterns (positive vs. negative), personal response to empathic scale [Balanced Emotional Empathy Scale (BEES)], and dorsal medial prefrontal cortex (dMPFC) contribution to mediate the facial detection task. Nineteen subjects took part in the study and they were required to recognize facial expression of emotions, after having empathized with these emotional cues. Repeated Transcranial Magnetic Stimulation (rTMS) method was used in the present research in order to produce a temporary virtual disruption of dMPFC activity. dMPFC disruption induced a worse performance, especially in response to negative expressions (i.e. anger and fear). High-BEES subjects paid a higher cost after frontal brain perturbation: they showed to be unable to correctly detect facial expressions more than low-BEES. Moreover, a “negative valence effect” was observed only for high-BEES, and it was probably related with their higher impairment to recognize negative more than positive expressions. dMPFC was found to support emotional facial expression recognition in an empathic condition, with a specific increased responsiveness for negative-valenced faces. The contribution of this research was discussed to explain the mechanisms underlying affective empathy based on rTMS application.     

Surgeons’ Emotional Experience of Their Everyday Practice - A Qualitative Study

Background

Physicians’ emotions affect both patient care and personal well-being. Surgeons appear at particularly high risk, as evidenced by the high rate of burnout and the alarming consequences in both their personal lives and professional behavior. The aim of this qualitative study is to explore the emotional experiences of surgeons and their impact on their surgical practice.

Methods and Findings

27 purposively selected liver and pancreatic surgeons from 10 teaching hospitals (23 men, 4 women) participated. Inclusion took place until data saturation was reached. Data were collected through individual interviews and thematically analyzed independently by 3 researchers (a psychologist, a psychiatrist, and a surgeon). 7 themes emerged from the analysis, categorized in 3 main or superordinate themes, which described surgeons’ emotional experience before, during, and after surgery. Burdensome emotions are present throughout all 3 periods (and invade life outside the hospital)—surgeons’ own emotions, their perception of patients’ emotions, and their entwinement. The interviewees described the range of emotional situations they face (with patients, families, colleagues), the influence of the institutional framework (time pressure and fatigue, cultural pressure to satisfy the ideal image of a surgeon), as well as the emotions they feel (including especially anxiety, fear, distress, guilt, and accountability).

Conclusions

Emotions are ubiquitous in surgeons’ experience, and their exposure to stress is chronic rather than acute. Considering emotions only in terms of their relations to operative errors (as previous studies have done) is limiting. Although complications are quite rare events, the concern for possible complications is an oppressive experience, regardless of whether or not they actually occur.     

Empathy among Medical Students: Is There a Relation with Quality of Life and Burnout?

Background

We aimed to assess medical students'' empathy and its associations with gender, stage of medical school, quality of life and burnout.

Method

A cross-sectional, multi-centric (22 medical schools) study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index), quality of life (The World Health Organization Quality of Life Assessment) and burnout (the Maslach Burnout Inventory) in a random sample of medical students.

Results

Out of a total of 1,650 randomly selected students, 1,350 (81.8%) completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d≥0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (β = 0.27; p<0.001) and perspective taking (β = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (β = −0.18) and perspective taking (β = −0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (β = 0.21; p<0.001) and lower personal distress (β = −0.26; p<0.001) scores.

Conclusions

Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with decreasing personal distress and was also a predicting variable for perspective taking.     

Pain and Empathy: The Effect of Self-Oriented Feelings on the Detection of Painful Facial Expressions

Background

Painful facial expressions have been shown to trigger affective responses among observers. However, there is so far no clear indication about the self- or other-oriented nature of these feelings. The purpose of this study was to assess whether facial expressions of pain are unconsciously associated with other-oriented feelings (empathic concern) or with self-oriented feelings (personal distress).

Method

70 participants took part in a priming paradigm in which ambiguous facial expressions of pain were primed by words related to empathic concern, distress, negative or by neutral words. It was hypothesized that empathic concern or distress-related words might facilitate the detection of pain in ambiguous facial expressions of pain, independently of a mere effect of prime (i.e., neutral words) or an effect of valence congruency (negative primes).

Results

The results showed an effect of prime on the detection and on the reaction time to answer “pain” when confronted to ambiguous facial expressions of pain. More specifically, the detection of pain was higher and faster when preceded by distress primes relative to either neutral or negative primes.

Conclusion

The present study suggests that painful expressions are unconsciously related to self-oriented feelings of distress and that their threat value might account for this effect. These findings thus shed new light on the automatic relationship between painful expressions and the affective components of empathy.     

Inter-individual relationships in empathic traits and feedback-related fronto-central brain activity: an event-related potential study

Background

Neuroimaging studies continue to indicate the major role the anterior cingulate cortex (ACC) plays in processing empathic responses. Error-related negativity (ERN), an event-related potential (ERP) thought to arise from the ACC, has been found to correlate with scores for individual empathic personality. This study investigated the relationship between empathic personality traits and the amplitude of feedback-related negativity (FRN), an ERP sourced from the ACC and similar to the ERN, using a task involving feedback of monetary gains or losses.

Methods

Sixteen healthy participants answered an empathy trait questionnaire and performed a gambling task to elicit FRN. Because FRN amplitude is thought to be associated with attention, motivation, emotional state, and anxiety trait, we performed a partial correlation analysis between the empathic trait score and FRN amplitude while controlling for variables.

Results

In partial correlation analysis, FRN amplitude was significantly inversely correlated with scores for personal distress and marginally correlated with scores for empathic concern and with total average score.

Discussion

The study revealed for the first time an association between FRN and emotional empathic traits, after controlling for variables that can affect FRN amplitude. However, we also found a reversed directional correlation contrary to our expectations. This fronto-central brain activity may be associated with empathic properties via dopaminergic neuronal function. Future study using these electric potentials as experimental tools is expected to help elucidate the neurological mechanism of empathy.

     

Alexithymia impact on EEG activity of anterior and posterior regions of the right hemisphere while experiencing positive and negative emotions

The present study was aimed to assess the influence of alexithymia (an emotional disorder associated with difficulties in identification and describing personal feelings) on regional activity while experiencing positive or negative emotional activation. The 62-channels EEG was recorded in non-alexithymic (n = 27) and alexithymic (n = 17) subjects viewing emotional film clips. Effects of alexithymia were found in the upper theta, low and upper alpha frequency bands; for all the bands the alexithymics exhibited greater reactivity of the right hemisphere, suggesting enhanced avoidance motivational tendencies, negative effect and autonomic arousal. The present phenomenon suggests engagement of additional cognitive resources in identification of emotional feelings. Such a 'cognitive effort' can be a result of impaired referential links and deficit of symbolic processing of emotions.     

Empathy in Cooperative Versus Non-cooperative Situations: The Contribution of Self-Report Measures and Autonomic Responses

Shared representations, emotion comprehension, and emotion regulation constitute the basic macro components of social empathy. The present study integrated two different measures of empathic behavior in a social context: verbal self-report measures (empathic response, emotional involvement and emotional significance, and valence), and autonomic responses (facial expression-corrugator supercilii and zygomaticus major muscle-, SCR-skin conductance-, and HR-heart rate-). Participants (N?=?thirty-five) were presented with different interpersonal scene types (cooperation, non-cooperation, conflict, indifference). Different empathic sensitivity to these interpersonal situations was verified, since self-rating on empathy, emotional involvement and valence varied as a function of interpersonal context. Situation rated as more empathically significant were considered also as the most positive (cooperation) and negative (non cooperation and conflictual) and emotionally significant (high emotional significance of the scenes) in comparison with neutral scenes. Nevertheless, subjective empathic response and personal emotional involvement were found to be dissociated measures in non-cooperative condition. On the autonomic level, facial mimicry was linked to and coherent with the empathic response in cooperative, non-cooperative and conflictual conditions, whereas SCR and HR were increased only in response to cooperative and conflictual situation, rated as more involving by the subject. The convergence of these multidimensional measures was discussed: empirical evidences are far from able to warrant claims that processes of emotional contagion and simulation provide the sole, primary important way by which we come to know what others are feeling.     

Empathy and Effortful Control Effects on Early Adolescents’ Aggression: When Do Students’ Perceptions of Their School Climate Matter?

Guided by the social emotional learning framework, this study examined whether early adolescents’ social awareness (empathic concern, perspective taking) and self-management (effortful control) would uniquely contribute to early adolescents’ subsequent forms of aggression, and whether perceptions of their school climate (friction, cohesion, competition, satisfaction with classes) would moderate those associations. Participants were 479 10- to 14-year old students (54% female; 78% European American) who completed the first wave of a survey in sixth and seventh grades and the second wave 1 year later. Hierarchical regression analyses indicated that across gender, empathic concern was the only competency to reduce subsequent overt and relational aggression. None of the school climate perceptions made unique contributions to aggression, nor did they show protective functions. Rather, several instances of cumulative advantage were observed, whereby positive school climate perceptions only reduced aggression for students with high levels of empathic concern. Unexpectedly, boys’ perceived cohesion contributed to overt aggression if they reported high levels of effortful control.     

Poor sleep quality affects empathic responses in experienced paramedics

Sleep and Biological Rhythms - The ability to experience emotional empathy is critical for vicariously sharing the emotional state of others. This important empathic skill is significantly affected...     

Not As Good as You Think? Trait Positive Emotion Is Associated with Increased Self-Reported Empathy but Decreased Empathic Performance

How is positive emotion associated with our ability to empathize with others? Extant research provides support for two competing predictions about this question. An empathy amplification hypothesis suggests positive emotion would be associated with greater empathy, as it often enhances other prosocial processes. A contrasting empathy attenuation hypothesis suggests positive emotion would be associated with lower empathy, because positive emotion promotes self-focused or antisocial behaviors. The present investigation tested these competing perspectives by examining associations between dispositional positive emotion and both subjective (i.e., self-report) and objective (i.e., task performance) measures of empathy. Findings revealed that although trait positive emotion was associated with increased subjective beliefs about empathic tendencies, it was associated with both increases and decreases in task-based empathic performance depending on the target’s emotional state. More specifically, trait positive emotion was linked to lower overall empathic accuracy toward a high-intensity negative target, but also a higher sensitivity to emotion upshifts (i.e., shifts in emotion from negative to positive) toward positive targets. This suggests that trait positive affect may be associated with decreased objective empathy in the context of mood incongruent (i.e., negative) emotional stimuli, but may increase some aspects of empathic performance in the context of mood congruent (i.e., positive) stimuli. Taken together, these findings suggest that trait positive emotion engenders a compelling subjective-objective gap regarding its association with empathy, in being related to a heightened perception of empathic tendencies, despite being linked to mixed abilities in regards to empathic performance. (Word count: 242).     

Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise

Recent brain imaging studies using functional magnetic resonance imaging (fMRI) have implicated insula and anterior cingulate cortices in the empathic response to another's pain. However, virtually nothing is known about the impact of the voluntary generation of compassion on this network. To investigate these questions we assessed brain activity using fMRI while novice and expert meditation practitioners generated a loving-kindness-compassion meditation state. To probe affective reactivity, we presented emotional and neutral sounds during the meditation and comparison periods. Our main hypothesis was that the concern for others cultivated during this form of meditation enhances affective processing, in particular in response to sounds of distress, and that this response to emotional sounds is modulated by the degree of meditation training. The presentation of the emotional sounds was associated with increased pupil diameter and activation of limbic regions (insula and cingulate cortices) during meditation (versus rest). During meditation, activation in insula was greater during presentation of negative sounds than positive or neutral sounds in expert than it was in novice meditators. The strength of activation in insula was also associated with self-reported intensity of the meditation for both groups. These results support the role of the limbic circuitry in emotion sharing. The comparison between meditation vs. rest states between experts and novices also showed increased activation in amygdala, right temporo-parietal junction (TPJ), and right posterior superior temporal sulcus (pSTS) in response to all sounds, suggesting, greater detection of the emotional sounds, and enhanced mentation in response to emotional human vocalizations for experts than novices during meditation. Together these data indicate that the mental expertise to cultivate positive emotion alters the activation of circuitries previously linked to empathy and theory of mind in response to emotional stimuli.     

Effects of a Dog-training Intervention on At-risk Youth

In the past few decades, interventions that involve animals have gained support among therapists, as they encourage verbal and non-verbal expressions of emotions. Our aim was to examine the impact of a dog-training intervention on the empathic skills of at-risk youth, compared with an intervention using empowerment groups. We hypothesized that participants in the dog-training group would report improved empathic abilities, compared with those in the comparison group. A prospective study was conducted, with a final sample of 55 at-risk youth: 30 in the dog-training group and 25 in the empowerment-based group (n = 25). Empathic skills were measured using the Interpersonal Reactivity Index, which consists of four subscales: fantasy abilities, perspective taking, empathic concern, and personal distress. We found a significant improvement in the empathic concern subscale only among participants in the dog-training group (F_(1,53) = 16.6, p < 0.01). This is discussed, along with limitations of the research and possible avenues for future research.     

Exploring Wellness of Wildlife Carers in New Zealand: A Descriptive Study

The rescue and care of vulnerable wildlife is rewarding. Most people involved in animal rescue have a strong commitment to service but the work can be profoundly challenging. The ability to know and respond appropriately to an animal's needs depends on the professional skills and knowledge of wildlife carers. In the face of unrelenting suffering and countless numbers of animals in need, there are multiple stressors, vulnerabilities, and barriers that can undermine carers’ wellbeing and put them at risk of compassion fatigue. The balance between compassion satisfaction and compassion fatigue is considered professional quality of life. The aim of this study was to provide a preliminary understanding of the potential for compassion satisfaction and the risk of compassion fatigue among wildlife carers within New Zealand. Thirty wildlife carers voluntarily completed a self-report survey, which included questions on socio-demographics, self-perceived quality of life (EUROHIS-QOL), professional quality of life (ProQOL), job satisfaction, motivation for ongoing work in wildlife rehabilitation, and coping mechanisms. We found that there were significant differences in compassion satisfaction and compassion fatigue on the basis of age, gender, financial capability, and years of experience. Overall, this sample showed high levels of compassion satisfaction and low levels of compassion fatigue. Understanding the elements of professional quality of life can have a positive effect on work environment. These results may provide clues to help identify wildlife carers’ strengths for compassion satisfaction and vulnerabilities to compassion fatigue, and to help develop strategies to improve their professional quality of life.     

Anterior Insula GABA Levels Correlate with Emotional Aspects of Empathy: A Proton Magnetic Resonance Spectroscopy Study

Background:

Empathy is a multidimensional construct referring to the capacity to understand and share the emotional and affective states of another person. Cerebral γ-aminobutyric acid (GABA)-ergic levels are associated with a variety of neurological and psychiatric disorders. However, the role of the GABA system in different dimensions of empathy has not been investigated.

Materials and Methods:

Thirty-two right-handed healthy volunteers took part in this study. We used proton magnetic resonance spectroscopy to determine GABA concentrations in the anterior insula (AI) and the anterior cingulate cortex (ACC) and to examine the relationship between the GABA concentrations and the subcomponents of empathy evaluated by the Interpersonal Reactivity Index (IRI).

Result:

Pearson correlation analyses (two-tailed) showed that AI GABA was significantly associated with the empathy concern score (r = 0.584, p<0.05) and the personal distress score (r = 0.538, p<0.05) but not significantly associated with other empathy subscales. No significant correlation was found between ACC GABA and empathy subscores.

Conclusion:

Left AI GABA was positively correlated with the emotional aspects of empathy. These preliminary findings call into question whether AI GABA alterations might predict empathy dysfunction in major psychiatric disorders such as autism and schizophrenia, which have been described as deficits in emotional empathic abilities.