Empathic Distress Research Articles

Neuroanatomical and Functional Correlates of Cognitive and Affective Empathy in Young Healthy Adults.

Neural substrates of empathy are mainly investigated through task-related functional MRI. However, the functional neural mechanisms at rest underlying the empathic response have been poorly studied. We aimed to investigate neuroanatomical and functional substrates of cognitive and affective empathy. The self-reported empathy questionnaire Cognitive and Affective Empathy Test (TECA), T1 and T2∗-weighted 3-Tesla MRI were obtained from 22 healthy young females (mean age: 19.6 ± 2.4) and 20 males (mean age: 22.5 ± 4.4). Groups of low and high empathy were established for each scale. FreeSurfer v6.0 was used to estimate cortical thickness and to automatically segment the subcortical structures. FSL v5.0.10 was used to compare resting-state connectivity differences between empathy groups in six defined regions: the orbitofrontal, cingulate, and insular cortices, and the amygdala, hippocampus, and thalamus using a non-parametric permutation approach. The high empathy group in the Perspective Taking subscale (cognitive empathy) had greater thickness in the left orbitofrontal and ventrolateral frontal cortices, bilateral anterior cingulate, superior frontal, and occipital regions. Within the affective empathy scales, subjects with high Empathic Distress had higher thalamic volumes than the low-empathy group. Regarding resting-state connectivity analyses, low-empathy individuals in the Empathic Happiness scale had increased connectivity between the orbitofrontal cortex and the anterior cingulate when compared with the high-empathy group. In conclusion, from a structural point of view, there is a clear dissociation between the brain correlates of affective and cognitive factors of empathy. Neocortical correlates were found for the cognitive empathy dimension, whereas affective empathy is related to lower volumes in subcortical structures. Functionally, affective empathy is linked to connectivity between the orbital and cingulate cortices.

The role of microbiota and inflammation in self-judgement and empathy: implications for understanding the brain-gut-microbiome axis in depression

RationaleThe gut-brain axis includes bidirectional communication between intestinal microbiota and the central nervous system. Bifidobacterium and Lactobacillus spp. have been implicated in psychological health, such as depression, through various pathways (e.g. inflammation). Research needs a better understanding of direct and indirect effects through examination of psychological factors that make people susceptible to, or offer protection against, depression.ObjectiveThis study investigated the relationships between gut microbiota, inflammation and psychological risk and resilience factors for depression.MethodsForty participants (13 m/27 f) recruited from the general population completed self-report questionnaires for depression, self-judgement, over-identification and affective and cognitive empathy. Faecal and blood samples were taken to assay microbiota (Bifidobacterium; Lactobacillus spp.) and pro-inflammatory molecules (C-reactive protein, CRP and interleukin-6, IL-6), respectively.ResultsHierarchical regression analyses (controlling for sex, age and the shared variance of risk and resilience factors) showed that (i) cognitive depression was significantly predicted by negative self-judgement and reduced cognitive empathy; (ii) abundance of Lactobacillus spp. was directly related to positive self-judgement but only indirectly to cognitive depression and lower affective empathy (both through self-judgement); and (iii) CRP was the strongest predictor of reduced cognitive empathy, with suppression effects seen for age (negative) and IL-6 (positive) after controlling for CRP.ConclusionsFindings suggest that lactobacilli and inflammation may be differentially associated with mood disorder via brain mechanisms underpinning self-judgement and cognitive empathy, respectively. Further trials investigating interventions to increase Lactobacillus spp. in depression would benefit from direct measures of self-judgement and affective empathic distress, whilst those that aim to reduce inflammation should investigate cognitive empathy.

Is Self-Compassion Selfish? The Development of Self-Compassion, Empathy, and Prosocial Behavior in Adolescence.

Both self-compassion and empathy have been theorized to promote prosociality in youth, but there is little longitudinal data examining this possibility. We assessed self-compassion, empathy, and peer-rated prosociality yearly, in a cohort of 2,078 youth across 17 schools (M age at T1=14.65years; 49.2% female), as they progressed from Grade 9-12. We utilized multi-level modeling to predict prosocial behavior, nested within students, classes, and schools. We found that self-compassion and empathy uniquely predicted peer-rated prosocial behavior. However, only empathy predicted increases in prosocial behavior across time. While self-compassion is not selfish, it does not appear to facilitate the development of kindness toward adolescent peers. Self-compassion may help to buffer against possible negative effects of empathic distress.

Friends and foes: Neural correlates of prosocial decisions with peers in adolescence

Adolescence is a critical period for social orientation to peers and for developing social skills in interactions with peers. In the current study we examined the neural correlates of prosocial decisions for friends and disliked peers, and their links with participants' friendship quality and empathy as indices of social competence. Participants’ friends and disliked peers were identified using sociometric nominations. Mid-adolescents (Mage = 14.6; N = 50) distributed coins between themselves and another player in a set of allocation games where they could make prosocial or selfish decisions for their friends and disliked peers, as well as for neutral and unfamiliar peers. Participants made the most prosocial decisions for friends and the least prosocial decisions for disliked peers. Prosocial decisions for friends yielded activity in the putamen and posterior middle temporal gyrus (pMTG) when compared to prosocial decisions for disliked peers, and in the superior parietal lobule (SPL) and precentral gyrus when compared to prosocial decisions for unfamiliar peers. Selfish decisions for friends and decisions for disliked peers did not result in heightened neural activity. Exploratory analyses of the associations between these neural activation patterns and measures of social competence revealed that putamen activity related negatively to negative friendship quality and that empathic personal distress related positively to SPL and precentral gyrus activity. Together, the findings illustrated that the SPL, precentral gyrus, pMTG, and putamen may be involved in promoting the continuation of friendships, and that social competence may modulate these neural mechanisms.

Understanding of Emotions and Empathy: Predictors of Positive Parenting with Preschoolers in Economically Stressed Families

This study investigated predictors of sensitive and responsive parenting of 3- to 5-year old children within the context of a small urban Head Start system, serving mostly African American and Latino families (N = 86 dyads; 91% African American). Mothers and their children participated in a brief sadness induction (viewing a video clip validated for sadness induction in children), and mothers were subsequently asked to engage their child in discussion about the video. Mother-child discussions were videotaped and parenting behaviors and maternal affect were coded by trained raters. Controlling for maternal verbal ability, maternal facilitative emotional intelligence (understanding the adaptive functions of emotions) and aspects of maternal empathy (self-focused vs other focused emotional resonance) were examined as predictors of observed parenting with children during the interaction task. Higher levels of maternal facilitative emotional intelligence and lower levels of maternal empathic personal distress predicted sensitive and responsive parenting (maternal sensitivity; positive regard toward child), even after controlling for maternal verbal ability. Higher levels of maternal empathic personal distress predicted harsh and intrusive parenting (intrusive behaviors; expressions of anger and frustration). Results contribute to knowledge pertaining to predictors of parenting, particularly predictors of positive parenting. The results support the important and nuanced role of parental empathy in influencing parenting behaviors and point to facilitative emotional intelligence as an additional correlate of sensitive and responsive parenting. Measuring and investigating growth in parents’ facilitative emotional intelligence and empathic distress tolerance could help inform innovative new approaches to studying change processes in various parenting support programs.

Empathy and social closeness toward refugees from Syria: The mediating role of cultural intelligence.

The predictors of social closeness toward refugees are rarely examined. In this study (N = 337), higher cultural intelligence (CQ) and higher empathy were defined as predictors of higher social closeness (lower social distance [the Social Distance Scale] and warmer feelings [the Feeling Thermometer]) toward refugees from Syria. This is the target group of prejudice and intensive coverage in the European mass media. The obtained results indicated that other-oriented empathy (empathic concern and perspective taking) and the motivational CQ predicted higher social closeness and warmer feelings toward refugees from Syria. Empathic personal distress predicted lower social closeness and colder feelings toward this group. Motivational CQ consistently served as the mediator of the relationship between empathy dimensions and social closeness toward Syrian refugees. Our findings reveal the previously unexplored correlations between empathy dimensions and cultural intelligence factors, including the mediational effects in predicting social closeness toward Syrian refugees.

Family accommodation and empathic responses to persons with obsessive-compulsive symptoms: The moderating effect of consideration of future consequences

BackgroundAlthough families’ empathic responses can lead to family accommodation, the association between empathic responses to patients and accommodation remains to be examined quantitatively. Therefore, we examined the relationship between families’ empathic responses (empathic concern, personal distress, and perspective-taking) toward persons with obsessive-compulsive symptoms and, accommodation. Further, we examined whether consideration of future consequences moderated the association between these factors. MethodsSixty-nine families (mean age = 53.34 ± 11.75 years, 72% women) including persons with obsessive-compulsive symptoms completed several questionnaires assessing empathic responses, family accommodation, and consideration of future consequences. ResultsResults indicated that personal distress did not significantly predict accommodation; however, analyses showed that consideration of future consequences moderated the relationships between perspective-taking and accommodation (β = −0.78, p < .05). Among those low on consideration of future consequences, perspective-taking significantly positively affected accommodation (β = 0.59, p < .05). DiscussionWhen professionals help decrease accommodation in families with low consideration of future consequences, it may be effective to incorporate self-regulation strategies. Although this study provided key insights into the relationship between families’ empathic responses and accommodation, and the moderating effect of consideration of future consequences, a replication study is needed because of the relatively small sample size.

Empathic distress and concern predict aggression in toddlerhood: The moderating role of sex

Impaired empathy is an important risk factor of aggression, but results are contradictory in toddlerhood. The association between empathy and aggression may differ for empathic distress and empathic concern in response to empathy-evoking situations, and for boys and girls. Therefore, the current study investigated whether empathic distress and empathic concern at age 20 months (N = 133, 69 boys) predicted aggression at ages 20 and 30 months (N = 119, 62 boys), while taking a potential moderating effect of sex into account. Empathic behavior was observed during a distress simulation task 20 months post-partum. Physical aggression was assessed through maternal report, using the Physical Aggression Scale for Early Childhood. Linear regression analyses revealed sex differences in the associations between empathic distress and concern on the one hand and physical aggression at age 20 months on the other. Furthermore, physical aggression at age 30 months was predicted by the interaction of sex with empathic distress at age 20 months, while controlling for aggression at age 20 months. More empathic distress and concern were associated with less physical aggression in girls, but not in boys. The findings indicate that the prediction of physical aggression by empathic distress was more robust over time than for empathic concern. This study sheds new light on the intricate relationship between empathy, aggression, and sex from a developmental perspective.

Empathy and Emotion Regulation

In this paper, I evaluate one of the most prominent accounts of how emotion regulation features in empathy. According to this account, by Nancy Eisenberg and colleagues, empathy develops into either personal distress or sympathy depending on the ability to regulate one’s empathic distress. I argue that recent evidence suggests (1) that empathic distress and sympathy co-occur throughout the empathic episode, (2) that a certain degree of empathic distress may be necessary for prosocial motivation, as high emotion regulation leads to loss of this motivation, and (3) that emotion regulation is not an unmitigated good since much of it is achieved by dehumanizing the sufferer or minimizing her pain. A fertile ground for further research, I suggest, is the role of up-regulation of sympathy.

Reconceiving Decisions at the End of Life in Pediatrics: Decision-Making as a Form of Ritual.

Medical anthropologists have long recognized that healing practices and rituals may seek to address family dynamics, alter roles within a community, and resolve social rifts, and that illness itself may be rooted in social and cultural concerns as much as physical and biological ones. Within this framework, decision-making for children at the end of life can be conceptualized as a type of healing ritual, directed not at physical healing of the individual body, but at the healing of a family, which will continue beyond the patient's death. Using this lens, the decision-making process becomes more important than the decisions themselves, as it is the process itself that initiates, or interferes with, family healing. This essay presents anthropological perspectives on the goals of healing and healing rituals, providing examples in which the recipient of healing was not the patient but the family or community. Drawing on this scholarship, the author reconceives decision-making at the end of life in pediatrics as a form of healing ritual, explores how this perspective might help clinicians to reframe situations that provoke moral and empathic distress, and analyzes the ethical implications of these arguments.

Alexithymia explains increased empathic personal distress in individuals with and without eating disorders.

It is often assumed that empathy impairments are common in individuals with eating disorders (EDs), but empirical work has been limited and produced mixed results, making the clinical features and treatment needs of this population difficult to determine. Alexithymia, characterised by difficulties identifying and describing one's own emotions, frequently co-occurs with EDs and is associated with atypical recognition of, and empathy for, others' emotions. This study used an existing empathy for pain paradigm to determine whether atypical empathy in EDs stems from co-occurring alexithymia, rather than EDs per se. Empathy (specifically personal distress in response to others' pain) was assessed in individuals with EDs (N = 21) and an alexithymia-matched control group (N = 22). Participants were simultaneously members of a high alexithymia (N = 16) or low alexithymia (N = 27) group, allowing the independent contributions of alexithymia and EDs to be determined. Participants judged the laterality of hands and feet in painful and non-painful situations, and the degree of empathic interference on response times was measured. Results indicated that observation of painful stimuli affected task performance in those with high levels of alexithymia more than those with low levels, but no effect of ED diagnosis was observed. These findings suggest that co-occurring alexithymia explains increased empathic personal distress in ED populations. Atypical empathy may therefore not be a core feature of EDs, and interventions aimed at improving empathy-related social functioning may only be necessary for patients who also have alexithymia. These findings emphasise the importance of determining the influence of co-occurring alexithymia when assessing empathy in clinical populations.

Understanding the sex disparity in living kidney donation.

Living donors are the preferred source of organs for kidney transplantation, which is the treatment modality of choice for end-stage kidney disease. Health care systems widely promote living kidney donation. However, women are consistently overrepresented among living donors. The reasons behind the sex-based disparity in living kidney donation remain poorly understood. Compared to women, men possess a greater amount of kidney function, and the higher deceased donation rate among men reflects their higher overall kidney quality. A plausible medical explanation for the sex-based disparity in living kidney donation includes an uncompromising emphasis on preserving donor health, with less emphasis placed on organ quality, which is the main criterion in deceased donor selection. On the other hand, consent to deceased donation is also greater in women, indicating their greater desire to donate even though fewer women actually become deceased donors. Therefore, nonmedical reasons for the sex disparity in living donation must be sought. Increased empathic distress or emotional memory; a greater sense of responsibility, urgency, and impulsiveness with increased reaction to empathy; a different body image; and a different social status may all contribute to greater living kidney donation in women. Economic inequity may be the singular explanation when personal worth links to economic worth. To better understand the sex disparity in living kidney donation, we need better data on the reasons behind both nondonation and donor rejection after evaluation in clinical practice. Nondirected living kidney donation provides unique opportunities to minimize factors such as emotional distress, empathy, and impulsiveness. More liberal acceptance criteria for donors with isolated medical abnormalities and testing legitimate donor reimbursement strategies based on actual income levels rather than a fixed amount can assist in both ascertaining the reasons behind the sex disparity in living kidney donation and increasing overall living kidney donation rates.

Narrative Training as a Method to Promote Nursing Empathy Within a Pediatric Rehabilitation Setting

PurposeEmpathy is deemed essential to nursing, yet interventions that promote and sustain empathy in practicing nurses within healthcare organizations are limited. We tested the feasibility and perceived impact of an arts-based narrative training intervention involving pediatric rehabilitation nurses for the purpose of promoting nursing empathy. Design and MethodsOne-group qualitative repeated-measures design at an urban Canadian pediatric rehabilitation hospital. Eight nurse participants attended six 90-minute weekly group narrative training sessions and two in-depth interviews pre- and post-intervention. ResultsThe intervention positively impacted participants in three primary domains: Empathy for Patients and Families, Empathy Within Nursing Team, and Empathy for the Self. Major findings included: increased value placed on patients' and families' backstory, identification of “moral empathic distress” (MED), enhanced sense of collaborative nursing community, and renewal of professional purpose. ConclusionsThis study is the first of its kind conducted in the pediatric rehabilitation nursing context. Results indicate that arts-based narrative training enhances nursing empathy and contributes to a supportive nursing culture. Practice ImplicationsIn addition to enhancing empathy in clinical domains, nurses who participated in narrative training reported improved team collaboration, self-care practices, and renewed professional purpose. The results from the intervention are encouraging and future research needs to explore its utility in other settings with larger and more diverse sample.

Visual Attention to Suffering After Compassion Training Is Associated With Decreased Amygdala Responses.

Compassion meditation training is hypothesized to increase the motivational salience of cues of suffering, while also enhancing equanimous attention and decreasing emotional reactivity to suffering. However, it is currently unknown how compassion meditation impacts visual attention to suffering, and how this impacts neural activation in regions associated with motivational salience as well as aversive responses, such as the amygdala. Healthy adults were randomized to 2 weeks of compassion or reappraisal training. We measured BOLD fMRI responses before and after training while participants actively engaged in their assigned training to images depicting human suffering or non-suffering. Eye-tracking data were recorded concurrently, and we computed looking time for socially and emotionally evocative areas of the images, and calculated visual preference for suffering vs. non-suffering. Increases in visual preference for suffering due to compassion training were associated with decreases in the amygdala, a brain region involved in negative valence, arousal, and physiological responses typical of fear and anxiety states. This pattern was specifically in the compassion group, and was not found in the reappraisal group. In addition, compassion training-related increases in visual preference for suffering were also associated with decreases in regions sensitive to valence and empathic distress, spanning the anterior insula and orbitofrontal cortex (while the reappraisal group showed the opposite effect). Examining visual attention alone demonstrated that engaging in compassion in general (across both time points) resulted in visual attention preference for suffering compared to engaging in reappraisal. Collectively, these findings suggest that compassion meditation may cultivate visual preference for suffering while attenuating neural responses in regions typically associated with aversive processing of negative stimuli, which may cultivate a more equanimous and nonreactive form of attention to stimuli of suffering.

Mindfulness Among Genetic Counselors Is Associated with Increased Empathy and Work Engagement and Decreased Burnout and Compassion Fatigue.

Genetic counselors experience high rates of compassion fatigue and an elevated risk for burnout, both of which can negatively impact patient care and retention in the profession. In other healthcare professions, mindfulness training has been successfully used to address similar negative psychological sequelae and to bolster empathy, which is the foundation of our counseling work. We aimed to assess associations between mindfulness and key professional variables, including burnout, compassion fatigue, work engagement, and empathy. Data were collected via an anonymous, online survey that included validated measures of mindfulness and these key professional variables. The survey was completed by 441 genetic counselors involved in direct patient care. Half of the respondents (50.1%) reported engaging in yoga, meditation, and/or breathing exercises. Mindfulness was positively correlated with work engagement (r = 0.24, p < 0.001) andempathy (as measured through four subscales: perspective taking (r = 0.15, p = 0.002), empathic concern (r = 0.11, p = 0.03), fantasy (r = - 0.11, p = 0.03) and personal distress (r = - 0.15, p = 0.001)). Mindfulness was negatively correlated with compassion fatigue (r = - 0.48, p < 0.001) and burnout (r = - 0.50, p < 0.001). Given these findings, mindfulness training may be a valuable addition to graduate and continuing education for genetic counselors. The integration of mindfulness into the genetic counseling field will likely improve professional morale and well-being, while promoting workforce retention and bolstering the relational and counseling aspects of our clinical work.

Low Mood Leads to Increased Empathic Distress at Seeing Others' Pain.

Previous studies have shown changes in empathy in patients with depression, including an elevated level of trait personal distress. This study examined if low mood causes changes in self-reported empathic distress when seeing others in pain. To test this, we conducted an initial (n = 26) and close replication study (n = 46) in which sad mood was induced in healthy participants (overall mean age M = 21, SD = 5, range = 18–41 years). Participants viewed and rated video stimuli inferring pain experienced by other people. Results showed that participants perceived the videos depicting others’ pain (versus no-pain) to be more distressing under a sad mood compared to a neutral mood condition, implying that sadness enhances one’s emotional reactivity toward others’ distress. This supports previous depression literature suggesting an impaired emotional processing ability, and could contribute to some of the unhelpful behaviors seen in depression such as social withdrawal and avoidance.

Relationship with siblings as a predictor of empathy and humor styles in early adulthood

Aim of the studyThe issue of relationships with siblings in early adulthood is relatively rarely explored by researchers. The purpose of the presented research was to characterize this relationship and to define its importance for the interpersonal function of young adults.Subject or material and methodsThe study included 100 participants at an average age of 27.08 years (SD=4.38). In the surveyed group 60% were women (n=60) and 40% men (n=40). The following methods were used in the study: Adult Siblings Relationships Questionnaire – Short Form, the Empathic Sensitiveness Scale and Humour Styles Questionnaire.ResultsThe results of the research revealed that sisters have the relationships with siblings based on Warmth, achieve higher average results in Empathic Care and Personal Distress and lower average results in Self-defeating humour than brothers. Relational variables with predictive value for empathy and humour styles were identified in both groups. In the group of brothers, they explained a higher percentage of variance in results.DiscussionThe presented results indicate that the quality of relationships with adult siblings significantly influences selected dimensions of interpersonal functioning.ConclusionsThe results of the study broaden the psychological knowledge of family psychology and have application aspect.

The effects of compassionate mind training on student psychotherapists

PurposeThe purpose of this paper is to examine pre and post outcome measures following a course of Compassionate Mind Training (CMT). Participants were students enrolled on a Post Graduate Diploma in Cognitive Behavioural Psychotherapy (CBP). The aim of the research was to explore whether CMT would increase self-compassion, compassion for others, dispositional empathy and reduce self-critical judgement.Design/methodology/approachIn total, 21 participants who had enrolled on the CBP programme took part in the study. Data were collected using the self-compassion scale, interpersonal reactivity index, and the compassion for others scale.FindingsResults reveal an overall statistically significant increase in self-compassion scores and statistically significant reduction in self-critical judgement scores post training. There was no statistically significant difference post training on the interpersonal reactivity index or the compassion for others scale.Research limitations/implicationsCMT training may help students develop healthy coping strategies, which they can use to balance their affect regulation systems when faced with organisational, placement, client, academic, personal and supervision demands. Further research and longitudinal studies, using larger sample sizes are needed to explore if cultivating compassion whilst on psychotherapy training helps students build resilience and provide a barrier against empathic distress fatigue, compassion fatigue, secondary traumatic stress, and burnout.Practical implicationsIncorporating CMT into a CBP programme may bring changes in student levels of self-compassion and self-critical judgement.Originality/valueThis inaugural study examines whether incorporating CMT into a CBP programme impacts on students levels of compassion, dispositional empathy and self-critical judgement. The findings from this preliminary study suggest the potential benefits of training students in compassion focused practices.

A Preliminary Study of Empathy in Romanian College Students

Keywords The Interpersonal Reactivity Index is a self-report instrument used for assessing empathy. The theoretical model of empathy for IRI assumes that empathy is multidimensional in nature containing affective aspects (Empathic Concern and Personal Distress) and cognitive aspects (Perspective Taking and Fantasy). The objective of this study was to compare the level of empathy in Romanian college students to the level of empathy in American college students and to compare empathy in college students based on gender and field of study. The IRI was administered to a sample of 216 Romanian college students. We were interested only on Empathic Concern and Perspective Taking scales. The results revealed that Empathic Concern in Romanian college students is lower than in American college students, women score higher than men on the two scales used and students studying at humanities colleges have a higher Perspective Taking than students studying at science colleges. Our suggestion as a result of this study is to introduce more classes in the curriculum at the elementary school level to teach children empathy using diverse methods.

Empathic Care and Distress: Predictive Brain Markers and Dissociable Brain Systems

Encountering another's suffering can elicit both empathic distress and empathic care-the warm desire to affiliate. It remains unclear whether these two feelings can be accurately and differentially predicted from neural activity and to what extent their neural substrates can be distinguished. We developed fMRI markers predicting moment-by-moment intensity levels of care and distress intensity while participants (n= 66) listened to true biographies describing human suffering. Both markers' predictions correlated strongly with self-report in out-of-sample participants (r= 0.59 and r= 0.63, p<0.00001), and both markers predicted later trial-by-trial charitable donation amounts (p< 0.05). Empathic care was preferentially associated with nucleus accumbens and medial orbitofrontal cortex activity, whereas distress was preferentially associated with premotor and somatosensory cortical activity. In tests of marker specificity with an independent behavioral sample (n= 200), the empathic care marker was associated with a mixed-valence feeling state, whereas the empathic distress marker was specific to negative emotion.