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.     

Emotional intelligence as a mediator between attachment security and empathy in pre-clinical medical students: A multi-center cross-sectional study

ObjectiveTo explore the association of emotional intelligence (EI) and attachment security (AS) with empathy dimensions in medical students by examining the mediating role of EI.MethodsIn a cross-sectional design, the Interpersonal Reactivity Index (IRI), the Emotional Quotient Inventory (EQ-i), the Attachment Style Questionnaire (ASQ), and demographic questions were administrated to second-year medical students of two medical schools in Northern Italy.Results253 medical students (56.13% female), aged 19–29, participated in this study. AS positively correlated to Empathic Concern (r = 0.17, p = 0.008) and Perspective Taking (r = 0.24, p < 0.001), and negatively to Personal Distress (r = ?0.33, p < 0.001). Individuals with the same level of AS and a higher score on EQ-i had a higher score (β = 0.072, p = 0.033) on empathy latent factor (at the basis of Empathic Concern and Perspective Taking) and a lower score (β = ?0.290, p < 0.001) on Personal Distress than those with a lower EQ-i score.ConclusionThis study shows that EI completely mediated the relationship between AS and empathy dimensions among medical students.Practice implicationsEI training and workshop should be considered when designing educational interventions and programs to enhance empathy and decrease interpersonal distress in medical students.     

How reward modulates mimicry: EMG evidence of greater facial mimicry of more rewarding happy faces

Spontaneous mimicry is a marker of empathy. Conditions characterized by reduced spontaneous mimicry (e.g., autism) also display deficits in sensitivity to social rewards. We tested if spontaneous mimicry of socially rewarding stimuli (happy faces) depends on the reward value of stimuli in 32 typical participants. An evaluative conditioning paradigm was used to associate different reward values with neutral target faces. Subsequently, electromyographic activity over the Zygomaticus Major was measured whilst participants watched video clips of the faces making happy expressions. Higher Zygomaticus Major activity was found in response to happy faces conditioned with high reward versus low reward. Moreover, autistic traits in the general population modulated the extent of spontaneous mimicry of happy faces. This suggests a link between reward and spontaneous mimicry and provides a possible underlying mechanism for the reduced response to social rewards seen in autism.     

Right frontal cortical asymmetry predicts empathic reactions: support for a link between withdrawal motivation and empathy

Depression, diminished positive affect, and exaggerated negative affect have all been linked to right frontal cortical asymmetry as measured by electroencephalography (EEG). Emerging evidence, however, suggests that right frontal EEG asymmetry might be linked to empathic responding. EEG was used to assess baseline asymmetries in frontal brain activity. Participants viewed images associated with a charity and then rated their sadness, personal distress, perspective-taking, and empathic concern towards the images. We found that baseline measures of right frontal asymmetry were a significant predictor of empathic concern, a relationship that was mediated by feelings of sadness. These results provide a more complex view of right frontal asymmetry and suggest that this pattern of brain activity might facilitate sensitivity towards the suffering of others.     

The relationship between mirror-touch synaesthesia and empathy: New evidence and a new screening tool

People with mirror-touch synaesthesia (MTS) report tactile sensations on their own body when seeing another person being touched. Although this has been associated with heightened empathy and emotion perception, this finding has been disputed. Here, we conduct two experiments to explore this relationship further. In Experiment 1, we develop a new screening measure for MTS. We show that MTS is related to vicarious experiences more generally, but is not a simple exaggerated version of normality. For example, people with MTS report videos of scratching as “touch” rather than “itchiness” and have localized sensations when watching others in pain. In Experiment 2, we show that MTS is related to increased emotional empathy to others and better ability to read facial expressions of emotion, but other measures of empathy are normal. In terms of theoretical models, we propose that this is more consistent with a qualitative difference in the ability to selectively inhibit the other and attend to the self.     

共情与主观幸福感:情绪调节的中介作用

目的:探讨共情和情绪调节与个体主观幸福感的关系和作用机制。方法:问卷法。结果:①同情关怀与主观幸福感呈正相关,身心忧急与主观幸福感呈负相关。②同情关怀与正情绪增强型调节、负情绪增强型调节呈正相关,与正情绪减弱型调节呈负相关;身心忧急与负情绪增强型调节呈正相关,与负情绪减弱型调节呈负相关。③正情绪增强型调节与主观幸福感呈正相关,正情绪减弱型调节与主观幸福感呈负相关。④正情绪增强型调节在同情关怀和主观幸福感间起完全中介作用。结论:共情整体上通过对正性情绪的增强调节提高主观幸福感。     

Training in communication and emotion handling skills for students attending medical school: Relationship with empathy,emotional intelligence,and attachment style

ObjectiveTo describe the Emoty-Com training, its impact on medical students’ attitudes towards doctors’ emotions and to explore the association between students’ empathy, emotional intelligence (EI), and attachment style (AS) with post-training performance scores.MethodsThe 16-hour Emoty-Com training was delivered to all second-year medical students of Verona and Milan (Italy) Universities. At pre-training, students filled out three questionnaires assessing empathy, AS and EI and responded to three questions on attitudes towards doctors’ emotions in the doctor-patient encounter. The same three questions and a final evaluation test were proposed at post-training.Results264 students participated in the study. The training reduced students’ worry about managing emotions during doctor-patient relationships. Gender was associated with specific subscales of empathy, EI, and AS. Final performance scores were associated with students’ attitudes towards emotions but not with empathy, EI, and AS.ConclusionThe Emoty-Com training increased students’ self-efficacy in handling their own emotions during consultations. Students' performance scores were related to their attitude towards doctors’ emotions in clinical encounters.Practice ImplicationsThe Emoty-Com training suggests ways to teach and evaluate emotion-handling skills for medical students. Possible links between empathy, EI, AS, and the attitudes towards doctors’ emotions during the years of education are highlighted.     

Toward a consensus on the nature of empathy: A review of reviews

ObjectiveThe objective was to provide a synthesis of already synthesized literature on empathy in order to identify similarities and differences among conceptualizations.MethodsA review of reviews was conducted to locate synthesized literature published between January 1980 and December 2019. Two authors screened and extracted data, and quality-appraised the sources. A total of 52 articles deemed relevant to this overview were synthesized using thematic analysis.ResultsThe analysis resulted in four themes found in most empathy conceptualizations. In empathy, the empathizer (1) understands, (2) feels, and (3) shares another person’s world (4) with self-other differentiation.ConclusionsMost writings about empathy begin by claiming that there is far from a consensus on how empathy should be defined. This article shows a developing consensus among neuroscientists, psychologists, medical scientists, nursing scientists, philosophers, and others that empathy involves understanding, feeling, sharing, and self-other differentiation.Practice implicationsA clarification of the content of empathy may assist practitioners and researchers in avoiding confusion regarding the meaning of the concept, as well as in developing and measuring the relevant aspects of the concept.     

Error monitoring and empathy: Explorations within a neurophysiological context

Past literature has proposed that empathy consists of two components: cognitive and affective empathy. Error monitoring mechanisms indexed by the error‐related negativity (ERN) have been associated with empathy. Studies have found that a larger ERN is associated with higher levels of empathy. We aimed to expand upon previous work by investigating how error monitoring relates to the independent theoretical domains of cognitive and affective empathy. Study 1 (N = 24) explored the relationship between error monitoring mechanisms and subcomponents of empathy using the Questionnaire of Cognitive and Affective Empathy and found no relationship. Study 2 (N = 38) explored the relationship between the error monitoring mechanisms and overall empathy. Contrary to past findings, there was no evidence to support a relationship between error monitoring mechanisms and scores on empathy measures. A subsequent meta‐analysis (Study 3, N = 125) summarizing the relationship across previously published studies together with the two studies reported in the current paper indicated that overall there was no significant association between ERN and empathy and that there was significant heterogeneity across studies. Future investigations exploring the potential variables that may moderate these relationships are discussed.     

Investigating empathy in interpreter-mediated simulated consultations: An explorative study

Objective

To explore i) the ways in which empathic communication is expressed in interpreter-mediated consultations; ii) the interpreter's effect on the expression of empathic communication.

Culture and nonverbal expressions of empathy in clinical settings: A systematic review

ObjectiveTo conduct a systematic review of studies examining how culture mediates nonverbal expressions of empathy with the aim to improve clinician cross-cultural competency.MethodsWe searched three databases for studies of nonverbal expressions of empathy and communication in cross-cultural clinical settings, yielding 16,143 articles. We examined peer-reviewed, experimental or observational articles. Sixteen studies met inclusion criteria.ResultsNonverbal expressions of empathy varied across cultural groups and impacted the quality of communication and care. Some nonverbal behaviors appeared universally desired and others, culturally specific. Findings revealed the impact of nonverbal communication on patient satisfaction, affective tone, information exchange, visit length, and expression decoding during cross-cultural clinical encounters. Racial discordance, patients’ perception of physician racism, and physician implicit bias are among factors that appear to influence information exchange in clinical encounters.ConclusionCulture-based norms impact expectations for specific nonverbal expressions within patient-clinician dyads. Nonverbal communication plays a significant role in fostering trusting provider-patient relationships, and is critical to high quality care.Practice implicationsMedical education should include training in interpretation of nonverbal behavior to optimize empathic cross-cultural communication and training efforts should accommodate norms of local patient populations. These efforts should reduce implicit biases in providers and perceived prejudice in patients.     

Affective neuroscience and psychophysiology: toward a synthesis

This article reviews the author's program of research on the neural substrates of emotion and affective style and their behavioral and peripheral biological correlates. Two core dimensions along which affect is organized are approach and withdrawal. Some of the key circuitry underlying approach and withdrawal components of emotion is reviewed with an emphasis on the role played by different sectors of the prefrontal cortex (PFC) and amygdala. Affective style refers to individual differences in valence-specific features of emotional reactivity and regulation. The different parameters of affective style can be objectively measured using specific laboratory probes. Relations between individual differences in prefrontal and amygdala function and specific components of affective style are illustrated. The final section of the article concludes with a brief discussion of plasticity in the central circuitry of emotion and the possibility that this circuitry can be shaped by training experiences that might potentially promote a more resilient, positive affective style. The implications of this body of work for a broader conception of psychophysiology and for training the next generation of psychophysiologists are considered in the conclusion.     

Misdiagnosis and failure to diagnose in emergency care: Causes and empathy as a solution

Diagnostic error is the most frequent cause of allegations of negligence in emergency care in the United States and is estimated to contribute to the death of hundreds of thousands of patients worldwide each year. In this special contribution, we elucidate the cognitive mechanisms that emergency physicians use to make decisions and identify how these mechanisms can become sources of diagnostic error. The discussion centers on the appraisal of proposed methods to reduce the risk of diagnostic error, including debiasing strategies and a brief discussion of the theoretical basis for interventions to improve clinician empathy.     

Medical student empathy and breaking bad news communication in a simulated consultation

ObjectivesThis study examined the relationship between self-reported empathy and breaking bad news (BBN) communication skills performance in a sample of undergraduate medical students (n = 100) in the clinical years of their program.MethodsCorrelational and regression analysis examined the relationship between Jefferson Scale of Physician Empathy (JSPE-S) and Empathy Quotient (EQ) scores, and communication skills performance based on students’ application of the SPIKES protocol to a BBN scenario in a simulated encounter.ResultsHigher BBN communication skills performance was positively correlated with scores on the “Social Skills” EQ sub-scale (r (99) = 0.31, p = 0.002), which measures spontaneous and context-independent use of social skills. Multiple regression confirmed that “Social Skills” sub-scale variation predicted BBN score variation (B = 2.17, 95% CI = 0.65–3.69, p < 0.01). A weak positive association was also observed between BBN score and the “Standing in Patient’s Shoes” JSPE sub-scale (r (99) = 0.22, p = 0.03).ConclusionsFindings suggest that specific aspects of dispositional empathy may moderate BBN communications skills competence in medical students.Practice implicationsA better understanding of the moderating role of personality may lead to more tailored BBN communications skills training interventions and improved transfer of skills to workplace settings.     

Mimicking non-verbal emotional expressions and empathy development in simulated consultations: An experimental feasibility study

Objective

To explore the feasibility of applying an experimental design to study the relationship between non-verbal emotions and empathy development in simulated consultations.

Experiences of empathy training in healthcare: A systematic review of qualitative studies

ObjectiveTo synthesise qualitative studies reporting student, practitioner, or patient experiences of empathy-training in healthcare.MethodsWe included qualitative studies exploring (i) student or practitioner experiences of empathy training, or (ii) patient experiences of being treated by someone who has undergone empathy training. We used the Critical Appraisal Skills Programme (CASP) tool to assess study quality. Thematic synthesis was used to integrate findings from studies and to generate new insights.ResultsOur search yielded 2768 citations, of which 23 (1487 participants) met inclusion criteria. Two clusters of themes were identified from included studies. Firstly, themes related to practitioner/trainee professionalism and wellbeing, where the main finding was that participants experienced benefit from therapeutic empathy training. Secondly, themes related to the understanding and treatment of patients, where the main finding was practitioners’ deeper recognition of the positive impact of empathic care.ConclusionsThis review found that taking part in empathy-focused training can benefit practitioner/student personal growth and professional development, and benefits patient care. This review is limited by the difficulty in defining empathy and heterogeneity amongst included studies.Practice implicationsThese results support a rationale for empathy training and the development of a framework to ensure training is having the desired effect.     

Prefrontal modulation of tactile responses in the ventrobasal thalamus of rats

Prefrontal cortex (PFC) has been implicated in modulation of sensory information processing in somatosensory cortex. However, it remains unclear whether or not PFC regulates sensory information in thalamus. In the present study, the effect of PFC stimulation on tactile responses of neurons in the ventrobasal thalamus (VB) of the rat was investigated by single-unit recording. PFC stimulation significantly enhanced the signal-noise ratio (tactile responses/background activities) in 16 out of 66 VB neurons (24.2%) that had receptive fields in fore or hind limbs. Such changes can be classified into three different categories: (1) PFC stimulation not only increased the tactile responses, but also suppressed the background activities of neurons (six neurons, 9.1%); (2) PFC stimulation only increased the tactile responses of neurons (five neurons, 7.6%); (3) PFC stimulation only suppressed the background activities of neurons (five neurons, 7.6%). Our results suggest that PFC also modulates somatosensory information at the thalamic level.     

Rapid and highly resolving associative affective learning: Convergent electro- and magnetoencephalographic evidence from vision and audition

Various pathway models for emotional processing suggest early prefrontal contributions to affective stimulus evaluation. Yet, electrophysiological evidence for such rapid modulations is still sparse. In a series of four MEG/EEG studies which investigated associative learning in vision and audition using a novel MultiCS Conditioning paradigm, many different neutral stimuli (faces, tones) were paired with aversive and appetitive events in only two to three learning instances. Electrophysiological correlates of neural activity revealed highly significant amplified processing for conditioned stimuli within distributed prefrontal and sensory cortical networks. In both, vision and audition, affect-specific responses occurred in two successive waves of rapid (vision: 50–80 ms, audition: 25–65 ms) and mid-latency (vision: >130 ms, audition: >100 ms) processing. Interestingly, behavioral measures indicated that MultiCS Conditioning successfully prevented contingency awareness. We conclude that affective processing rapidly recruits highly elaborate and widely distributed networks with substantial capacity for fast learning and excellent resolving power.