Emotional contagion, empathic concern and communicative responsiveness as variables affecting nurses' stress and occupational commitment

Based on data gathered from registered nurses at two hospitals, this research examined the extent to which empathy variables contributed to nursing stress and occupational commitment. The empathy variables examined were emotional contagion (i.e. sharing the emotions of patients), empathic concern (i.e. being concerned for patients) and communicative effectiveness (i.e. effectively communicating with patients and their families). Nursing stress was explored through the variables of depersonalization, reduced personal accomplishment and emotional exhaustion. Multiple regression analyses revealed that the combination of the three emotional communication variables explained significant proportions of the variance in all three of the stress variables, as well as occupational commitment. The analyses further revealed that a lack of empathic concern and poor communicative responsiveness accounted for significant proportions of the variance in depersonalization. Lack of empathic concern, poor communicative responsiveness and high emotional contagion significantly contributed to reduced personal accomplishment. Emotional contagion explained a significant proportion of the variance in emotional exhaustion. Emotional contagion also significantly reduced occupational commitment. The findings are discussed in terms of nursing education and administration.     

Placing dental clinicians within the normative base regarding vicarious response

This paper describes the development and psychometric properties of the Curtin Vicarious Response Scales (CVRS), a research tool specifically developed to evaluate emotional reponsivity in clinical practice and in undergraduate training. The measure yields scores on three substantive scales, (I) Perspective Taking, the capacity to shift perspectives and to step outside of self when dealing with other people, (II) Empathy, the ability to understand another?s mental and emotional states and (III) Emotional Lability, affective sensitivity and changeability. The construct validity of the CVRS is unequivocal and concurrent validation demonstrates its expected place within personality space. The psychometric properties of the device demonstrate its viability as a research tool in the area of Empathy and Emotional Responsivity.     

Physiological and psychological responses induced by expressing empathy with others

Aim: To assess the physical and mental burdens associated with expressing empathy with another person's stress. Methods: Nine female subjects listened to their partner's negative emotions aroused by a stress task (Stroop color‐word test) under two conditions. In the first, the subject reacted empathetically to their partner (“with empathy”); in the second, the subject offered no response (control). Electroencephalograms and skin temperature of the second finger were recorded during the test. Subjective stress was estimated using a visual analog scale, whereas the level of cognition was expressed on a five‐point ranking. Responses during and after expressions of empathy were examined by comparisons with control or by correlation. Results: Sympathetic nerve tone increased under both conditions (i.e. the skin temperature of the second finger fell). Subjective stress was not recognized by the subject while listening “with empathy”, although it did increase significantly after the subject has listened “with empathy”. Subjective stress was not felt under the control conditions. Right temporal activity while listening showed a significantly positive correlation with the level of cognition of feeling the same emotion as the stressed partner, whereas bilateral frontal activity after listening was significantly negative correlated with the level of cognition of understanding the emotions of the stressed partner. Conclusion: Expressing empathy with another person's negative emotion led to increased physiological activity and subjective stress. Physiological responses to empathy depended on cognition of the different subjective factors. Cognition of sharing negative emotions activated the right temporal region of the brain, whereas cognition of understanding negative emotions inhibited bilateral frontal activities.     

Sex,Love and Incest

The author shows how Ferenczi's ideas from the 1920s and early 30s are being revived in interpersonal-relational thinking and how they have become integral to her work with a World Trade Center survivor. She specifically looks at Ferenczi's ideas about the importance of reliving, the healing power of new experience, the commingling of suffering, and the shared unconscious in psychoanalysis.     

护生共情能力与职业获益感的相关性研究

[目的]探讨护理实习生的共情能力、职业获益感水平及两者的关系。[方法]采用杰弗逊共情量表和职业获益感量表对福建省某三级甲等综合医院的201名护理实习生进行调查。[结果]护生的共情能力总分为(80.60±9.44)分,职业获益感总分为(59.95±16.27)分;共情能力与职业获益感呈正相关关系(r=0.395,P<0.01)。[结论]实习护生共情能力处于中等水平,职业获益感处于较低水平,两者存在正相关。护理教育者可根据两者现状及关系有针对性地制定提升共情能力和职业获益感的措施。     

The role of empathy in the care of dementia

The role of empathy in the care of dementia
The concept of empathy in relation to caring is reviewed. A variety of definitions of empathy are considered to show how empathy has been used within general nursing practice A wide range of literature is drawn on to gain insights into the multifaceted and diverse information on this topic. The differing perceptions that arise from various professional viewpoints are explored. A set of attributes are identified for empathy and these are considered in relation to clinical practice in elderly mental health.
Three examples of care are discussed to show how emotive empathy can be employed to give an improved direction to care of dementia clients. The concept is reviewed in relation to the particular needs of caring for dementia. It is suggested that it should be included in mental health training. It is concluded that emotive empathy has a vital part to play in the delivery of care for the elderly mentally ill.     

Discussing health care costs with patients

Escalating health care costs are affecting patients across the country. As employers and insurance companies face higher expenses, they may move to a cost-sharing strategy, which potentially increases financial burdens on patients. In this situation, physicians may find themselves serving as both medical and financial advisors for their patients. Clinical encounters in which patients experience financial hardship can be awkward and frustrating for both parties. Physicians must learn to discuss issues of affordability in a manner that builds, rather than detracts, from a therapeutic alliance. This article describes our experiences using several communication skills that can help in the discussion of health care costs with patients. The primary skill, empathic communication, which includes "we" statements and "I wish ..." statements, serves to create a platform for shared decision-making, negotiation, and a search for alternatives. In addition, it is helpful if physician offices have resource materials available and strategies identified to assist patients facing financial hardship.     

Synchronous caregiving from birth to adulthood tunes humans’ social brain

Mammalian young are born with immature brain and rely on the mother’s body and caregiving behavior for maturation of neurobiological systems that sustain adult sociality. While research in animal models indicated the long-term effects of maternal contact and caregiving on the adult brain, little is known about the effects of maternal–newborn contact and parenting behavior on social brain functioning in human adults. We followed human neonates, including premature infants who initially lacked or received maternal–newborn skin-to-skin contact and full-term controls, from birth to adulthood, repeatedly observing mother–child social synchrony at key developmental nodes. We tested the brain basis of affect-specific empathy in young adulthood and utilized multivariate techniques to distinguish brain regions sensitive to others’ distinct emotions from those globally activated by the empathy task. The amygdala, insula, temporal pole (TP), and ventromedial prefrontal cortex (VMPFC) showed high sensitivity to others’ distinct emotions. Provision of maternal–newborn contact enhanced social synchrony across development from infancy and up until adulthood. The experience of synchrony, in turn, predicted the brain’s sensitivity to emotion-specific empathy in the amygdala and insula, core structures of the social brain. Social synchrony linked with greater empathic understanding in adolescence, which was longitudinally associated with higher neural sensitivity to emotion-specific empathy in TP and VMPFC. Findings demonstrate the centrality of synchronous caregiving, by which infants practice the detection and sharing of others’ affective states, for tuning the human social brain, particularly in regions implicated in salience detection, interoception, and mentalization that underpin affect sharing and human attachment.

Being born a mammal implies that the brain is immature at birth and develops in the context of the mother’s body, lactation, and caregiving behavior (1). Infants rely on the provisions embedded in the mother’s body, sensory stimuli (2), and the expression of well-adapted caregiving for maturation of neurobiological systems that sustain participation in the social world. Extant research in animal models has shown that breeches in the mother’s continuous presence and variability in the consistency of caregiving carry long-term effects on brain structure and function, particularly on systems that underpin sociality, and these effects are maintained throughout life, altering the adult animal’s capacity to coordinate social bonds, manage hardships, and parent the next generation (3, 4). However, while the human brain is slowest to mature and requires the most extended period of dependence (5), the long-term consequences of caregiving for the human social brain are largely unknown. The current birth-to-adulthood study examines the effects of maternal–newborn skin-to-skin contact (Kangaroo Care, KC) and parent–child social synchrony experienced across development on the brain’s empathic response to others’ emotional states in young adulthood. Social synchrony describes the coordination between the parent’s and child’s nonverbal behavior and communicative signals during social interactions in ways that enhance positivity, reciprocity, and mutual engagement (6, 7), and we tested its longitudinal impact on the brain basis of empathy, a core feature of the social brain.The human social brain integrates activity of subcortical, paralimbic, and cortical structures to sustain human social life, which requires rapid processing of social inputs, top–down regulation of intention and affect, and coordination of the two into the present moment (8). The social brain has undergone massive expansion across primate evolution to support humans’ exquisite social skills, communicative competencies, and mindreading capacities. It has been suggested that Homo sapiens’ success over other hominin owes to their unique empathic abilities, which allow humans to quickly identify and mentally share others’ affective states (9). Such multifaceted empathy, which integrates automatic identification of others’ distinct emotions with the ability to use interoceptive signals to detect others’ specific affect and the capacity to reflect on the changing emotional states of social partners, marks a fundamental achievement of the human social brain. The empathic social brain, in turn, enabled humans to coordinate actions for survival, fine-tune communicative signal systems, and partake in the joys and sorrows of others (10). Yet, while empathy is a core feature of human sociality that is tuned in mammals by patterns of parental care, the relational precursors of the neural empathic response have not been fully explored in human studies.Social synchrony is first observed in the third month of life when parents begin to coordinate with the infant’s nonverbal signals and interactive rhythms. Synchrony continues to mature across childhood and adolescence with the parent’s and child’s increasing reciprocity and adaptation to each other’s verbal and nonverbal communications, affective state, and pace of dialogue and is considered a prototypical experience that prepares children to life with others (11, 12). Through ongoing adaptation first to the infant’s nonverbal cues and then to the older child’s verbal and affective communications, parents orient children to social moments, practice rapid assessment of distinct emotional states, and, over time, enable children to simulate others’ mental states, fine-tuning the social brain and its capacity for empathy (13). Social synchrony undergoes maturation across development and evolves from nonverbal matching to a verbal dialogue that acknowledges others’ emotions, engages multiple perspectives, and reflects on feelings while retaining the interactive rhythms of the familiar dialogue from infancy to adulthood (1). The early experience of synchrony plays a key role in children’s social–emotional development and has been shown to predict the child’s later ability to engage with peers (14, 15), regulate emotions (4), exhibit cognitive control (16), manage stress (17), and display empathic understanding (18), indicating that improvements in mother–infant synchrony during its early stages may have long-term effects on the capacity for empathy and its neural underpinnings.The development of synchrony is highly sensitive to initial conditions. Conditions that compromise maternal–infant bonding bear long-term negative consequences for the development of social synchrony and, consequently, for maturation of human social abilities (19, 20). When infants are born prematurely and full maternal–infant bodily contact is initially lacking, the development of synchrony is halted and socioemotional competencies compromised. Notably, when we provided structured maternal–infant skin-to-skin contact (KC) to premature neonates during the postpartum period, the intervention improved not only social synchrony but also the functioning of regulatory support systems, such as circadian rhythmicity, autonomic maturity, stress responsivity, and exploratory behavior, the same systems that are shaped in young mammals by contact with the mother’s body (17, 18) and consistent presence (21).What may be the effects of maternal–newborn skin-to-skin contact and synchronous caregiving across development on the social brain in young adulthood? Utilizing our unique cohort, we imaged the neural empathic response in three groups of healthy young adults who were recruited at birth: infants born at full-term (FT), preterm infants receiving kangaroo contact (KC), and demographically and medically matched preterm infants receiving standard incubator care (SC) who were followed in our laboratory for two decades (Fig. 1A). We focused on the neural basis of empathy, particularly on the brain’s capacity to detect, affectively share, reflect, and empathize with the different emotions of others (22). Two key hypotheses were tested. First, we expected that the provision of maternal bodily contact in the neonatal period would enhance the expression of social synchrony in infancy and across development. This hypothesis is based on research in animal models which shows that maternal bodily contact, consistent presence, and sensory stimuli improve maternal caregiving and have long-term effects on brain and behavior (21, 23–25). Second, we hypothesized that the experience of synchrony would augment the brain’s capacity to differentiate among others’ emotional states. Synchrony is a dyadic experience by which infants practice the identification and sharing of others’ emotions and, as they develop, learn to imbue others’ feelings with meaning and representations (26). We expected that such practice would tune the brain of young adults to empathize with others’ distinct emotions, particularly in areas that have been linked with parent–child synchrony in the parental brain, the amygdala (27, 28) and insula (29).Open in a separate windowFig. 1.Birth-to-adulthood longitudinal study design and fMRI paradigm. (A) Three cohorts of infants and parents recruited at birth: full-term (FT) infants and two case-matched neurologically intact premature infants assigned to either Kangaroo Care (KC: infants receiving skin-to-skin contact with mother) or matched controls receiving standard incubator care (SC). Mother–child social synchrony was assessed at 4 mo (SD =1.14), 3 y (SD = 1.38), 12 y (SD = 1.62), and 20 y (SD = 2.01). (B) fMRI empathy paradigm. Example illustrates a pseudorandomized design in which participants were presented with an emotional probe followed by four photos depicting this probe. Participants were asked to empathize with the protagonists, and five blocks per condition were presented.Using a longitudinal sample of n = 96 young adults who were followed from infancy, we first examined the neural basis of affect-specific empathy. We employed a validated functional MRI (fMRI) paradigm that exposed participants to others’ distinct emotions (joy, sadness, and distress) and asked them to mentally empathize with the protagonists (30) (Fig. 1B). Consistent with prior imaging studies on the brain regions activated during empathy tasks (31–33), we focused on a network of regions sustaining empathy. This included limbic regions: the amygdala, a key player in emotion detection (34), and the parahippocampal gyrus. Also included were the anterior insula, superior temporal sulcus (STS), and temporal pole (TP) that have been repeatedly implicated in human empathy research (32, 35). We also examined the ventromedial prefrontal cortex (VMPFC), precuneus, and inferior parietal gyrus, known as hubs of the default mode network, which is related to self-referential processing, perspective-taking, and theory of mind tasks (36, 37) and plays a key role in social understanding (38).We used Representational Similarity Analysis (RSA), a multivariate brain pattern analytic technique, to differentiate brain areas that show a distinct neural pattern while empathizing with specific affective states from those generally activated by the empathy task but without a unique response to each emotion. By using RSA, we aimed to compare the distinct neural patterns activated during empathy to different emotions and characterize the brain basis of affect-specific empathy (39). A recent study employing RSA to pinpoint the neural signature of basic emotions indicated that the amygdala, insula, medial prefrontal cortex, frontal pole, and precuneus showed distinct representations for different emotional states (40). Consequently, and in light of research highlighting the role of the amygdala in fear (41) and empathy for negative affective states (42), we focused on the amygdala as a key area that may present differential response during empathy to positive versus negative emotions. Similarly, the insula exhibits similar activations during empathy for physical pain and emotional distress (43, 44), and we expected the insula to show differential activations during empathy to distressing versus nondistressing affective states. Areas including the dorsomedial prefrontal cortex (DMPFC), VMPFC, insula, TP, and precuneus have been shown in research using multivoxel pattern analysis to display specific activation patterns to emotion-related actions and mentalization (36), and we expected these areas to exhibit specific activation patterns during empathy with others’ distinct emotions.