Two experiments by de Wied et al. (2001) showed the content of the emotional cue can also have an influence on pain processing. Participants seeing pictures of people in pain had low pain thresholds; in contrast, negative pictures without a painful element seemed to have the same effect on pain thresholds as neutral pictures. According to Preston and de Waal (2002), perception of emotion activates the neural mechanisms that are responsible for the generation of emotions, described as the perception action model. This can also be the case for observing pain or ‘empathy for pain’ (Fan & Han, 2008; Singer, Seymour, O’Doherty, Kaube, Dolan & Frith, 2004; Ushida et al., 2008). The recent growing neuroscientific research on empathy for pain contributes to the knowledge about the effects of observed pain on brain areas involved in actual pain. From research on empathy for pain, it is clear that seeing someone else in pain activates the brain regions involved in the emotional-motivational aspects of pain: the ACC, insula and thalamus (Botvinick, Jha, Bylsma, Fabian, Solomon & Prkachin, 2005; Fan et al., 2008; Jackson, Brunet, Meltzoff & Decety, 2006; Jackson, Meltzoff and Decety, 2005; Morrison & Downing, 2007; Morrison, Lloyd, di Pellegrino & Roberts, 2004; Singer et al., 2004). But, researchers also found activation in the SI during processing of pain of others (Bufalari, Aprile, Avenanti, Di Russo & Aglioti, 2007). Not many researchers have examined the effects of empathy for pain on pain processing yet. Godinho, Magnin, Perchet and Garcia-Larrea (2006) found that pictures showing physical pain content enhanced SEP amplitudes in comparison to unpleasant pictures without reference towards pain. The effect was found later than 270 ms. Valeriani et al (2008) showed that observation of needle penetration reduced the N1/P1 component of the SEP, indicating effects of empathy for pain on SI and SII. The effects were explained by the competitive influence of the observed pain stimuli and painful stimulation. So, both Godinho et al. (2006) and Valeriani et al. (2008) found effects of empathy for pain on SEPs, but the temporal characteristics remain a topic for discussion.
Experiment 2 was designed to study the effect of empathy for pain on M1 excitability contralateral to the pricked hand. A figure-eight coil connected to a Magstim 200 stimulator (Magstim, Whitland, UK) was placed over the right or left M1, and MEPs were recorded from the first dorsal interosse- ous muscle contralateral to the side of the stimulated cortex. Electromyographic signals were sampled at 10 kHz. The intersection of the coil was placed tangentially to the scalp with the handle pointing backward and laterally at 45° from the midline. The coil was moved on the scalp to determine the optimal position from which maximal amplitude MEPs were elicited in the recording muscle. The intensity of mag- netic pulses was set at 120% of the resting motor thresholds, defined as the minimal intensity of the stimulatory output that produces MEPs with an amplitude of at least 50 μV with a 50% probability. A magnetic pulse was randomly delivered at 0, 1000, and 2000 ms after the onset of the video clips (Figure 1).
Empathy for pain has been shown to exist in animals other than humans. Chimpanzees, monkeys, and even rats demonstrate such empathy for pain (19, 20). Interestingly, following observation of a noxious stimuli applied to a conspecific, response to other modalities of nociceptive stimuli (such as thermal or electrical) changes, which demonstrates that central mechanisms are responsible for these alterations (11). Mogil et al were the first to report alterations in pain response following the application of noxious stimuli to a cage mate. They found that the first animals taken from a cage had a higher threshold for pain in comparison to the animals taken from the same cage after the return of the first animal to the cage (13, 14). This finding led to the discovery of empathy-like behaviors in rats by Langford et al (2006), who demonstrated that pain response of different modalities is altered following observation of pain in a conspecific (13, 14). The reason for conducting experiments on the cage mates came from the observations of Mogil et al and Lu et al. (2017), who demonstrated that being a cage mate is important in invocation of empathy in the animals (11-13, 21). Empathy might invoke several emotional responses in animals. In this study, anxiety-like behaviors were significantly increased in the pain observing animals. This shows that empathy for pain alters emotional processes as well. One of the mechanisms involved might be the changes in different brain regions. Singer et al (2004) demonstrated that brain regions responsible for affective dimensions of pain demonstrate altered activation patterns following empathy in humans (7, 22). One of the most important of these regions is anterior cingulate cortex (ACC), which is also involved in emotional response to noxious stimuli and modulation of affect and mood, including hedonic evaluation and behavioral prediction. Furthermore, it has been demonstrated that ACC function is altered in anxious subjects (23). Thus, it might be plausible to observe that empathy alters anxiety-like behaviors. Furthermore, more studies should be conducted to investigate the role of different brain regions in anxiety-like behavior alterations following empathy for pain and also different neural circuitry for these observations should be elucidated in future studies.
Definitions of empathy are manifold. They vary from empathy being the “appropriate understanding of another person” [ , p. 332] to the ability to understand and mir- ror patients’ feelings adequately  and the intention to help . A recent meta-ethnography identified a certain “conceptual confusion” [ , p. 1217] in medical students’ definition of empathy. Some authors see empathy as an emotion  or cognitive attribute  while others deem it a personality trait . Most authors can consent on em- pathy having a cognitive component, that means empathy being someone’s’ ability to understand and reflect some- one else’s emotions [e.g., [6, 8, 10, 11]]. According to Mer- cer and Reynolds  healthcarers’ empathy is a complex, multidimensional construct including: understanding the patient, reflecting your understanding, checking whether you understood the patient right and acting upon that un- derstanding in a therapeutic way.
model, greater emphasis on technological than hu- manistic aspects of medicine, and the developing sense of being part of an elite group are amongst the factors that contribute to a decline in empathy during medical education . Eight-year program students usually rank in the top 1% of high school graduates, and enjoy the highest standard of medical training, which may easily foster a sense of elitism and lead to de- terioration of empathy. On the other hand, this downward trend also suggests that empathy could be amenable to a range of educational interventions during medical school [34, 35], which might explain why empathy scores in- creased in other studies as students progressed through medical school [21, 27, 33]. Further research is required to identify factors that contribute to changes in empathy and to examine whether targeted educational strategies could help to retain, reinforce, and cultivate empathy among medical students.
191 | P a g e As Crocker concludes his thorough examination of development ethics and the promise of deliberative theory, with reference to ‘development ethicists,’ so too will I. For him, ‘beginning in and returning to their own local and national communities, development ethicists become part of global efforts to build institutions in which all human beings, regardless of where they are born, have a say in policies that affect them and fair opportunities to achieve a life they have reason to value. (Crocker 2008: 397). While I am in agreement with this abstract aspiration and ‘call to action’, it is to the spirit of Joan Tronto’s equally compelling call for the placement of care at the centre of our ethical considerations that I return. As Robinson argues, ‘it is through caring for those with whom we exist in relations of interdependence and responsibility that we learn how to listen, understand and be attentive to their needs (Robinson 2011a: 856). I suggest that Goulet’s invocation of the ‘Means of the Means’, would be best answered with a critical ethic of development which I have described as praxeological and collaborative- expressive in nature; an ethic which reflects how we do behave (and think and feel) in relation with one another; and an ethic which also reflects, imaginatively and empathically, how we might wish to behave together. At this critical juncture in the establishment of new goals for the next fifteen years of international development practice, meaningful engagement with both the realities of interdependence (and shifting positions of power and vulnerability across spaces and across time) and responsibility, will require that development ethicists engage with and within the pluriverse of development visions which care, empathy, and ultimately social justice most require of them now.
There are also several potential limitations. First, our method for measuring the difference between female and male practitioners was likely to be an underestimate. If studies with majority female practitioners resulted in greater patient-rated empathy, it is reasonable to assume that if all the practitioners were female, the difference between male and female practitioners would have been greater. In the context of this observational research we do not know whether the additional time caused female practitioners to be more empathic, or whether female practitioners ’ higher empathy caused them to spend more time with patients, or whether these two factors cannot be separated. Second, response bias [26, 31, 32] could have affected the results. Patients who know they are rating their practitioners may wish to please their practitioners,  for example by giving them higher scores than they otherwise would [31, 32]. The lack of response rate reporting in most of the studies makes the extent of this problem unclear. Furthermore, selection bias might have influenced the results: the CARE ques- tionnaire could be delivered in areas where the empathy of the practitioners is believed to be anomalous (either particularly high or particularly low). Next, the compari- son between countries could have been influenced by the number of studies per country. Specifically, some of the countries with low scores had very few studies (Croatia had 1, Ethiopia had 2, and India had 1). More- over in spite of validation of CARE translations, patients in different countries may have divergent prior expecta- tions and beliefs about what it means to be an empathic practitioner. Finally, the comparison with normative values (resulting in the average score we found being in the lowest 5%) is problematic. In spite of being relatively low, the average score is still above 40. Further work needs to be done to investigate the meaning of average CARE scores.
This paper attempts to assess the empathy as a skill needed in teaching. It also will note the importance of future teachers’ role in society. The application of new methods of teaching is gaining attention nowadays, but a special importance has still to be given to the social, psychological, and emotional relationship between the teacher and the student. The ability to move from one’s psychological perspective, to apprehend, to understand the other is a crucial element needed in teaching, which is considered as the skill of empathy. This case study endeavors to measure the level of empathy of in-service teachers and if they regard it as an important element in teaching. Future teachers will also be taken into consideration in order to evaluate their ability of understanding not only perceptions, thoughts and beliefs of their future students but also their needs, feelings and emotions. Another important form of empathy, also called “compassionate empathy”, takes our attention in this case study. It has to do with the ability to experience feelings that show care and emotional connection with other people’s feelings, concerns, situations, or circumstances. This paper tries to identify the current level of empathy as a skill in some schools in Albania, but it also furnishes future teachers with information regarding empathy as a skill, its importance and tools needed in order to implement this skill for a more accurate teaching process. It also will help future teachers to build a friendlier environment and make their pupils feel at ease and help them become better citizens for our society.
Another limitation is that our assessment of empathy was confined to self-report measures as provided by the IRI. However, clinical studies demonstrate that patient groups showing disturbed empathy as measured by the IRI also perform worse in objective tests of empathy and social behavior as well as in judgments of patients’ empathic skills by relatives (Cusi et al. 2010, 2012; Shany-Ur et al., 2012; Beadle et al., 2013), and direct correlations of IRI measures with objective empathy measures in healthy subjects con- firm a generally positive relationship (Rogers et al. 2007; Dziobek et al. 2008). These findings indicate that biases to which self reports may be more susceptible than other measures (e.g., social desirability) do not challenge their general validity. Still, future studies further examining the relationship between empathy and memory should also include objective tests of empathy. Another aspect to be further explored in relation to memory processing would be state empathy, i.e. transient empathic reactions to spe- cific situations, rather than dispositional trait empathy that was in the research focus here. Furthermore, especially from the perspective of basic research that we are adopting here, more non-clinical studies would be needed to circum- vent the interpretation problems that arise from data ob- tained in patient groups, as mentioned above (see also Choong and Doody 2013).
When examining cognitive empathy deficits among children with elevated CU traits, results are mixed. Among the extant research, some studies have shown that youth with high levels of CU traits show deficits in cognitive empathy when measured by affective facial recognition (Dadds et al., 2009) or self-reports of perspective-taking (Chabrol et al., 2011; Pardini et al., 2003). However, other studies employing emotion recognition (Schwenck et al., 2012; Dadds et al., 2012) or cognitive perspective-taking tasks (Anastassiou-Hadjicharalambous & Warden, 2008; Cheng et al., 2012; Jones et al., 2010) found youth high on CU traits did not exhibit deficits in cognitive empathy. Importantly, the study by Dadds and colleagues (2009) suggests age differences in the association between empathy and CU traits. Specifically, this study found that parent reported CU traits were associated with both emotional and cognitive empathy deficits in boys under the age of nine, but they were unrelated to cognitive empathy deficits after this age (Dadds et al., 2009). These findings suggest that youth with CU traits may be more likely to exhibit deficits in cognitive empathy earlier on (along with affective empathy deficits) but learn perspective-taking later in development.
Patients referred for orthopaedic consultation (n = 13) were recruited from two health care centres in the re- gion of Västra Götaland, Sweden, during February to August 2016. A purposeful sampling strategy was used , with the aim of obtaining a variation of gender, age and pain location for referral. Data collection was intended to continue until no new information seemed to be forthcoming in the interviews. Inclusion criteria were: patients of working age (18–67 years) with sub- acute (4 weeks–3 months) or persistent (>3 months) pain due to MSDs, who were referred for orthopaedic consultation, with the ability to understand and speak Swedish. The exclusion criteria were based on a previ- ously published protocol for a randomised controlled trial (RCT) , and were chosen in collaboration with an orthopaedic surgeon. Patients were excluded if the stated diagnosis on the referral was hallux valgus, gan- glion or trigger finger.
lecture sessions and the issue of emotional management hardly touched upon. It is important to acknowledge that social work practice is emotionally demanding and a lack of competence in terms of dealing with emotions can have an adverse impact on the practitioner as well as on service users (Cooper, 2005, Howe, 2008). There is hence the need for a concerted effort to ensure that a variety of teaching techniques and classroom methodologies are used to inculcate skills of empathy, emotional regulation and reflective ability in student social workers to enable them to consciously incorporate these skills within their professional repertoire.
experiences of similar circumstances to imagine how another would feel. Meanwhile, in other- focused role-taking, “people focus directly on the victim and imagine how he feels” (p. 54). 3 As a result of other-focused role-taking, the observer may have feelings similar to the victim’s. Hoffman suggests that the latter form of role-taking may be enhanced if the observer has more personal information regarding the victim, including understandings of “his character, life- condition, [and] behavior in similar situations” (ibid.). Furthermore, he argues that a cognitive empathic response can be improved if the observer has additional normative knowledge of how most people would feel in the same circumstance. Therefore, programs dedicated to educating for empathy can foster more effective role-taking capacities if they explore normative emotional responses to normative stimuli.
Empathy is a basic competency of helping relationship and an integral component of person-centered care. Person-centered care, in turn, improves the quality of care and patients’ outcomes [14, 16]. Empathy towards patients increased patients’ satisfaction and reduced their distress . Empathy has been defined as a cognitive attribute involving an understanding of patients’ experi- ences, concerns, and perspectives together with the abil- ity to communicate this understanding and the intention to help . Iranian hospitalized elderly patients re- ported their needs for an empathetic understanding . On the other hand, a qualitative study showed that nurse assistance communication with elderly people in home care was mostly task-oriented and that person-oriented communication had to be promoted in nurse-elderly communication . In addition, it has been reported that nursing students’ empathy towards elderly people somewhat decreased during academic education [21, 22]. Empathy is a teachable competency , which is particularly important for students in the last years of their education. Therefore, it is important to investigate evidence-based interventions to improve nursing stu- dents’ empathy and attitudes towards elderly people.
A one-way between-groups analysis of variance was conducted to explore the impact of empathy on levels of positive coping, as measured by Compas and colleagues (2001). Participants were divided into three groups according to their levels of empathy (low, average, high). There was a statically significant difference at the p < .05 level in coping scores for the empathy groups: F(2, 120) = 6.63, p = .01. Despite reaching statistical significance, the effect size (Eta squared) was .09, which is classified by Cohen as having a medium effect. Post-hoc comparisons using the Tukey HSD test indicated that the mean score for Low Empathy (M = 2.72, SD = .77) was significantly different from High Empathy (M = 2.87, SD = 3.6). When trying to predict empathy with demographics and internal factors (e.g., self-control), parental care (β =-.49, p < .001) and positive coping skills (β = .38, p <.01) were significant predictors for higher empathy among females. Social capital was a trending variable for females but not significant by traditional p-value standards. None of the predictor variables significantly predicted level of empathy among males (see Table 4).
is caused by such overarousal (Decety & Lamm, 2006; Eisenberg, 2000). Hoffman (2000) conceived of empathic overarousal as “an involuntary process that occurs when an observer’s empathic distress becomes so painful and intolerable that it is transformed into an intense feeling of personal distress, which may move the person out of the empathic mode entirely” (p. 198). If complementarity of the CE and EE systems has been selected for during evolution, then disruption to the neural basis of the CE system could be accompanied by disinhibition of the EE system in both development and on-line processing. People with CE deficit disorder would thus be particularly susceptible to parallel affect and personal distress, without necessarily being conscious of the empathic origin of such feelings. In balanced empathy, CE provides crucial top-down processing that harnesses EE (Decety & Lamm, 2006). For example, psychotherapists, compared with matched controls, appear to have superior CE ability and a lower susceptibility to personal distress (Hassenstab, Dziobek, Rogers, Wolf, & Convit, 2007). Clinicians have observed that people with autism can be very distressed by others’ emotions (e.g., Attwood, 1993), and I propose that this distress is caused by empathic overarousal. On the basis of the EIH, one might predict that people with autism would be more willing to pay attention to calm, happy people than to distressed or angry people. Exuberant positive emotion in others may also sometimes cause confusion and an uncomfortable degree of empathic arousal in children with autism. Indeed, there is evidence that children with autism, unlike control participants, respond avoidantly to praise by looking away or turning away from the people who are praising them (Kasari, Sigman, Baumgartner, & Stipek, 1993).
problems recruited from the community (Jones, Happé, Gilbert, Burnett, & Viding, 2010), in line with the empathy imbalance theory of Smith (2009, 2010). In addition, studies that examined only cognitive empathy showed normal cognitive empathy (Sutton, Reeves, & Keogh, 2000; Woodworth & Waschbusch, 2008). However, these studies investigated empathy by using questionnaires and failed to measure affective empathy with physiological measures. Although physiological arousal is not synonymous with affective empathy, it certainly represents a reliable, objective, and direct measure of affective empathy (Bons et al., 2013), and has often been related to antisocial behaviour (e.g. Gao, Raine, Venables, Dawson, & Mednick, 2010; Van Goozen, 2015). Furthermore, verbal reports of one’s own experienced emotion (-s) are difficult, especially for antisocial boys, who are known to have low verbal IQ and problems with self-reflection, which could result in unreliable self-reported affective empathy (Bowen, Morgan, Moore, & van Goozen, 2014; Tyson, 2005). Similarly, studies that used physiological measures to assess affective empathy often did not include measures of cognitive empathy. These affective empathy studies reported that children with disruptive behaviour disorders (De Wied, Boxtel, Posthumus, Goudena, & Matthys, 2009; De Wied, van Boxtel, Matthys, & Meeus, 2012; De Wied, van Boxtel, Zaalberg, Goudena, & Matthys, 2006), and children with conduct disorder with and without CU-traits (Marsh, Beauchaine, & Williams, 2008) displayed decreased physiological responses and thus less affective empathy in response to negative emotions. With the present study we extend the existing literature by using objective physiological measures for affective empathy, combined with both cognitive and affective empathy.
Results. The mean empathy score in final-year medical students was 107 (standard deviation (SD) 10.9). The mean empathy score was higher in 95 female students than in 63 male students (109 SD 9.8 v. 104 SD 12) (t=2.51; p<0.013). The inter-item score correlations were positive and statistically significant. Cronbach’s coefficient alpha was 0.79. Factor analysis using principal component analysis identified three factors that are generally consistent with the grand conceptual aspects of the notion of empathy in the JSPE-S (viz. perspective taking, compassionate care and standing in the patient’s shoes).