empathy research

‘I Feel Your Pain’: The Neuroscience of Empathy

• Developmental Psychology
• Forecasting
• Neuroscience
• Sensory Systems

Whether it’s watching a friend get a paper cut or staring at a photo of a child refugee, observing someone else’s suffering can evoke a deep sense of distress and sadness — almost as if it’s happening to us. In the past, this might have been explained simply as empathy, the ability to experience the feelings of others, but over the last 20 years, neuroscientists have been able to pinpoint some of the specific regions of the brain responsible for this sense of interconnectedness. Five scientists discussed the neuroscience behind how we process the feelings of others during an Integrative Science Symposium chaired by APS Fellow Piotr Winkielman (University of California, San Diego) at the 2017 International Convention of Psychological Science in Vienna.

Mirroring the Mind

Cultural emphasis on ingroups and outgroups may create an “empathy gap” between people of different races and nationalities, says Ying-yi Hong .

“When we witness what happens to others, we don’t just activate the visual cortex like we thought some decades ago,” said Christian Keysers of the Netherlands Institute for Neuroscience in Amsterdam. “We also activate our own actions as if we’d be acting in similar ways. We activate our own emotions and sensations as if we felt the same.”

Through his work at the Social Brain Lab, Keysers, together with Valeria Gazzola, has found that observing another person’s action, pain, or affect can trigger parts of the same neural networks responsible for executing those actions and experiencing those feelings firsthand. Keysers’ presentation, however, focused on exploring how this system contributes to our psychology. Does this mirror system help us understand what goes on in others? Does it help us read their minds? Can we “catch” the emotions of others?

To explore whether the motor mirror system helps us understand the inner states behind the actions of others, Keysers in one study asked participants to watch a video of a person grasping toy balls hidden within a large bin. In one condition, participants determined whether or not the person in the video hesitated before selecting a ball (a theory-of-mind task). Using transcranial magnetic stimulation (TMS) in combination with fMRI, Keysers showed that interfering with the mirror system impaired people’s ability to detect the level of confidence of others, providing evidence that this system indeed contributes to perceiving the inner states of others. Performing fMRI and TMS on other brain regions such as the temporoparietal junction (TPJ) further suggests that this motor simulation in the mirror system is then sent onward to more cognitive regions in the TPJ.

“Very rapidly, we got this unifying notion that when you witness the states of others you replicate these states in yourself as if you were in their shoes, which is why we call these activities ‘vicarious states,’” Keysers said.

Studies have suggested that this ability to mentalize the experiences of others so vividly can lead us to take prosocial steps to reduce their pain, but Keysers also wanted to investigate the depth of this emotional contagion — how and to what extent we experience other people’s suffering. To do this, Keysers’ lab studied two very different populations: human psychopaths and rats.

While witnessing the pain of others is correlated with activity in the insula, which is thought to contribute to self-awareness by integrating sensory information, and the anterior cingulate cortex (ACC), which is associated with decision making and impulse control, the researchers found that psychopaths who passively observed an aggressor twisting someone’s hand exhibited significantly less brain activity than their neurotypical peers. When the psychopathic individuals were asked to attempt to empathize with the person in the video, however, their brain activity increased to baseline levels.

This suggests that the current model of empathy as a one-dimensional scale with empathic individuals at one end and psychopaths at the other may be overly simplistic, Keysers said.

“Psychopaths are probably equally high on ability, it’s just that they don’t recruit this spontaneously, so their propensity is modified,” he explained.

These findings could lead to more effective interventions for psychopathic individuals, as well as to future research into where people with autism spectrum disorders may fall on these axes.

Shared Pain

Studies of emotional contagion in animal models have allowed researchers to further examine the role of deep brain activity, which can be difficult to neurostimulate in humans. Keysers’ work with rats has found that these animals are more likely to freeze after watching another rat receive an electric shock if they themselves had been shocked in the past.

Inhibiting a region analogous to the ACC in the rats’ brains reduced their response to another rat’s distress, but not their fear of being shocked themselves, suggesting that the area deals specifically with socially triggered fear, Keysers said.

Claus Lamm, University of Vienna, investigates the processes that regulate firsthand pain and those that cause empathy for pain through numerous studies on the influence of painkillers.

In these experiments, participants who took a placebo “painkiller” reported lower pain ratings after receiving a shock than did those in the control group. When those same participants watched a confederate get shocked, they reported a similar drop in their perception of the actor’s pain.

“If you reduce people’s self-experienced pain, if you induce analgesia, that not only helps people to deal with their own pain, but it also reduces empathy for the pain of another person,” Lamm said.

On the neural level, Lamm said, fMRI scans showed that people in the placebo group displayed lower levels of brain activity in the anterior insula and mid cingulate cortex in both cases. These results were further confirmed in another study that compared participants who received only the painkiller placebo with those who received both the placebo and naltrexone, an opioid antagonist that prevents the brain from regulating pain.

This resulted in a “complete reversal” of the placebo effect, causing participants to report both their own pain and the pain of others at near baseline rates, supporting Lamm’s previous claims about the pain system’s role in empathy.

“This suggests that empathy for pain is grounded in representing others’ pain within one’s own pain systems,” Lamm said.

The Self/Other Divide

Empathy may not give us a full sense of someone else’s experiences, however. When observers in one of Keysers’ studies were given the opportunity to pay to reduce the severity of the electric shocks a confederate was about to receive, on average participants paid only enough to reduce her pain by 50%.

Lamm studied this self/other distinction through a series of experiments that measured people’s emotional egocentricity bias. To do so, participants were presented with visuo-tactile stimulation that was either congruent or incongruent with that of a partner under fMRI. In an incongruent pair, for example, one participant might be presented with an image of a rose and be touched with something that felt like a rose, while the other was shown a slug and touched with a slimy substance.

Participants’ own emotions were found to color their perception of other people’s affect at a relatively low rate — however, when researchers inhibited the right supramarginal gyrus (rSMG), a region of the brain previous associated mainly with language processing, this egocentricity bias increased, suggesting that the rSMG may be responsible for maintaining a self/other divide, Lamm said.

“Empathy not only requires a mechanism for sharing emotions, but also for keeping them separate. Otherwise we are getting ‘contaged,’ emotionally distressed and so on,” he said.

The rate of rSMG activation also changes significantly across a lifetime, Lamm added, with the area’s developmental trajectory causing emotional egocentricity to be more common in adolescents and the elderly.

Developing Division

Researchers are working to unite neuroscientific and psychological perspectives on feelings, empathy, and identity, says Piotr Winkielman .

Rebecca Saxe (Massachusetts Institute of Technology) said her work with developmental psychology confirms this trend. In one series of experiments, Saxe monitored the brain networks that 3- to 5-year-old children used to consider a character’s mind (the temporoparietal junction, posterior cingulate, and prefrontal cortex) and body (the secondary somatosensory cortex, insula, middle frontal gyrus, and ACC) throughout a short film.

Saxe found that while these brain regions may interact with each other, there were no points of overlap between the mind and body networks’ activities.

“When we’re getting information from the same source and about the same people, we still nevertheless impose a kind of dualism where we alternate between considering what their bodies feel like and the causes of their minds,” Saxe said.

Furthermore, Saxe and her colleagues found that while these networks were more distinct in children who were able to pass an explicit-false-belief task (e.g., if Sally puts her sandwich on a shelf and her friend moves it to the desk, where will she look for it?), the division was present in participants of all ages.

“Most people have treated explicit false belief as if it were the milestone,” Saxe said. “Actually, the false-belief task is just one measure of a much more continuous developmental change as children become increasingly sophisticated in their thinking about other people’s minds.”

Next, Saxe scaled this experiment down to test the theory of mind of infants as young as 6 months, this time measuring their response to children’s facial expressions, outdoor scenes, and visual static. This time period may be key to understanding the neuropsychology of empathy because most of the brain’s cognitive development happens within the first year of life, she explained.

“A baby’s brain is more different from a 3-year-old’s brain than a 3-year-old’s brain is from a 33-year-old’s brain,” Saxe said.

Under fMRI, the infants’ brains were found to have many of the same regional responses that allow adults to distinguish between faces and scenes. Their brains didn’t show any regional preferences for objects and bodies, however.

This level of regional specificity suggests that the Kennard Principle, the theory that infants’ brains possess such resilience and plasticity because the cortex hasn’t specialized yet, may be only partially true. There does appear to be some functional organization of social process, Saxe said, with gradually increasing specialization as the child ages.

Empathy in Action

Brian D. Knutson says analysis of individuals’ brain activity when considering a purchase may be predictive of aggregate market choices.

On the surface, neuroforecasting sounds like a concept that would be right at home in the world of Philip K. Dick’s Minority Report — a science fiction thriller about a society that stops crime before it happens based on the brainwaves of three mutant “precogs” — said APS Fellow Brian D. Knutson (Stanford University), but someday it could play a very real role in the future of economics.

Knutson’s research on the brain mechanisms that influence choice homes in on three functional targets: the nucleus accumbens (NAcc) for gain anticipation, the anterior insula for loss anticipation, and the medial prefrontal cortex (mPFC) for value integration.

Using fMRI, Knutson was able to predict participants’ purchases in a simulated online shopping environment on the basis of brain activations in these areas. Before participants chose to buy a product, increased activity in the NAcc and mPFC was paired with a decrease in the insula, while the reverse was true of trials in which participants chose not to make a purchase.

“This was very exciting to me as a psychologist to be able to say, ‘Wow, we can take activity out of the brain and, not knowing anything else about who it is and what product they’re seeing, we can predict choice,’” Knutson said.

His economist colleagues weren’t as impressed: They were interested in market activity, not individual choice. Knutson said he accepted this challenge by applying his neuroanaylsis to large-scale online markets such as Kiva and Kickstarter.

Knutson asked 30 participants to rate the appeal and neediness of loan requests on Kiva and found that posts with photos of people displaying a positive affect were most likely to trigger the increased NAcc activity that caused them to make a purchase — or in this case, a loan. More importantly, the averaged choices of those participants forecasted the loan appeal’s success on the internet. Two similar studies involving Kickstarter campaigns also suggested a link between NAcc activity and aggregate market activity.

While brain activity doesn’t scale perfectly to aggregate choice, Knutson said, some components of decision making, such as affective responses, may be more generalizable than others.

“The paradox may be that the things that make you most consistent as an individual, that best predict your choices, may not be the things that make your choices conform to those of others. We may be able to deconstruct and decouple those components in the brain,” Knutson said.

Global Empathy

The neuroanatomy of our brains may allow us to feel empathy for another’s experiences, but it can also stop us from making cross-cultural connections, said APS Fellow Ying-yi Hong (Chinese University of Hong Kong).

“Despite all these neurobiological capabilities enabling us to empathize with others, we still see cases in which individuals chose to harm others, for example during intergroup conflicts or wars,” Hong said.

This may be due in part to the brain’s distinction between in-group and out-group members, she explained. People have been found to show greater activation in the amygdala when viewing fearful faces of their own race, for example, and less activation in the ACC when watching a needle prick the face of someone of a different race.

The cultural mixing that accompanies globalization can heighten these responses, Hong added. In one study, she and her colleagues found that melding cultural symbols (e.g., combining the American and Chinese flags, putting Chairman Mao’s head on the Lincoln Memorial, or even presenting images of “fusion” foods) can elicit a pattern of disgust in the anterior insula of White Americans similar to that elicited by physical contaminant objects such as insects.

These responses can also be modulated by cultural practices, Hong said. One study comparing the in-group/out-group bias in Korea, a more collectivist society, and the United States, a more individualistic society, found that more interdependent societies may foster a greater sense of in-group favoritism in the brain.

Further research into this empathy gap should consider not just the causal relationship between neural activation and behavior, she said, but the societal context in which they take place.

“What I want to propose,” Hong said, “is that maybe there is another area that we can also think about, which is the culture, the shared lay theories, values, and norms.”

There is some fantastic research going on in empathy. From an evolutionary point of view however it’s important to distinguish an evolved motivation system from a competency. Empathy is a competency not a motivation. Empathy can be used for both benevolent but also malevolent motives. And psychopaths have a competency for empathy but what they lack is mammalian caring motivation. Insofar as part of the reproductive strategy of the psychopath is to exploit others and even threaten them then having a brain that turns off distress to the suffering they cause would be an advantage to them. Psychopaths are much more likely to be prepared to harm others to get what they want. Mammalian caring motivation, when guided by higher cognitive processes and human empathy gives rise to compassion. Without empathy compassion would be tricky but without compassion you can still have empathic competencies

Gilbert, P. (2017). Compassion as a social mentality: An evolutionary approach. In: P. Gilbert (ed). Compassion: Concepts, Research and Applications. (p. 31-68). London: Routledge

Gilbert. P. (2015). The evolution and social dynamics of compassion Journal of Social & Personality Psychology Compass, 9, 239–254. DOI: 10.1111/spc3.12176

Catarino, F., Gilbert, P., McEwan., K & Baião, R. (2014). Compassion motivations: Distinguishing submissive compassion from genuine compassion and its association with shame, submissive behaviour, depression, anxiety and stress Journal of Social and Clinical Psychology, 33, 399-412.

Gilbert, P., Catarino, F., Sousa, J., Ceresatto, L., Moore, R., & Basran, J. (2017). Measuring competitive self-focus perspective taking, submissive compassion and compassion goals. Journal of Compassionate Health Care, 4(1), 5

Very interesting article. The research behind what links our empathy to our actions determining the agenda is fascinating. As social creatures, we seem to inhibit empathetic tendencies naturally in our genetic makeup when studied. Since we have the highest empathetic behavior compared to other animals, who also show empathetic behavior, I wonder if it falls more on our social norms. What we consider relatable is worthy of our empathy. If we don’t relate, we may be less inclined to put ourselves in the other position.

I have what I call empathy pain. It radiates an aching pain in my legs and I can barely stand it. I’ve googled it in attempts to validate it is real. It seems people either do not believe me or can’t understand stand when I tell them it makes my legs ache. Seeing someone’s cuts, surgical incisions, bloody wounds. I can’t describe all the triggers, but I can 100% say the pain I feel in response is intense, even when they say “oh, it didn’t hurt” or “it’s not hurting”. Well, it hurt ME seeing it.

I am currently writing a literature review for my psychology course in University, based on what I am writing about I believe you may have Mirror Touch Synesthesia. This condition is characterized by viewing others being touched and feeling tactile sensations, and this seems quite similar to what you shared. I would recommend doing a bit of research on MTS, and see if it relates to you.

Since I was 7 years old I felt others pain Then I thought everyone could . I came to realize I feel so much more than most . I feel what I see, I feel what I hear. My sensitive to touch is more like pain but my pain level is very high, I can take a lot of pain.

What about feeling pain or illness without observing it or even having knowledge of someone else’s pain? Such as the phenomenon of twins. I’m looking for research of this outside of the twin sibling relationship.

When carrying out functional mapping of the amygdala cortex by means of electrical stimulation in one of my patients with focal epileptic seizures who was being evaluated for resective epilepsy surgery of the orbitofrontal, opercular, and anterior insular cortex the stimulation caused the patient to reminisce over video films he had seen of cartoons (animaniacs) as a child, at the same time empathizing with the suffering of those characters. I had probably activated a limbic pathway connected to the limen insulae where I was administering electrical stimulation at that time. The visual imagery stopped as soon as the stimulus train was over but the patient still empathized with the cartoon characters for about 20 seconds after the stimulation was over and reported his feelings to me.

Wow… I thought I was alone in the way I feel everyone’s pain and joy. I find that I can not watch scenes of torture or violence on tv, thus I hate most movies, unless it’s a children flick. I get pulled into every story I read. On 911 I thought my heart really was breaking, it consumed my entire body. I can’t watch history shows of Pearl Harbor, or nazis. If I do, sometimes those images stay with me for years and come back as nightmares. It’s not easy living with this in today’s world.

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Empathy is a social process by which a person has an understanding and awareness of another's emotions and/or behaviour, and can often lead to a person experiencing the same emotions. It differs from sympathy, which involves concern for others without sharing the same emotions as them.

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The psychology of emotional and cognitive empathy.

The study of empathy is an ongoing area of major interest for psychologists and neuroscientists in many fields, with new research appearing regularly.

Empathy is a broad concept that refers to the cognitive and emotional reactions of an individual to the observed experiences of another. Having empathy increases the likelihood of helping others and showing compassion. “Empathy is a building block of morality—for people to follow the Golden Rule, it helps if they can put themselves in someone else’s shoes,” according to  the Greater Good Science Center , a research institute that studies the psychology, sociology, and neuroscience of well-being. “It is also a key ingredient of successful relationships because it helps us understand the perspectives, needs, and intentions of others.”

Though they may seem similar, there is a clear distinction between empathy and sympathy. According to Hodges and Myers in the  Encyclopedia of Social Psychology , “Empathy is often defined as understanding another person’s experience by imagining oneself in that other person’s situation: One understands the other person’s experience as if it were being experienced by the self, but without the self actually experiencing it. A distinction is maintained between self and other. Sympathy, in contrast, involves the experience of being moved by, or responding in tune with, another person.”

Emotional and Cognitive Empathy

Researchers distinguish between two types of empathy. Especially in social psychology, empathy can be categorized as an emotional or cognitive response. Emotional empathy consists of three separate components, Hodges and Myers say. “The first is feeling the same emotion as another person … The second component, personal distress, refers to one’s own feelings of distress in response to perceiving another’s plight … The third emotional component, feeling compassion for another person, is the one most frequently associated with the study of empathy in psychology,” they explain.

It is important to note that feelings of distress associated with emotional empathy don’t necessarily mirror the emotions of the other person. Hodges and Myers note that, while empathetic people feel distress when someone falls, they aren’t in the same physical pain. This type of empathy is especially relevant when it comes to discussions of compassionate human behavior. There is a positive correlation between feeling empathic concern and being willing to help others. “Many of the most noble examples of human behavior, including aiding strangers and stigmatized people, are thought to have empathic roots,” according to Hodges and Myers. Debate remains concerning whether the impulse to help is based in altruism or self-interest.

The second type of empathy is cognitive empathy. This refers to how well an individual can perceive and understand the emotions of another. Cognitive empathy, also known as empathic accuracy, involves “having more complete and accurate knowledge about the contents of another person’s mind, including how the person feels,” Hodges and Myers say. Cognitive empathy is more like a skill: Humans learn to recognize and understand others’ emotional state as a way to process emotions and behavior. While it’s not clear exactly how humans experience empathy, there is a growing body of research on the topic.

How Do We Empathize?

Experts in the field of social neuroscience have developed  two theories  in an attempt to gain a better understanding of empathy. The first, Simulation Theory, “proposes that empathy is possible because when we see another person experiencing an emotion, we ‘simulate’ or represent that same emotion in ourselves so we can know firsthand what it feels like,” according to  Psychology Today .

There is a biological component to this theory as well. Scientists have discovered preliminary evidence of “mirror neurons” that fire when humans observe and experience emotion. There are also “parts of the brain in the medial prefrontal cortex (responsible for higher-level kinds of thought) that show overlap of activation for both self-focused and other-focused thoughts and judgments,” the same article explains.

Some experts believe the other scientific explanation of empathy is in complete opposition to Simulation Theory. It’s Theory of Mind, the ability to “understand what another person is thinking and feeling based on rules for how one should think or feel,”  Psychology Today says. This theory suggests that humans can use cognitive thought processes to explain the mental state of others. By developing theories about human behavior, individuals can predict or explain others’ actions, according to this theory.

While there is no clear consensus, it’s likely that empathy involves multiple processes that incorporate both automatic, emotional responses and learned conceptual reasoning. Depending on context and situation, one or both empathetic responses may be triggered.

Cultivating Empathy

Empathy seems to arise over time as part of human development, and it also has roots in evolution. In fact, “Elementary forms of empathy have been observed in our primate relatives, in dogs, and even in rats,” the Greater Good Science Center says. From a developmental perspective, humans begin exhibiting signs of empathy in social interactions during the second and third years of life. According to  Jean Decety’s article “The Neurodevelopment of Empathy in Humans ,” “There is compelling evidence that prosocial behaviors such as altruistic helping emerge early in childhood. Infants as young as 12 months of age begin to comfort victims of distress, and 14- to 18-month-old children display spontaneous, unrewarded helping behaviors.”

While both environmental and genetic influences shape a person’s ability to empathize, we tend to have the same level of empathy throughout our lives, with no age-related decline. According to “Empathy Across the Adult Lifespan: Longitudinal and Experience-Sampling Findings,” “Independent of age, empathy was associated with a  positive well-being and interaction profile .”

And it’s true that we likely feel empathy due to  evolutionary advantage : “Empathy probably evolved in the context of the parental care that characterizes all mammals. Signaling their state through smiling and crying, human infants urge their caregiver to take action … females who responded to their offspring’s needs out-reproduced those who were cold and distant,” according to the Greater Good Science Center. This may explain gender differences in human empathy.

This suggests we have a natural predisposition to developing empathy. However, social and cultural factors strongly influence where, how, and to whom it is expressed. Empathy is something we develop over time and in relationship to our social environment, finally becoming “such a complex response that it is hard to recognize its origin in simpler responses, such as body mimicry and emotional contagion,” the same source says.

Psychology and Empathy

In the field of psychology, empathy is a central concept. From a mental health perspective, those who have high levels of empathy are more likely to function well in society, reporting “larger social circles and more satisfying relationships,” according to  Good Therapy , an online association of mental health professionals. Empathy is vital in building successful interpersonal relationships of all types, in the family unit, workplace, and beyond. Lack of empathy, therefore, is one indication of conditions like antisocial personality disorder and narcissistic personality disorder. In addition, for mental health professionals such as therapists, having empathy for clients is an important part of successful treatment. “Therapists who are highly empathetic can help people in treatment face past experiences and obtain a greater understanding of both the experience and feelings surrounding it,” Good Therapy explains.

Exploring Empathy

Empathy plays a crucial role in human, social, and psychological interaction during all stages of life. Consequently, the study of empathy is an ongoing area of major interest for psychologists and neuroscientists in many fields, with new research appearing regularly. Lesley University’s  online bachelor’s degree in Psychology  gives students the opportunity to study the field of human interaction within the broader spectrum of psychology.

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Empathy Defined

What is empathy.

The term “empathy” is used to describe a wide range of experiences. Emotion researchers generally define empathy as the ability to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling.

Contemporary researchers often differentiate between two types of empathy : “Affective empathy” refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety. “Cognitive empathy,” sometimes called “perspective taking,” refers to our ability to identify and understand other people’s emotions. Studies suggest that people with autism spectrum disorders have a hard time empathizing .

Empathy seems to have deep roots in our brains and bodies, and in our evolutionary history . Elementary forms of empathy have been observed in our primate relatives , in dogs , and even in rats . Empathy has been associated with two different pathways in the brain, and scientists have speculated that some aspects of empathy can be traced to mirror neurons , cells in the brain that fire when we observe someone else perform an action in much the same way that they would fire if we performed that action ourselves. Research has also uncovered evidence of a genetic basis to empathy , though studies suggest that people can enhance (or restrict) their natural empathic abilities.

Having empathy doesn’t necessarily mean we’ll want to help someone in need, though it’s often a vital first step toward compassionate action.

For more: Read Frans de Waal’s essay on “ The Evolution of Empathy ” and Daniel Goleman’s overview of different forms of empathy , drawing on the work of Paul Ekman.

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Why Practice It?

Empathy is a building block of morality—for people to follow the Golden Rule, it helps if they can put themselves in someone else’s shoes. It is also a key ingredient of successful relationships because it helps us understand the perspectives, needs, and intentions of others. Here are some of the ways that research has testified to the far-reaching importance of empathy.

• Seminal studies by Daniel Batson and Nancy Eisenberg have shown that people higher in empathy are more likely to help others in need, even when doing so cuts against their self-interest .
• Empathy is contagious : When group norms encourage empathy, people are more likely to be empathic—and more altruistic.
• Empathy reduces prejudice and racism : In one study, white participants made to empathize with an African American man demonstrated less racial bias afterward.
• Empathy is good for your marriage : Research suggests being able to understand your partner’s emotions deepens intimacy and boosts relationship satisfaction ; it’s also fundamental to resolving conflicts. (The GGSC’s Christine Carter has written about effective strategies for developing and expressing empathy in relationships .)
• Empathy reduces bullying: Studies of Mary Gordon’s innovative Roots of Empathy program have found that it decreases bullying and aggression among kids, and makes them kinder and more inclusive toward their peers. An unrelated study found that bullies lack “affective empathy” but not cognitive empathy, suggesting that they know how their victims feel but lack the kind of empathy that would deter them from hurting others.
• Empathy reduces suspensions : In one study, students of teachers who participated in an empathy training program were half as likely to be suspended, compared to students of teachers who didn’t participate.
• Empathy promotes heroic acts: A seminal study by Samuel and Pearl Oliner found that people who rescued Jews during the Holocaust had been encouraged at a young age to take the perspectives of others.
• Empathy fights inequality. As Robert Reich and Arlie Hochschild have argued, empathy encourages us to reach out and want to help people who are not in our social group, even those who belong to stigmatized groups , like the poor. Conversely, research suggests that inequality can reduce empathy : People show less empathy when they attain higher socioeconomic status.
• Empathy is good for the office: Managers who demonstrate empathy have employees who are sick less often and report greater happiness.
• Empathy is good for health care: A large-scale study found that doctors high in empathy have patients who enjoy better health ; other research suggests training doctors to be more empathic improves patient satisfaction and the doctors’ own emotional well-being .
• Empathy is good for police: Research suggests that empathy can help police officers increase their confidence in handling crises, diffuse crises with less physical force, and feel less distant from the people they’re dealing with.

For more: Learn about why we should teach empathy to preschoolers .

How Do I Cultivate It?

Humans experience affective empathy from infancy, physically sensing their caregivers’ emotions and often mirroring those emotions. Cognitive empathy emerges later in development, around three to four years of age , roughly when children start to develop an elementary “ theory of mind ”—that is, the understanding that other people experience the world differently than they do.

From these early forms of empathy, research suggests we can develop more complex forms that go a long way toward improving our relationships and the world around us. Here are some specific, science-based activities for cultivating empathy from our site Greater Good in Action :

• Active listening: Express active interest in what the other person has to say and make him or her feel heard.
• Shared identity: Think of a person who seems to be very different from you, and then list what you have in common.
• Put a human face on suffering: When reading the news, look for profiles of specific individuals and try to imagine what their lives have been like.
• Eliciting altruism: Create reminders of connectedness.

And here are some of the keys that researchers have identified for nurturing empathy in ourselves and others:

• Focus your attention outwards: Being mindfully aware of your surroundings, especially the behaviors and expressions of other people , is crucial for empathy. Indeed, research suggests practicing mindfulness helps us take the perspectives of other people yet not feel overwhelmed when we encounter their negative emotions.
• Get out of your own head: Research shows we can increase our own level of empathy by actively imagining what someone else might be experiencing.
• Don’t jump to conclusions about others: We feel less empathy when we assume that people suffering are somehow getting what they deserve .
• Show empathic body language : Empathy is expressed not just by what we say, but by our facial expressions, posture, tone of voice, and eye contact (or lack thereof).
• Meditate: Neuroscience research by Richard Davidson and his colleagues suggests that meditation—specifically loving-kindness meditation, which focuses attention on concern for others—might increase the capacity for empathy among short-term and long-term meditators alike (though especially among long-time meditators).
• Explore imaginary worlds: Research by Keith Oatley and colleagues has found that people who read fiction are more attuned to others’ emotions and intentions.
• Join the band: Recent studies have shown that playing music together boosts empathy in kids.
• Play games : Neuroscience research suggests that when we compete against others, our brains are making a “ mental model ” of the other person’s thoughts and intentions.
• Take lessons from babies: Mary Gordon’s Roots of Empathy program is designed to boost empathy by bringing babies into classrooms, stimulating children’s basic instincts to resonate with others’ emotions.
• Combat inequality: Research has shown that attaining higher socioeconomic status diminishes empathy , perhaps because people of high SES have less of a need to connect with, rely on, or cooperate with others. As the gap widens between the haves and have-nots, we risk facing an empathy gap as well. This doesn’t mean money is evil, but if you have a lot of it, you might need to be more intentional about maintaining your own empathy toward others.
• Pay attention to faces: Pioneering research by Paul Ekman has found we can improve our ability to identify other people’s emotions by systematically studying facial expressions. Take our Emotional Intelligence Quiz for a primer, or check out Ekman’s F.A.C.E. program for more rigorous training.
• Believe that empathy can be learned : People who think their empathy levels are changeable put more effort into being empathic, listening to others, and helping, even when it’s challenging.

For more : The Ashoka Foundation’s Start Empathy initiative tracks educators’ best practices for teaching empathy . The initiative gave awards to 14 programs judged to do the best job at educating for empathy . The nonprofit Playworks also offers eight strategies for developing empathy in children .

What Are the Pitfalls and Limitations of Empathy?

According to research , we’re more likely to help a single sufferer than a large group of faceless victims, and we empathize more with in-group members than out-group members . Does this reflect a defect in empathy itself? Some critics believe so , while others argue that the real problem is how we suppress our own empathy .

Empathy, after all, can be painful. An “ empathy trap ” occurs when we’re so focused on feeling what others are feeling that we neglect our own emotions and needs—and other people can take advantage of this. Doctors and caregivers are at particular risk of feeling emotionally overwhelmed by empathy.

In other cases, empathy seems to be detrimental. Empathizing with out-groups can make us more reluctant to engage with them, if we imagine that they’ll be critical of us. Sociopaths could use cognitive empathy to help them exploit or even torture people.

Even if we are well-intentioned, we tend to overestimate our empathic skills. We may think we know the whole story about other people when we’re actually making biased judgments—which can lead to misunderstandings and exacerbate prejudice.

The 6 Essential Aspects of Empathy

A big-tent model of empathy that creates no exiles..

Posted July 1, 2024 | Reviewed by Jessica Schrader

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• Empathy research tends to create exiles, or lists of people who are allegedly unempathic.
• It's unempathic to exile people from empathy, and this exiling can do a great deal of harm.
• A deeper and more functional model of empathy welcomes the exiles and makes room for them.

When I was asked to write a book on empathy back in 2012, I dove into the research and found a great deal of confusion and a great many things that concerned me.

First, there was very little agreement about how empathy worked, what empathy was, or whether compassion was better overall. You want to see this kind of confusion in a young science, but it was very hard to organize my thinking, so I entered grad school to be able to access the research directly. For better or worse.

Seeking a Big-Tent Model of Empathy

My intentions in developing my book were to create a model of empathy that would work for everyone. For people whose empathy was painfully high, I wanted to provide a clear understanding of what that meant and how to address it.

For people who struggled to empathize, I wanted an overview of empathy that could help them approach empathy systematically and find their own way to access it at will.

But what I found as I dove deeper into the research was a continual push to exile people and create a hierarchy of humanness. Gender essentialism and sexism were everywhere: Boys and men were usually exiled from empathy and treated as emotionally backward, while women and girls who struggled with empathy were not even mentioned. Empathy was expected from women and girls and denied to men and boys. Autistic people were absolutely exiled as unempathic, even though most of my autistic friends and family members are hyper- empathic to the point of physical pain.

People struggling with narcissism , psychopathy , and sociopathy were endlessly trotted out as scary circus sideshows, as if their humanity didn't matter. And while I found some useful studies and books, I also found a horror show of dehumanization and near-gleeful exiling in empathy research.

I knew that a new, humane, and fully operationalized model of empathy was necessary.

Assembling a New Model

I found many useful pieces of research about different aspects of empathy that I could build upon, and I spent a few months winnowing through them and deciding which ones were most useful and where they should appear in my model.

I ended up with six aspects that are essential to understanding empathy, working with it intentionally, and moderating it so that empathizing can be comfortable and accessible (no matter where people start).

I also built my model to help people develop empathy that's sustainable throughout their lifetimes in order to address the compassion fatigue and empathic burnout we see all around us.

In 2013, I published The Art of Empathy (because empathy was not a science then, and it still isn't now) and I began sharing my model. My book has now been translated into five languages, and has informed empathy education in schools, workplaces, and healthcare organizations across the world.

The Good News: Empathy Can Be Developed (or Calmed Down) at Any Age

The most hopeful thing I discovered is that empathy isn't a concrete trait , and that it can be moderated at any stage of a person's life. Empathy is best described as an interaction instead of a trait, because even when people tend toward high trait empathy, they can face situations that drop their empathy to zero (we all can).

For instance, hierarchies have a famously damaging effect on empathy, where people at the top tend to lose their empathic abilities (even if their trait empathy was high when they came into the hierarchy) while people at the bottom often need to develop hyper-empathy as a kind of counterbalance (and to keep themselves safe).

Empathy is not so much a trait as it is an interaction, which means that empathy is malleable and situation-specific. When researchers grade entire groups of people as unempathic, they misunderstand the very nature of empathy.

Enter the Six Essential Aspects of Empathy

My six aspects pull from research across many disciplines and appear in a step-by-step order based on the conditions that are required for successful empathizing to occur.

• Emotion Contagion (or Emotional Awareness) : Before empathy can take place, you need to sense that an emotion is occurring—or that an emotion is expected of you. Empathy relies upon your ability to detect, feel, and share emotions. Empathy is first and foremost an emotional skill.
• Empathic Accuracy : Skilled empathy is based on your ability to accurately identify and understand emotions and intentions in yourself and others. When you can clearly understand which emotions are present (once you become aware of them), you can make appropriate responses and take suitable actions.
• Emotion Regulation : To empathize effectively, you need to recognize, understand, and work with your own emotions; you’ve got to be self -aware. When you can identify and regulate your emotions, you’ll tend to be skillful in the presence of strong emotions (your own and others’), rather than being overtaken or knocked out of commission by them. Good news: developing a stronger emotional vocabulary—all by itself—can increase your emotion regulation skills.
• Perspective-Taking : This skill helps you imaginatively put yourself in the place of others, see situations through their eyes, and accurately sense what they might be feeling. This skill helps you understand clearly—from their perspective and not yours—what others want or need. In this aspect, we clearly see the difference between empathy (providing what others need) and generosity (offering what you assume they might like).
• Concern for Others : Empathy helps you connect with others, but the quality of your response depends on whether you care about them or not. Your sensitive concern will help you engage and empathize in a way that displays your care and compassion. As you may know, fatigue and overwhelm can reduce your concern for others to zero, so monitoring your own inner health is a key to being able to empathize skillfully.
• Perceptive Engagement : This is your ability to respond empathically to others. This full expression of your empathy is dependent upon the first five aspects, and it helps you respond or act* wisely in a way that works for others. Perceptive engagement combines your capacity to sense and accurately identify the emotions of others (and yourself), skillfully regulate your own emotions, take the perspective of others, focus on them with care and concern, and then engage perceptively. Perceptive engagement helps you clearly understand others’ feelings, desires, and needs so that you can empathize skillfully while respecting your own feelings and needs as well.

*A note about action: Sometimes, the most empathic thing you can do is nothing at all , if people need space and privacy. Many people (and many researchers) want to see an empathic action , such as consolation, offering a helping hand, or communicating out loud. But sometimes, the most empathic thing you can do is nothing, for instance, when people are trying to hide their tears, when they're too angry to speak, when they feel ashamed of needing help, or when they signal that they're not available. ​​

With this six-aspects model, you'll be able to understand how and when to offer help (or not), because you'll know how empathy works and how you can key into what others want and need.

The Art of Empathy: A Complete Guide to Life's Most Essential Skill . (2013). Karla McLaren. Boulder, CO: Sounds True.

The Age of Empathy: Nature’s Lessons for a Kinder Society. (2009). Frans de Waal. New York: Harmony.

The Social Neuroscience of Empathy. (2009). Jean Decety and William Ickes (eds.). Cambridge, MA: MIT Press.

Empathic Accuracy. (1997). William Ickes (ed.). New York: Guildford Press .

Karla McLaren, M.Ed., is an author, educator, workplace consultant, social science researcher, and emotions and empathy innovator.

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Speaking of Psychology: The decline of empathy and the rise of narcissism, with Sara Konrath, PhD

Episode 95 – the decline of empathy and the rise of narcissism.

Concern and care for others’ feelings are virtues we seek to instill in our children, yet they are sorely lacking in many adult Americans today. There’s scientific research to back up the notion that Americans are caring less for others and more about themselves. Our guest is Sara Konrath, PhD, an associate professor of philanthropic studies at Indiana University and director of the Interdisciplinary Program on Empathy and Altruism Research. We’ll be exploring why empathy is declining and what we can do to create more kindness and caring in our communities.

About the expert: Sara Konrath, PhD

Streaming Audio

Kaitlin Luna‏: Hello and welcome to Speaking of Psychology , a bi-weekly podcast from the American Psychological Association that explores the connections between Psychological Science and everyday life. I'm your host, Kaitlin Luna‏. Concern and care for others' feelings are virtues we seek to instill in our children, yet they are sorely lacking in many adult Americans today. Flip on the news, scroll through social media sites, or read the comments on any news article, and you realize just how unempathetic so many of us are.

There's scientific research to back up the notion that Americans are caring less and less for others. For instance, one study found a steep decline in empathy among young people from 1979 to 2009. One of the authors of that study is joining me today. Dr. Sara Konrath is an associate professor of philanthropic studies at Indiana University, and director of an Interdisciplinary Program on Empathy and Altruism Research.

She teaches classes on the psychology of giving, and altruism and health. Her other work has also found that narcissism is on the rise in young people. She's done some fascinating research examining narcissism's effect on social media usage. We will be exploring why empathy is declining and what we can do to create more kindness and caring in our communities. Welcome, Dr. Konrath.

Dr. Sara Konrath: Thanks for having me.

Luna: When I was researching this topic, I came across an article in The New York Times from 1989, the cited research that found that newborn babies can display empathy, which was notably by crying in response to another nearby baby. Other research from our journal developmental psychology from that same time period found that mothers have a profound influence on their child's development of empathy. From your perspective, is it nature? Is it nurture? Or is it both? Why are mothers more influential in the development of empathy?

Konrath: Based on research that I know of, it's actually both. Like most things in psychology, there's lots of research showing that empathy has a genetic component, about half of empathy that a baby is born with is a genetic component, but then the parenting, the schools, the community, the environment, the culture can have an influence on empathy as well. The context matters, along with the genetics.

I like that study actually on the crying response because even primates, other primates have that kind of response, what I call proto empathy. It's the building block of empathy, to feel what others are feeling. That emotional contagion, but obviously, we need to go a lot more further for it to be deeper, more mature empathy.

Luna: Other animals, animals other than humans, you're saying, do exhibit empathy?

Konrath: Different kinds of empathy? Yes. Not necessarily the sophisticated mental gymnastics that we can do when it comes to understanding other people's intentions and motivations, but there is some evidence by primatologists and others, finding that there are some forms of empathy, including care, concern, in different types of animals such as in primates and even rats.

Luna: It's a really fascinating thing. I could see primates, of course, because we're closely linked, but if they're seeing it in rats as well, why do you think they're seeing it in an animal that's so different from our species?

Konrath: I would guess that in many mammals, that would be why they would see it in animals that rear their young in similar ways, because of the nurturing that comes from early parenting. That links to your question about why mothers. I don't think there's something- at least in humans, that makes mothers somehow better at teaching empathy, obviously, because humans are very flexible and adaptable.

I do think that within humans, mothers are spending a lot more time with their babies and children than fathers. I think it's the person who's spending the time that will have the most influence on developing empathy.

Luna: That will be really interesting to do this study today, because the one I just mentioned that we were just talking about was from 1990. Seeing as how culture shifted with more stay-at-home-dads, more fathers being more involved than they were at that point in time, it'd be interesting to see how that would play out if fathers, if they are teaching their children more empathy. Do you think that would be the case today? It might be different?

Konrath: There's probably been a- probably more of a role. Still, if you look at current research on the time spent with children, women are still spending more time than men, even though both women and men are spending more time over time. Since the ‘60s, there's been an increase in the time we actually spend with children, taking care of them.

Luna: Really? That's probably a topic for another time, but that's really fascinating to think today people are working, we're working longer hours yet we're spending more time with our children. You're talking about that genetic component which is really fascinating. Does that mean that some people are just inherently born more empathetic than others?

Konrath: I would think that they're born more responsive. Like those infants, there's probably differences in infants and which ones are more likely to cry when they hear the other one cry. That's a building block for later, more general types of empathy that are more mature. There are genotypes that are associated with more empathy, so people's actual genetic structures, such as the oxytocin receptor gene-- Though there are some people who I think have more of a inherent potential, but all of us can learn.

Luna: I want to talk about mirror neurons, which is something that came up as I was looking into this topic. Do you think mirror neurons play a role in empathy?

Konrath: Mirror neurons are the areas of our brain that are overlapping with other people's actions, so that if we see a person pick up a cup, then the area of the brain that would light up when we pick up the cup is activated. It shows you that there's this inherent physiological connection between people. I do believe that mirror neurons help us to become more empathetic because they help us have a moment of similar experience with somebody. That can lead to deeper expressions of empathy.

Luna: Does that go along with why you think empathy even exists in the first place? You talked about mother animals nurturing their young. We're talking about mirror neurons as being a prosocial behavior among animals. Is that why you think empathy exists? Does it exist to keep us, I guess, we're pack animals, we're social animals. Does it exist to keep us together, or does it exist to keep us thriving and to keep the species alive?

Konrath: I do think that there's a biological basis for empathy. The reason it stays in our societies over time is because it helps to keep infants alive. The parental nurturing helps to keep infants alive, and then we can generalize that to relatives, and to people who are our friends, and then even to strangers.

Luna: There, obviously, is a genetic component, as you mentioned, and it can be a learned behavior as well, the nature and nurture. How can we cultivate empathy within ourselves?

Konrath: There are many, many different ways and lots of research trying to increase empathy. I don't think there's one way. The first thing I would say is that, we have to want to, it has to be important to us. The motivation really matters. Then from there, there's many ways. There's research showing that, for example, reading fiction actually helps to increase empathy, and also focusing on similarities between yourself and others.

Just imagining. Taking a moment to imagine what other people are feeling and thinking what the world is like from their perspective. There's many, many, many ways to increase empathy. There's some research on the role of the arts and how it can help us to be more empathetic. A big factor is actually just having experience, practicing with- nurturing, either animals, or vulnerable children or babies, because just the practice of interacting with another being who can't really just tell us in words what they're feeling, or what they need. It helps us to tune in, and to imagine, and to respond.

Luna: I want to touch on something you just mentioned I found really interesting was about how reading fiction can make you more empathetic. Do you have more to share about why that would be the case, because you almost think it might be nonfiction. I don't know. What is it about fiction that makes people more empathetic, or increases that trait?

Konrath: Overall, the research is finding that just reading in general is helpful, but fiction in particular because it allows us to imagine other people's lives. Oftentimes in fiction, you're getting a window into what's going on in someone's mind. You can almost see the world through their eyes and practice what it might be like to be another person. That person could be somebody really, really different.

It can be a different gender, or political affiliation, or ethnicity, or culture. You just get to live all these different lives and to stay close to people you might not encounter in your everyday life from the inside perspective.

Luna: That is incredibly fascinating. I'm going to hold on to that one to use as a good fact at some point.

Konrath: [laughs]

Luna: I want to go back to that study I mentioned in the intro here. You found that among young people empathy is declining. Can you share why you think empathy is on a decline? I know that the last study ended over ten years ago now, but from that time period, what did you find, why do you think that was the case, and where does research stand today, in terms of what's happened between 2009 and 2019?

Konrath: Just to clarify, we found that college students, American college students, self-reported that they were becoming lower in empathy over time, when we looked at different samples and studies using a meta-analysis over time. Other researchers also looked at national samples of high school seniors and college freshmen and found similar results that there had been declines over time in concern for others.

All these studies so far have only been done up to 2009, and we're now working on updates to these studies. I'm not sure what's happening since then and I know it's easy to say that- assume that things are declining, but until we have the data I don't know what's happening. It's hard to say with cultural change why that's happening, so I can only guess. After ten years of thinking about it at this point, I have some ideas.

I'm working on a book, finishing my book called, "Culture Burnout , " that tries to explain what's happening and why. Over time, I started realizing that the declines in empathy were happening at the same time as the rise in mental health problems among young people. I put two-and-two together and saw those both as symptoms of burnout. I've been thinking about that empathy is not just--

The decline in empathy is not just an excuse down on our youth and tell them that you're not kind. It's an opportunity for us to understand better the pressures that are on them right now and the expectations that are pushing them to really just try to achieve success. With a lot of challenges that earlier generations didn't face, because incredibly high tuition rates that are rising very, very fast, higher than the cost of health care, for example.

The expectations of trying to get a job with a college degree is really challenging. Rising inequality makes it very hard for average people to have a sustainable lifestyle economically and so on. All of these different pressures on young people, I think crowd out their focus on their own self-care and care for others, because they're really focused on just trying to be successful and make it.

Luna: That's a really interesting connection, one that I hadn't even thought of. I just thought maybe it's just because what's going on in the culture and in the world today, but that's absolutely fascinating. It could be because of so much pressure on people. Of course, if you're already burned out yourself, you're facing all these pressures, you're worried about your economic future, which- it's widely covered that generations today will not do better, or maybe the same as previous generations.

There's a lot of pressure on our young people today. Guess it's really no wonder why someone wouldn't be as empathetic, because they're more concerned about themselves and surviving.

Konrath: That's what I think at this point. I wasn't sure earlier and I had other ideas, but over time, this is what I see is happening. When I talk to young people about it, they are like, "Yes. You get us. You understand us. We're very stressed out." They're really good at working, work. I've talked to college students about this idea of culture burnout and one of the things I asked about is, "In an ideal life, you have an eight-hour workday, which we fight for, for workers rights to have an eight-hour workday, you have eight hours of sleep and you have eight hours of leisure," and then people start laughing. Students laugh at that.

I was like, "I didn't know that was a joke." Just listening to stories from young people and the pressures they are facing and how taking a break, even just having a night off, it makes them feel really guilty.

Luna: Absolutely. I wonder if that relates to a decline in people spending more time on hobbies and in volunteering, if you're focused on school, if you're focused on work, if you're focused on this or the other thing.

Konrath: That's what I think, yes.

Luna: I want to bring this over to a topic that keeps coming up in my mind today, the lack of empathy or the decrease in empathy that you've seen in your study. Obviously, we have a 10-year gap of which we don't know yet what's happened, but could that be the cause of why people can be so basically nasty today? You read news article comments and it's just a terrible place to go. It's where you go if you want to feel bad or- I don't know.

It's just like you get down that rabbit hole of reading all the these awful things people have to say. I think in a lot of ways, what comes to my mind is the issues going on in our southern border and this really in a lot of cases you have- some people are incredibly empathetic to the plight of people leaving oppression and violence. We have so many people who are just downright mean about it, and you don't want to don't help anyone at all- obviously there's a lot that goes into why people behave the way they do. But is this an example of people who might not feel like they have what they need, they cannot be empathetic to others?

Konrath: Yes. I think if people are saying cruel things to others who are oppressed, or victimized, or in deep trouble that is a signal of low empathy. Because empathy is- we didn't even define it but I'll define it. Empathy is both imagining other people's perspectives and their world's cognitive type of empathy, and it's also caring, compassion and concern for others, that emotional empathy.

Konrath: If you're not showing that for somebody then you are showing low empathy, and I think if I just say whether those expressions online are a sign that empathy is really declined even more, or whether people used to say those things in the privacy of their home and now they just say them online. I don't know.

Luna: Yes. [laughs]

Konrath: But it is obviously upsetting and concerning to see that groups who are in need are not getting the help that they need.

Luna: Yes. You kept it to yourself and now you feel emboldened perhaps because you can be anonymous online.

Konrath: Yes.

Luna: That could be another thing too. This leads me to my next question about- are there times in history you've noticed where- even during that period time 1979 and 2009, where people were more empathetic. An example came to mind after 9/11 where it seemed like America came together in a lot of ways. Albeit briefly perhaps, but it seemed like people came together, I'm not sure that's necessarily empathy, but are there times where you've seen where people are more empathetic and times where you've seen people are less empathetic?

Konrath: Well, just looking at the data looks like it's just- it was just declining over time and especially accelerating since 2000. I actually looked at that the graphs from my study to see if there was a blip [chuckles] in 2001 and there wasn't. As somebody who was- I had just-- I'm a Canadian and I had just moved to the States in fall of 2001, a couple of weeks before 9/11, and I as a somebody who is not a citizen living in the States at that time I can't say that I was feeling empathy from Americans.

Konrath: [laughs] I was feeling very nervous at the anti-immigrant sentiment.

Konrath: I don't know that Americans coming together, it would sort of to affirm patriotism and sort of like American amazingness or something [laughs] but I don't know, but empathy I think would have been broader and would have been like empathy for other people too, and people who were being treated badly and experiencing hate crimes because they happen to be a member of an ethnic group that was part of the 9/11 events, but obviously those individuals were not implicated. In fact, people from Middle Eastern countries, my research has found, actually scored the highest in the world in empathy.

Luna: Yes. There was one thing I want to touch on. Are there certain people in the world who are more empathetic cultures, countries, as you said Middle Eastern people, do you see specific countries on that?

Konrath: Yes. I always like to talk about the study limitations, because I think people should make up their own mind about whether they think it's something they want to believe. We did a study, it was just an accidental study where we had posted online a link to an empathy measure and people from all over the world for some reason wanted to take this measure.

We had over 104,000 people in the study from 63 different countries. Because it was just kind of an accident, the study was not intended to be a cross-cultural study it was all in English. That's important to keep in mind. We then were able to compare the different countries and see which ones were highest in empathy and lowest in empathy and we were able to correlate empathy scores at the cultural level with behaviors like volunteering, and helping, and traits like individualism.

We're trying to validate this as a potential measure and currently, it's the best available study, but I still think we need to work on really understanding cultural differences and empathy.

Luna: When you do a study like that can you talk about how you measure empathy?

Konrath: Yes. We measure empathy using just a self-report trait measure. The one we used and that we've used a lot is called the interpersonal reactivity index. It's just about responding to others. It's pretty widely used and many scientists appreciate the validity of it. It includes statements such as, "I often have tender concern feelings for those who are less fortunate," or, "I try to imagine what other people's- or other people's side of a disagreement," for example.

Those are just off the top of my head. Those aren't exact, but just so you get a sense of them. We correlated them in that cross-cultural study with rates of volunteering behaviors which obviously that's not empathy, that's a behavior. Empathy is either a trait or a feeling.

Luna: You've talked about the countries that you found that were most empathetic. What were countries you found they're least empathetic?

Konrath: We found that individualistic countries were more likely to be low in empathy. Also, countries that were more accepting of emotions were higher in empathy. We also found that higher empathy countries had higher rates of volunteering and helping strangers, but it wasn't related to charitable giving, which is interesting. Finally, this like little fun fact, and I don't know if we actually published this, but I definitely looked because I was curious. We found that higher empathy countries had higher temperatures on average. They were warmer.

Luna: Interesting. You kind of think, like a cold person, cold climate.

Konrath: Like Canadians?

Luna: I'm from- not too far away from Canada. I'm Rochester, New York. Just across Lake Ontario. I think I'm an empathetic person from a cold area. That's really interesting though, about some of the cultures. Maybe cultures where- you find that people keep to themselves, don't make small talk might be different than a culture that's more like outgoing and that sort of thing. It's really, really fascinating.

There's a lot to there. I appreciate you sharing the limitations so that to- just how obviously it was only limited to English speakers, to a certain extent. This got me all thinking about how empathy or the lack thereof might relate to people who are more prejudiced or people who commit crimes. Are there connections between empathy and criminal behavior? Are less empathetic people more likely to commit a crime?

Konrath: Well I'm not sure if they're more likely to commit a crime, but research does find that on average people who are in jail for crimes, so if they've been caught, that those people score lower on empathy, both kinds of empathy, both emotional and cognitive. I don't think it means that if someone has low empathy, they're predisposed to criminal activity. I just think that people who have high empathy would find it difficult to hurt others because they're very aware of the consequences of their actions. I think that's going to mitigate harm to others.

Luna: Earlier you defined empathy, but can you talk about the difference between cognitive and emotional empathy? We didn't touch on that.

Konrath: Cognitive empathy, I see it more at this point- I've been studying this for a while. I see it more as a skill, so it's something-- It takes time and practice and effort and imagination. It's when we can think about what the world is like from someone else's perspective, and really from their point of view, not our own necessarily. To support that kind of imagination, we can use like our observation. We can listen carefully.

We can pay attention to body language, voice, facial expressions of emotion and other things like that. To me, I see that as more of a skill type process. Emotional empathy, I think it can start with that emotional contagion, so just that moment of sort of feeling what the other person is feeling, but the more mature form is feeling like extending into passions for care for others. Usually, the two of them go together. The research shows that people who are good at cognitive empathy tend to be also compassionate, show more compassion for others. You can imagine there are people out there who are good at cognitive empathy, but don't care. Those are psychopaths, and we need both together.

Luna: That's a possible other topic for our podcast, psychopaths. That's a very interesting topic as well we have not yet explored. Wrapping up our section about the study you did and bringing it full circle. You're showing declining rates. You're doing a new study to see what's happened over the past 10 years. Do you have any suggestions as a psychologist about what can be done to increase empathy? If it was on the downward trajectory for 30 years, what can be done to make people more empathetic to increase our cultural empathy? What do you think can be done?

Konrath: I've been thinking about what we can do to increase empathy at a broader level. Not just for individuals, because individually we already talked about some things that people can do that sounds more empathetic. As a culture, we have to actually decide it's important. As parents, thinking about prioritizing, teaching our children to care for others who are different than them. That means exposing them to people who are different.

Actually making an effort to get involved in some ways. Also, sometimes it might mean that we have to assess what kinds of messages our children are getting from us, because oftentimes children are internalizing the need to succeed and thinking that's the only thing that we care about for our children. When in fact maybe parents do want their children to be caring and empathetic.

Moving outside of parents then school systems are also giving messages to children about what's important. The school is an important socializing force and unfortunately, there's a lot of pressure on them right now to focus on testing and specific quantitative outcomes for kids. If schools decide to focus more on the whole child, including social and emotional skills, that will make a huge difference.

Community interactions are important to build up because when we're interacting with our neighbors, interacting with our co-workers, or attending either religious services or groups of various kinds that are community-based, we're interacting with people who we might not see at our tighter circles. That can challenge us and help us to grow and expand our circles of empathy.

Luna: In your research you did earlier and you were talking about the countries that are more empathetic, did you see a difference in the countries where depending on what was happening in the society, if it was a country that was at war, were you seeing less empathy? Less rates of empathy, because people were more focused on surviving. Are you seeing higher rates of empathy in countries that are doing well, that have more resources, that were- the economy is good. What differences did you see in that area?

Konrath: We didn't look at specifically war, whether countries were at war or not, but we did look at well-being rates across the- based on national surveys, and we did find that empathy was higher in countries that were happier, so it could be that happier countries lead to more empathy or that more empathy leads to more happiness or some other reason, but in any case that link is there, and it wasn't- if I remember right and I have to check. I don't think we found a connection to average income in the country.

Luna: Interesting. Yes, so it might just depend more on other factors. Interesting. Okay.

Konrath: It does seem to be linked to well-being, both- so within individuals empathy is associated with more happiness and well-being, but also across cultures, we found the same thing.

Luna: Also, you did a lot of work, you've done work on narcissism and found that rates of narcissism among young people are increasing, is that related to what we talked about, just a little while ago, when you're talking about the pressures on young people, because they have so much outward pressure is it making people more narcissistic? Is that the right way to describe what you're seeing?

Konrath: Yes, I see that rising narcissism [inaudible 00:28:29] similar as the declining empathy because people who are narcissistic are more focused on themselves and less focused on others so it's negatively correlated with empathy, and those two trends were happening around the same time and again, we're still working on the update for the narcissism paper as well.

Yes, I think that just generally all those pressures on young people can make them kind of shrink their scope of self, rather than expanding it to include a lot of other people and concerns. It's just about more like survival and making it, and I think, and I don't have any casual evidence of this but this is what I think is happening.

Luna: Yes, that's really- you think is it because of social media? That's my next thing I want to touch on. Is some of your research you did and you presented this at the APA's convention in San Francisco in 2018, and your study you presented found that compassionate people spend less time on social media than people who are more self-centered and narcissistic.

You also found that people of lower emotional intelligence or those who have difficulty identifying, describing and processing their emotions, they use social media more often than those who are more in touch with their feelings. Can you talk a little bit about that and how these traits interact with in the digital age and with social media?

Konrath: Yes, and there's a lot of research, including our own that finds a correlation between narcissism and social media usage, but I don't necessarily think that means that social media use causes increased narcissism. The studies that have tracked people over time find if anything, it's the other way around, that narcissistic people are just attracted to use social media because it really fits kind of--

It can be used to fit their aims, which is to get a lot of attention. I did present that work, it's still unpublished, but finding that empathy is correlated with less social media use. Since then, a mini meta-analysis came out with five different studies examining that link between empathy and social media. Interestingly, it actually found that there's a small positive correlation. More empathetic people are using social media on average, a little bit more.

Luna: Could that be because-- Social media can be a source for good and it can be an opportunity for people to do good things. I'm thinking about when people talk about their personal battles with depression, and then others chime in and sharing their stories, their family stories, or people who share posts about a dog at a high kill shelter, wanting to be adopted.

There's obviously a lot of good things going on on social media. I think a lot of times you hear a lot about the negative aspects of it. Is that one of those examples you're talking about, where you're seeing more empathetic people using social media to connect with others, to be forces for good out there?

Konrath: Yes, I think that people might, after looking at the research on this and understanding there's mixed effects both with narcissism and empathy in social media, I think the big picture takeaway that I have at this point is that people are online who they are offline. Empathetic people when they're online, they're using the technology for different purposes and in different ways than somebody who's narcissistic.

Luna: That's really interesting. That's a good way to kind of put a fine point on that.

Konrath: It's like to connect. Empathetic people are trying to-- If they're using it a little more, it's because they're trying to connect with others. There's many empathetic ways to engage with people. Sometimes I think that not engaging can be empathetic. If there's somebody who's saying something really, that's really getting under your skin and making you angry, and maybe the reaction would be to say something mean back, maybe inhibiting a mean response is an empathetic response nowadays.

Luna: Yes, and also, your lab from when I was reading, you're using mobile phones. I'm thinking social media making that connection to mobile phones. You developed an app and you've done research about using mobile phones to implement empathy building programs. Can you talk a little bit more about that and what offerings you have, in terms of harnessing this technology to build empathy in communities?

Konrath: That's exactly what we're trying to do because, I think a lot of the response to my declining empathy study was saying, "Well, empathy is declining because of social media, because of smartphones." I'm like, "Well, wait, let's look a little further back. It's been declining before then, and face to face social connections were declining before then, so what's going on here?"

We responded by saying, "Well, we don't think that's the cause necessarily but this is something that young people really use a lot, actually very attracted to using phones and social media, so why wouldn't we design programs it's from their perspective speaking their own language." It's an empathic design response actually, and we designed two programs. One is called Text to Connect and that's a daily text message reminders designed for obviously teenagers and older- and young adults, so older young people.

It's just a little reminder to do things that I think everyone knows to do, but just like next time you talk to a person, make sure you pay attention to their body language and, look them in the eye, like some really basic stuff. Or like next time you're talking to somebody, imagine what it feels like from their perspective. These are really obvious little reminders, but we have a published paper finding that this did help to increase empathy in college students.

We have unpublished data on teenagers we're working on writing up, but also finding that it works. We also designed and tested a smartphone app design for children age 10 to 17. This one is called Random Act of Kindness. We had children come into our lab, we would be- and then they receive either random act of kindness or a different app with for two months. Then we tested what happened to their empathy.

We found again that this app can increase empathy in children. Within that age range, the younger kids preferred it. It was cartoonish, and they seem to like that, compared to the older kids, but we still found effects overall.

Luna: Yes. You mentioned before about- I think that's really an interesting point, that I've just been thinking about my own life, about how sometimes you just need to be reminded of these basic things. We all know that we should be good to other people. I think it's- we all know it, we know these things, but I think someone bringing it to the forefront through these apps, whatever it's through on a regular basis, if not daily basis is really helpful, in terms of living a better life and being better to people and to yourself.

Konrath: Yes, that's what we were thinking. Part of it is if we see that there are gaps in our culture and what's surrounding ourselves and our children and these reminders, then why not use the thing that's with us at all times to remind us. Phones are really a lot of potential to change our habits.

Luna: Yes, just touching on your program that you run. It sounds pretty amazing. Interdisciplinary Program on Empathy and Altruism. Is it unique in the field of psychology, and what other disciplines do you have as part of it?

Konrath: We're just a lab group. Most psychology researchers have a group of collaborators and other people they write with and do research with, so that's pretty much what we are. It includes occasion studies, philosophy. I'm just thinking about the different journals. Marketing. [chuckles] Just various bit-- It's been mostly quantitative at this point, but-- Sociology.

Just a bunch of different collaborators on the topics of interest related to empathy and altruism. This topic is not just a psychology topic, it's actually a topic that many people from various scholarly backgrounds are interested in. That's part of why I like working at the School of Philanthropy, because they're people from all different backgrounds including humanities. We're all studying questions related to giving and other processional behaviors.

Luna: That's an excellent segue into- the next session I want to get into, about philanthropy, another area you study. You're in the School of Philanthropy in Indiana University. During the research for this topic, I was reading about how much Americans donate every year. Before we started recording, you and I were talking about this a little bit more and really pursing this information out.

When you look at the stats, they say that $427 billion was donated to charity last year, but as you told me, that number is, in terms of how that's divided up, that money is from mostly wealthy donors and not from individual donors. Can you talk a little bit more about that with these trends you're seeing in terms of wealthy donors giving larger chunks to that $427 billion and individual people giving less?

Konrath: Wealthy donors are individual donors, say as compared to corporations which are part of that number too. When you just look at the percentage of individuals who are giving, overall, if you look at generational changes, my colleague Patrick Rooney at the School of Philanthropy wrote a paper on this recently, and found that there are generational declines in the percentage of people who are giving to charity and then also how much giving on average.

The reason why we don't see that there are declines in the overall amount of giving is because there are larger donors who are giving more over time. It makes it look like there isn't an overall decline in giving, but for a lot of the givers, there is a decline over time. That means that nonprofits have to-- They are in a difficult position where they have to think about what the wealthy donors want [laughs] and how to receive gifts from those people, or that you don't have to get younger generations to be more involved in giving.

Luna: How does the new tax law play into all that, because in the past an individual donor would receive more of a tax benefit for giving, but for many Americans I know, myself included, I found out last year the money I gave to charity in the clothes and whatever I donated I got nothing back for. That's a bummer. You definitely want to feel your contribution- you want to help others and be altruistic, but you're also the same time it's, why not get a tax break? How do you think that might impact individual giving in the future?

Konrath: Again, my colleagues at the School of Philanthropy actually are studying this and are economists and they can answer much better than I can, but I can speak to work I've done on motivations for giving. I've designed a scale, a personality scale that measures why people give fairly on average. Actually, on average, people are not saying at least self-reporting that taxes are the most important motivation.

They're actually saying that they give because they care, so altruism. I still think that it would be obviously [unintelligible 00:40:09] a tax law when you're [inaudible 00:40:11] because you want a tax break. If you're used to getting a tax break and then suddenly you don't that might influence how you respond next year.

Luna: Yes, of course, and I can only speak from my own experience. I want to give to these causes, but it's certainly nice, "Hey, I cleared out the closet of some clothes shoes, gently used items and maybe get a little bit of money back." That was always a nice added bonus. I was thinking last year or earlier this year I was doing taxes. That is probably all frightening for some even non-profits, if people aren't getting that tax break it might impact how much they give. Something to monitor.

Konrath: I think that is the case and it's just that I'm not the one doing that research, a lot of people are looking at that question. Also all of us have a constellation of motives. It's not like the only thing we care about when giving to charity is altruism. We all have mixed- different reasons. Some of it is about [unintelligible 00:41:06] or because of taxes, or because it makes us feel good. Taxes are in the mix. It came out as one of the motivations out of all the options we had, it's just that it's not necessarily the main one.

Luna: You co-authored a recent study that found people who volunteered had a lower mortality rate than those who gave money. It is really interesting. Why do you think that was the case?

Konrath: Well, first I want just to talk a little bit about what we did and then why we think we found the results. We used a dataset available from the Wisconsin Longitudinal Study that follows older adults. They've been following people since 1957, when they graduated high school. We compared different kinds of giving behaviors and also giving related traits.

See how they were associated with the risk of dying, several years later. What we found was that giving time in various ways, whether it's volunteering or caregiving, or helping friends, giving time is associated with a lower risk of mortality, but giving money was not. It was not associated with a lower risk of mortality. Also, people who spot that they were paying people, so for social traits, was also associated with a lower risk of mortality. Just seeing yourself that way, actually, what seems to be associated with better health.

Luna: Why do you think giving to others, and particularly giving time as you mentioned, benefits mental and physical health?

Konrath: We think it has to do with how much people are giving of themselves. You can easily write a check and walk away without thinking about it, but it's hard to do that when you're volunteering. You're actually engaging, interacting with people. I think that there's a biological system that helps us to regulate stress, that when we are in a state where we're focusing on others and what they need and caring for others, that's- the system helps to increase our oxytocin and reduce our cortisol, so a bonding hormone, oxytocin and then cortisol, it's a stress hormone.

Doing that over and over again, whether because you just are naturally thinking of others and see yourself as pro-social, or whether because you're actually out there helping regularly, doing that can, I think, over time, be associated with better health, but I'm just guessing based on our results, we don't quite have evidence yet.

Luna: This is a really good conversation to be having at this time of year. This podcast will be running in December. Obviously, people can listen to it at any point, but at this time of year, people are giving a lot, whether they're giving time or money and it's obviously a time where people are focusing on other people, you hope. So that will be a time to express empathy to others, so this is a very timely conversation.

I want to thank you for taking the time to speak with me today. I think our listeners will really take a lot away from this. I'm really excited to see what happens with that research you will be publishing someday soon about what happened between 2009 and 2019 with rates of empathy.

Konrath: I'm really curious too. Thank you so much for your amazing questions. It was a really interesting conversation.

Luna:  Thank you. I really appreciate that. Before we go, I want to tell our listeners we want to hear from you. You can email your comments and ideas to  [email protected] . That's speaking of psychology, all one word, @apa.org. Also, please consider giving us a rating in iTunes, it really helps. You can find all episodes of Speaking of Psychology on Apple, Stitcher, Spotify, or wherever you get your podcasts, and also on our website,  SpeakingofPsychology.org . I'm Kaitlin Luna with the American Psychological Association. 

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Episode 95: The Decline of Empathy and the Rise of Narcissism

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About the host: Kaitlin Luna

Kaitlin Luna was the host of Speaking of Psychology from September 2018 to March 2020. A former broadcast journalist, she worked in APA's Office of Public Affairs as a public affairs manager.

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The Double-Edged Sword of Parental Empathy in Parenting Practice and its Impact on Children's Externalizing and Internalizing Problems

42 Pages Posted: 18 Jun 2024

Nanhua Cheng

Capital Normal University

Chinese Academy of Sciences Institute of Psychology

Zhengyan Wang

Numerous studies highlight the double-edged sword effect of empathy on individual’s multidimensional outcomes. Research has shown that empathy dimensions, such as self-oriented emotional contagion, may exacerbate the occurrence of maladaptive behaviors, while other-oriented empathic concern dimension can benefit the emergence of prosocial behaviors. However, the dual impact of empathy within parenting practice remains insufficiently explored. This longitudinal study of early school-age children (across three developmental stages at 7, 9 and 11 years old, N = 146) aimed to explore the role of parental empathy (contagion and concern) measured by the Interpersonal Reactivity Index and Empathy Index in shaping parenting behaviors and their subsequent effects on children's externalizing and internalizing problems, with an additional focus on gender differences among parents. The results revealed that parents' concern positively predicted positive parenting across all observed ages, while contagion positively predicted negative parenting at ages 7 and 11, predominantly among mothers. Moreover, parents' negative parenting mediated the relationship between their contagion traits and children's externalizing problems, and mothers' negative parenting also mediated the relationship between their concern and children's externalizing problems. Additionally, mothers' positive parenting was identified as a fully mediating variable in the prediction of children's problem behaviors by mothers’ concern traits. These findings are of significant importance for understanding the double-edged sword effect of empathy in human society, providing a new perspective for promoting positive parenting practice and preventing the emergence of children's externalizing problems.

Keywords: Parental Empathy, Parenting Practice, Internalizing Problems, Externalizing Problems, Parental Differences

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Empathy is transforming technology in surprising ways. Join hosts Andrea Goulet and Ray Myers as they discuss industry trends, cutting-edge research, practical skills, and ethical explorations around empathy in tech. 

Empathy in Tech Andrea Goulet

• MAY 26, 2024

Andrea and Ray dive into the "why" of the Empathy in Tech podcast. Why empathy? Why tech? Why us? Why now? Andrea shares the backstory of how the Empathy in Tech came to be, the mission of the Empathy in Tech organization, and why she's passionate about leading a scientific revolution. LINKS * Jamil Zaki's article: https://www.vox.com/future-perfect/24137520/americans-empathy-new-compassion-research * Roddenberry Hypothesis - https://www.ted.com/talks/jamil_zaki_we_re_experiencing_an_empathy_shortage_but_we_can_fix_it_together * Communication is just as important as code talks - https://www.youtube.com/watch?v=VFuNdKPV0jc * Empathy is a Technical Skill - https://www.youtube.com/watch?v=o1ZKwkPU_0Y * Corgibytes - https://corgibytes.com/ * Legacy Code Rocks - https://legacycode.rocks [https://legacycode.rocks/] * Milton Waddams from Office Space - https://www.youtube.com/watch?v=CvMeiKSD43E * Shannon-Weaver model of a General Communication System - https://en.wikipedia.org/wiki/Shannon%E2%80%93Weaver_model * Mender.ai - https://mender.ai/ * The Structure of Scientific Revolutions - https://en.wikipedia.org/wiki/The_Structure_of_Scientific_Revolutions * A Short History of the "Soft Skill" vs. "Hard Skill" Divide - https://www.linkedin.com/pulse/short-history-soft-skill-vs-hard-divide-why-its-farce-andrea-goulet * Unlearning the Empathy Stereotype - https://www.linkedin.com/pulse/unlearning-empathy-stereotype-andrea-goulet-xjyfc * Madison Mohns' TED Talk - https://www.youtube.com/watch?v=DbQjrA9VPjY HOSTS Andrea Goulet LinkedIn - https://www.linkedin.com/in/andreamgoulet Ray Myers LinkedIn - https://www.linkedin.com/in/cadrlife ABOUT EMPATHY IN TECH Empathy in Tech's mission is to accelerate the responsible adoption of empathy in the tech industry to help humanity solve our most pressing and complex problems. We do this by focusing on three key areas: * Technical Empathy - Close the empathy skills gap in the tech industry by leading a scientific revolution that embraces new research. * Ethical Empathy - Ensure empathy is used for social good through ethical, equitable, and responsible choices. * Actionable Empathy - Build a thriving community that makes effective empathy training accessible, affordable, and widely available. Learn more at https://empathyintech.com [https://empathyintech.com/]

• © Andrea Goulet & Ray Myers

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Political Empathy Lab (PEL) Reflection: Inattentive Blindness and State Politics Revealed

Political Empathy Lab is a 10-week summer research experience where I am traveling with seven undergraduates around the state of Pennsylvania the summer before the 2024 presidential election.  In each of the areas of Pennsylvania we visit we are simply talking with people about politics.  While not polling or canvasing, we are paying close attention to how we connect with others as we develop a repertoire of skills for connecting across socio political difference.  While we are still developing our observations, our skills and our major findings, we hope to contribute periodic articles about specific ideas or concepts that we’ve experienced.  This is the first in our series of short articles.  Enjoy!

Dr. Lia Howard

• Citizenship

Political Empathy Lab (PEL) Borrows the Netter Center for Community Partnerships’s Van

I want to start this reflection by thanking Rita Hodges and Yetunde Pinckney at the Netter Center.  Not only did you lend Political Empathy lab your van for a tour of Philadelphia you also exposed me to my favorite new term .

You see, to drive a van at Penn you must complete a series of 10 modules as part of a safe driver training.  Even though I did not end up being our driver, I did complete the modules just in case and while doing so I learned the term “inattentive blindness.” [1]   This is a fascinating concept that basically means that even if you have perfect vision, you fail to see something that is right in front of you because you are distracted by something you are thinking about.  In essence because you are not attending to something directly physically in front of you, you cannot see it because something that is not even there has captured your attention.

Bearing Witness to State Level Decision Making

To me this captures the feeling I had while in Harrisburg with the PEL team.  Sitting in the Gallery of the House of Representatives on the afternoon of June 11 we heard the last 30 minutes or so of voting for the day.  While we sat there, at least five pieces of very important legislation came up for a rapid vote.  Among the items I quickly tried to capture in my notes:

• Should SNAP recipients have 30 hour a week mandatory work requirements (determined “no” by the one vote majority held by Democrats)
• Should SNAP benefits be curtailed or reduced based on the overspending of six cases of overspending (likewise rejected by the one vote majority held by Democrats)
• Should Immigrants be able to receive SNAP benefits (this I am less sure on the dimensions of but had a party line vote D 101 yays and R 100 nays)
• Lifetime recovery care for substance abuse (unanimously passed)
• Two Agriculture bills (different ones that I would need to read the text of to see the nuances) but the first was unanimously voted upon in the affirmative. The second was more complex “Agriculture Innovation Fund” and was split (162 yays and 39 nays)

All of these pieces of legislation seemed pretty consequential, and many were voted for along party lines thus only being decided by a single members’ vote.  These are tenuous decisions upon legislation which have such big impact on the citizens of Pennsylvania, especially those of lower income.

And yet, who is paying attention to these votes?  Who even knows that they are going on?  What media outlets remain at this moment to report on them with the detail they deserve?

Having spent my career focused on American Politics and frequently teaching about federalism, I understand theoretically this quintessential element of American politics of shared distribution of power between the government in Washington DC, the 50 states and the thousands of local governments.  I know that state and local government have control over the many complex rules that govern our daily lives.  And even with this knowledge, I am almost exclusively focused on national politics, and “inattentively blind” to Harrisburg.  I practice a citizenship that ignores or cannot even see the politics that I actually have the most agency over.  Sitting in that gallery with just a few other people who were there to be formally recognized in the beginning of the day’s session and then a smattering of other staff as the day wore on, I was convicted of the power of bearing witness to state government at work.  The flip side of that coin is the danger of not watching (and elected representatives knowing you are not watching) as very important decisions are made in plain sight.  Anyone who subjects themselves to a metal detector can enter the Capitol building in Harrisburg and watch the proceedings.  This was my first time doing so and I am convinced that I need be paying attention a bit more.

I want to take a moment here to say that PEL is deeply fortunate to have the guidance and connections of Penn’s Director of Commonwealth Affairs, Michael F. Smith.  Working out of the University’s Office of Community and Government Affairs, Michael represents Penn in Harrisburg.   None of what is new to me is new to him and he has been and continues to be a patient teacher.  The PEL research team had lunch with him in the Capitol building.  While we were asking our questions and sharing about our day we noticed as a steady stream of Members of the Pennsylvania Congress and staffers stopped by our table to greet him and meet us.  It was very special.

Zoo Animals in the Capitol?

Beyond that vote, while we were in the Capitol building we saw a large group of Boy Scouts of America getting their picture taken in the rotunda entry way area.  We also saw a group called Free My Weedman make an appeal against criminalizing marijuana especially the unfair sentencing of Black men and women.  At the same time, we saw the Hershey Chocolate company have characters dressed up and walking around.  And there were a variety of other tables with information on a variety of policy issues from childcare to climate change.

As we went to the bottom floor however, we saw representatives from zoos across the state advocating for state funding.  To help them make their case they brought animals, a sloth climbed on a simulated tree, a mini alligator was held by a keeper, a capybara was on a leash, and I counted an uncomfortable number of snakes in aquariums some marked “venomous.”

June is the month where the PA Government works on the budget and different groups come to advocate for funding.  June 11 just happened to be the day where zoos and animal advocacy organizations were working to ensure funding support.

We walked outside and saw State Senator Doug Mastriano organized a press conference around service working animals and many organizations had a street fair of sorts with tables and service working dogs from a variety of different organizations (including Penn Vet).

It felt overwhelming, it felt democratic, it felt like I had no idea this all was happening.  Again, inattentive blindness to my state.

Political Empathy Lab is about connecting with people, and it is also about connecting with place.  We talk to people in different places not to extract specific data points about them or persuade them of a defined set of ideas, but to talk with them and see what is important to them and what they think about their place, and we did do that in Harrisburg.

The idea that remains with me, however, is how singularly self-revelatory this trip was.  Though all trips have taught me something about myself, this trip revealed my inability to see what is right in front of me.  On my reading list is Shoshana Zuboff’s The Age of Surveillance Capitalism: The Fight for A Human Future at the New Frontiers of Power especially for her discussion of the attention economy.  Our attention is a valuable resource that entities both commercial and political want to grab.  When we are not conscious of it we can be led to distraction and miss what is right in front of us.

I want to start noticing state and local politics and start bearing witness to the governance that influences me and that I might have agency do so something about.

Photos by Dr. Lia Howard.

[1] The term “inattentive blindness”, also known as “inattentional blindness” or “perceptual blindness” is the psychological phenomenon that causes an individual to miss things that are right in front of your eyes.

Simons, Daniel J.; Chabris, Christopher F. (1999). “Gorillas in our midst: sustained inattentional blindness for dynamic events” (PDF) . Perception . 28 (9): 1059–1074.

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An Overview of Empathy

Empathy is a powerful communication skill that is often misunderstood and underused. Initially, empathy was referred to as “bedside manner”; now, however, authors and educators consider empathetic communication a teachable, learnable skill that has tangible benefits for both clinician and patient: Effective empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship. Appropriate use of empathy as a communication tool facilitates the clinical interview, increases the efficiency of gathering information, and honors the patient.

Introduction

That the medical care experience is enhanced by effective communication between clinicians and their patients is a well established fact. Byproducts of this enhanced communication include improved health outcomes, 1 better patient compliance, 2 reduction in medical-legal risk, 3 – 5 and improved satisfaction of clinicians and patients. 6 , 7 Of all the elements involved in effective communication, empathy seems to be the component that is most powerful yet is easily overlooked—and some commentators have asserted that in medical practice the importance of empathy cannot be overemphasized. 8

What is Empathy?

The origin of the word empathy dates back to the 1880s, when German psychologist Theodore Lipps coined the term “einfuhlung” (literally, “in-feeling”) to describe the emotional appreciation of another’s feelings. Empathy has further been described as the process of understanding a person’s subjective experience by vicariously sharing that experience while maintaining an observant stance. 9 Empathy is a balanced curiosity leading to a deeper understanding of another human being; stated another way, empathy is the capacity to understand another person’s experience from within that person’s frame of reference. 10

Even more simply stated, empathy is the ability to “put oneself in another’s shoes.” In an essay entitled “Some Thoughts on Empathy,” Columbia University psychiatrist Alberta Szalita stated, “I view empathy as one of the important mechanisms through which we bridge the gap between experience and thought.” A few sentences earlier in her essay, she had emphasized that … “[empathy is] consideration of another person’s feelings and readiness to respond to his [or her] needs … without making his [or her] burden one’s own.” 11:p151

Can Empathy Be Taught?

Unfortunately, many physicians were trained in the world of “Find it and Fix it” medicine, a world where empathetic communication was only an afterthought—if this behavior was considered at all. Empathy was known as “bedside manner,” a quality considered innate and impossible to acquire—either you were born with it or you weren’t. More recently, greater emphasis has been placed on empathy as a communication tool of substantial importance in the medical interview, and many experts now agree that empathy and empathetic communication are teachable, learnable skills. 12 , 13 As we might therefore expect, empathy is the cornerstone of several communication models, including “The Four Habits” model (Invest in the Beginning, Elicit the Patient’s Perspective, Demonstrate Empathy, Invest in the End) developed by The Permanente Medical Group’s Terry Stein with Richard Frankel; 14 “The 4 E’s” (Engage, Empathize, Educate, and Enlist) model used by the Bayer Institute for Health Care Communication; 15 the “PEARLS” (Partnership, Empathy, Apology, Respect, Legitimization, Support) framework adopted by the American Academy on Physician and Patient; 16 and other models. 17 , 18

Many medical schools have developed curricula with a strong focus on physician-patient communication and empathy. Delivery of these curricula begins early in the students’ training. At the University of Colorado Health Sciences Center, this curriculum is known as the “Foundations of Doctoring” program, a curriculum whose teaching staff includes several physicians and trainers from the Colorado Permanente Medical Group (CPMG). CPMG has also developed an eight-hour clinician-patient communication course based on The Four Habits model which is offered to all newly hired physicians in the Kaiser Permanente (KP) Colorado Region. In this course, plenty of time is set aside to explore empathy and to practice empathetic communication with patients selected according to standard criteria.

Practical Empathetic Communication

Making practical use of an otherwise esoteric concept such as empathy requires division of the concept into its simplest elements. As outlined by Frederic Platt, 19 key steps to effective empathy include:

• recognizing presence of strong feeling in the clinical setting (ie, fear, anger, grief, disappointment);
• pausing to imagine how the patient might be feeling;
• stating our perception of the patient’s feeling (ie, “I can imagine that must be …” or “It sounds like you’re upset about …”);
• legitimizing that feeling;
• respecting the patient’s effort to cope with the predicament; and
• offering support and partnership (ie, “I’m committed to work with you to …” or “Let’s see what we can do together to …”).

Being a psychiatrist or mental health expert is not necessary for using empathetic communication; the only requirement is an awareness of opportunities for empathy as they arise during the interview with a patient. This type of opportunity arises from a patient’s emotion (either directly expressed or implied): This emotion creates the opportunity for an empathetic response by the physician. In a study by Wendy Levinson et al, 20 116 office visits to primary care and surgical physicians were audiotaped and transcribed to look at the frequency of empathy opportunities or “clues.” More than half of visits in each setting included one or more clues. In more than half of cases, patients presented these clues not overtly but in more subtle ways. Unfortunately, physicians responded to those clues in only 38% of surgical cases and in only 21% of primary care cases and frequently missed opportunities to adequately acknowledge a patient’s feelings. 20 Clues are often hidden in the fabric of discussion about medical problems and thus may be easily missed by physicians who are busy attending to biomedical details of diagnosis and management. In fact, when opportunities for empathy are missed by physicians, patients tend to offer them again, sometimes repeatedly. This phenomenon can lead to longer, more frustrating interviews, return visits, and “doctor shopping” by patients who feel dismissed or alienated.

After an opportunity for empathy has been presented, the clinician should consider offering a gesture or statement of empathy. Statements that facilitate empathy have been categorized as queries, clarifications, and responses. 21 Examples of each are as follows:

• “Can you tell me more about that?”
• “What has this been like for you?”
• “How has all of this made you feel?”
• “Let me see if I’ve gotten this right … ”
• “Tell me more about … ”
• “I want to make sure I understand what you’ve said … ”
• “Sounds like you are … ”
• “I imagine that must be … ”
• “I can understand that must make you feel … ”

Ideally, after perceiving the clinician’s statement of empathy, the patient expresses agreement or confirmation (“You got it, Doc!” or “Yeah, that’s exactly how I feel”). When we have not understood the patient’s experience exactly, we must allow the patient to correct our perception. Use of the Hypothesis-Test-Feedback Loop allows the patient to clarify his or her experience and thus allow the physician to restate an empathetic statement that originally missed its mark. The following exchange is an example of this Hypothesis-Test-Feedback Loop used in the doctor-patient encounter:

Patient: I am sick and tired of living with these headaches. No one has been able to help me, and none of the medications are working. Doctor (stating the hypothesis): I can see that you are frustrated by the lack of improvement in your symptoms. Patient (giving feedback): Yeah, but I’m really more worried that we’re missing something serious. I’ve got a wife and kids who are depending on me. Doctor (correcting the hypothesis): So, it sounds like you’re really more concerned that something serious could be going on that is causing these headaches. Patient (closing the empathy loop): Yes, exactly.

In this example, the physician makes an empathetic statement (hypothesis) about what he or she surmises is the chief aspect of the patient’s experience: frustration about an unrelenting headache. When the hypothesis is tested, the patient clarifies that although frustrated, he is mainly experiencing worry about the situation. Armed with this feedback, the physician restates the hypothesis back to the patient, who lets the physician know that he or she “got it exactly right.”

Barriers to Giving Empathy

Because empathy is such a powerful communication skill, we might suppose that clinicians would scramble to learn about and use it at every available opportunity. However, this is not necessarily the case. Clinicians have many reasons for not offering empathy to patients. An informal survey of practicing clinicians participating in a recent clinician-patient communication course revealed misgivings (and misconceptions) about empathetic communication. Concerns mentioned included:

• “There is not enough time during the visit to give empathy.”
• “It is not relevant, and I’m too busy focusing on the acute medical problem.”
• “Giving empathy is emotionally exhausting for me.”
• “I don’t want to open that Pandora’s box.”
• “I haven’t had enough training in empathetic communication.”
• “I’m concerned that if I use up all my empathy at work I won’t have anything left for my family.”

In our experience, empathy facilitates the clinical interview, increases efficiency of gathering information, and honors the patient. Empathy need not be awkward nor emotionally exhausting; unlike sympathy, empathy does not require emotional effort on the part of the clinician. An appropriate statement or gesture of empathy takes only a moment and can go a long way to enhance rapport, build positive relationships, and even improve difficult ones. Studies have shown that when opportunities for empathy were repeatedly missed, visits tended to be longer and more frustrating for both physician and patient. 18 , 20 Conversely, empathy may save time and expense and often is a cost-effective method of facilitating early diagnosis and proper treatment. 10

Empathy Versus Sympathy (and Versus Pity)

Despite some divergent opinion on the matter, we may propose a subtle but important distinction between empathy and sympathy.

Whereas empathy is used by skilled clinicians to enhance communication and delivery of care, sympathy can be burdensome and emotionally exhausting and can lead to burnout. Sympathy implies feeling shared with the sufferer as if the pain belonged to both persons: We sympathize with other human beings when we share and suffer with them. It would stand to reason, therefore, that completely shared suffering can never exist between physician and patient; otherwise, the physician would share the patient’s plight and would therefore be unable to help.

Empathy is concerned with a much higher order of human relationship and understanding: engaged detachment. In empathy, we “borrow” another’s feelings to observe, feel, and understand them— but not to take them onto ourselves. By being a participant-observer, we come to understand how the other person feels. An empathetic observer enters into the equation and then is removed.

Harry Wilmer 22 summarizes these three emotions—Empathy, Sympathy, and Pity—as follows:

• Pity describes a relationship which separates physician and patient. Pity is often condescending and may entail feelings of contempt and rejection.
• Sympathy is when the physician experiences feelings as if he or she were the sufferer. Sympathy is thus shared suffering.
• Empathy is the feeling relationship in which the physician understands the patient’s plight as if the physician were the patient. The physician identifies with the patient and at the same time maintains a distance. Empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship.

Empathy is a powerful, efficient communication tool when used appropriately during a medical interview. Empathy extends understanding of the patient beyond the history and symptoms to include values, ideas, and feelings. Benefits of improved empathetic communication are tangible for both physician and patient.

Acknowledgments

Ilene Kasper, MS, and Andrew M Lum, MD of Kaiser Permanente Colorado; and Brian Dwinnell, MD, and Frederic W Platt, MD, FACP, of the University of Colorado Health Sciences Center, reviewed the article.

James T Hardee, MD , Obtained his medical degree from the University of New Mexico School of Medicine, where he also completed his Internal Medicine residency. He joined the Colorado Permanente Medical Group in 1998 and is currently on the CPMG Board of Directors. He is the physician lead for Clinician-Patient Communication in the Colorado Region. E-mail: [email protected] .

Two Things Stand

Life is mostly froth and bubble, Two things stand like stone, Kindness in another’s trouble, Courage in your own. Adam Lindsay Gordon, 1833–1870, poet