empathy in research

Handbook of Research Methods in Health Social Sciences pp 237–252 Cite as

Empathy as Research Methodology

• Eric Leake 2  
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• First Online: 13 January 2019

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While a long-standing concern in psychology and philosophy, empathy is receiving increased attention in the social sciences for its importance in interpersonal relationships and its use in cross-cultural contexts. I begin this chapter with a brief history and overview of the concept of empathy as a means of understanding the perspectives and experiences of others. I then consider the features that distinguish empathy and the modes through which empathy functions. I address empathy’s value across disciplines and extend the application of empathy to the health and social sciences by outlining how practices of empathy might work as a component of research, especially in consideration of different perspectives and social conditions. I apply practices of empathy to research site and participant selection, communication, collaboration, self-reflection, and the recognition of limitations. I advocate the practice of critical empathy, in which researchers acknowledge the biases and shortcomings of empathy while simultaneously looking to establish shared goals and interests. To conclude this chapter, I consider the continued necessity of empathy as a component of research despite empathy’s limitations.

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Leake, E. (2019). Empathy as Research Methodology. In: Liamputtong, P. (eds) Handbook of Research Methods in Health Social Sciences. Springer, Singapore. https://doi.org/10.1007/978-981-10-5251-4_65

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Empathy: Assessment Instruments and Psychometric Quality – A Systematic Literature Review With a Meta-Analysis of the Past Ten Years

Felipe fernandes de lima.

1 Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil

Flávia de Lima Osório

2 National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Objective: To verify the psychometric qualities and adequacy of the instruments available in the literature from 2009 to 2019 to assess empathy in the general population.

Methods: The following databases were searched: PubMed, PsycInfo, Web of Science, Scielo, and LILACS using the keywords “empathy” AND “valid ∗ ” OR “reliability” OR “psychometr ∗ .” A qualitative synthesis was performed with the findings, and meta-analytic measures were used for reliability and convergent validity.

Results: Fifty studies were assessed, which comprised 23 assessment instruments. Of these, 13 proposed new instruments, 18 investigated the psychometric properties of instruments previously developed, and 19 reported cross-cultural adaptations. The Empathy Quotient, Interpersonal Reactivity Index, and Questionnaire of Cognitive and Affective Empathy were the instruments most frequently addressed. They presented good meta-analytic indicators of internal consistency [reliability, generalization meta-analyses (Cronbach’s alpha): 0.61 to 0.86], but weak evidence of validity [weak structural validity; low to moderate convergent validity (0.27 to 0.45)]. Few studies analyzed standardization, prediction, or responsiveness for the new and old instruments. The new instruments proposed few innovations, and their psychometric properties did not improve. In general, cross-cultural studies reported adequate adaptation processes and equivalent psychometric indicators, though there was a lack of studies addressing cultural invariance.

Conclusion: Despite the diversity of instruments assessing empathy and the many associated psychometric studies, there remain limitations, especially in terms of validity. Thus far, we cannot yet nominate a gold-standard instrument.

Introduction

There is growing consensus among researchers concerning empathy being a multidimensional phenomenon in recent years, which necessarily includes cognitive and emotional components ( Davis, 2018 ). Reniers et al. (2011) , for instance, consider that empathy comprises both an understanding of other peoples’ experiences (cognitive empathy) and an ability to feel their emotional experiences (affective empathy) indirectly. Baron-Cohen (2003 , 2004) considers that empathy is the ability to identify what other people are thinking and feeling (cognitive empathy) and to respond to these mental states with appropriate emotions (affective empathy), enabling individuals to understand other peoples’ intentions, anticipate their behavior and experience the emotions that arise from this contact with people. Hence, empathy enables effective interaction in the social world.

According to Kim and Lee (2010) , empathy can be assessed by self-report instruments/scales and observed through most psychological constructs. Moya-Albiol et al. (2010) stress that new strategies have been recently proposed to approach this construct from an ecological perspective, such as computational tasks with emotional stimuli.

The literature presents instruments to assess an individual’s ability to provide empathic responses in general and instruments designed to assess empathy in specific contexts, such as ethnocultural empathy ( Rasoal et al., 2011 ), empathy in the face of anger and pain ( Vitaglione and Barnett, 2003 ; Giummarra et al., 2015 ), empathy among physicians ( Alcorta-Garza et al., 2016 ), health workers, and patients ( Scarpellini et al., 2014 ) and empathy involved in the relationship between teachers and students ( Warren, 2015 ), among others.

Previous studies, such as systematic reviews, have assessed the psychometric quality of instruments intended to assess empathy in some of these specific contexts. Hemmerdinger et al. (2007) assessed the reliability and validity of scales used to assess empathy in medicine, analyzing 36 different instruments. The Medical Condition Regard Scale, Jefferson Scale of Physician Empathy, Consultation and Relational Empathy, and Four Habits Coding Scheme, which were developed for this specific population, stood out together with Davis Interpersonal Reactivity Index (IRI), Empathy Test, Empathy Construct Rating Scale, and Balanced Emotional Empathy Scale, which assess empathic ability in general, as they presented satisfactory psychometric qualities. However, the authors highlighted that instruments focusing on selecting candidates for the medical program lacked sufficient predictive validity evidence. Nonetheless, they concluded that there were measures with sufficient evidence to investigate the role of empathy in the medical and clinical care fields.

Later, Yu and Kirk (2009) attempted to verify the existence of a gold-standard instrument to assess empathy within the nursing field. They identified 12 instruments, 33.3% of these were originally developed with nursing workers and students (e.g., Empathy Construct Rating Scale and Layton Empathy Test), 33.3% addressed health workers and patients (e.g., Barrett-Lennard Relationship Inventory and Carkhuff Indices of Discrimination and Communication), and 33.3% were developed to assess empathic response in general (e.g., Emotional Empathy Tendency Scale and IRI). The results show that most instruments presented not very robust validity or reliability indicators, while less than 15% of the instruments verified the responsiveness item. The authors concluded that no instrument could be recommended as the gold standard but noted that the Empathy Construct Rating Scale gathered the most robust evidence.

Hong and Han (2020) recently conducted a systematic review to identify scales assessing empathy among health workers in general. Eleven studies were included in the review, among which the Consultation and Relational Empathy, Jefferson Scale of Physician Empathy, and Therapist Empathy Scale (TES). These scales stood out in terms of psychometric quality; however, like previous reviews, the conclusion was that there were no instruments with desirable psychometric qualities to be considered the gold standard. Additionally, none of the measures were specifically developed for professionals working with the elderly, which indicates an important gap in the field.

To our knowledge, no systematic reviews focus on instruments that measure empathic ability in the general population. Hence, this review aimed to describe the psychometric quality and adequacy of instruments available in the literature from 2009 to 2019 to assess empathy in the general population.

Materials and Methods

This study complied with the recommendations proposed by the Preferred Reporting Items for Systematic Review and Meta-Analyses – PRISMA ( Moher et al., 2009 ) and the methodological guidelines established by the BRASIL. Ministério da Saúde et al. (2014) . The following databases were searched: PubMed, PsycINFO, Web of Science, Scielo, and LILACS together with the keywords empathy, valid ∗ , reliability, and psychometr ∗ . Inclusion criteria were studies: (a) addressing 18-year-old or older individuals in the general population of both sexes; (b) published between 2009 and 2019, regardless of the language; and (c) with the objective to develop and/or assess the psychometric quality of instruments measuring empathic response in the general population. Figure 1 presents the exclusion criteria and the entire process used to select the studies.

Flowchart describing to the inclusion and exclusion criteria processes based on PRISMA protocol (* Bora and Baysan, 2009 ; Innamorati et al., 2015 ).

Two mental health workers experienced in psychological and psychometric assessments (FFL, FLO) independently decided on the studies’ eligibility; divergences were resolved by consensus. A standard form was developed to extract the following variables: (a) year of publication; (b) study’s objective; (c) sample characteristics (i.e., country of origin, sample size, sex, age, and education); (d) instrument’s characteristics (objective, number of items, application format, and scoring); and (e) psychometric indicators concerning validity and reliability.

The framework proposed by Andresen (2000) was used to assess the psychometric quality of the papers included in this review. It rates different criteria on a nominal scale ranging from A (strong adequacy) to C (weak or no adequacy), namely: Norms, Standard values; Measurement model; Item/instrument bias; Respondent burden; Administrative burden; Reliability; Validity; Responsiveness; Alternate/accessible forms, and Culture/language adaptations. This review’s authors independently assessed the studies’ psychometric quality and resolved divergences by achieving a consensus. The definitions of psychometric qualities and assessment criteria are presented in Supplementary Material 1 .

A qualitative synthesis of the results was performed for each instrument. Additionally, for those instruments with more than two studies, meta-analytic measures of reliability and convergent validity were produced using the Jamovi software. We conduct reliability generalization meta-analysis of Cronbach’s alpha (for the total scale and/or subscales) ( Pentapati et al., 2020 ), and intraclass correlation coefficients (ICC) were grouped for the computation of test-retest meta-analytic measures ( Macchiavelli et al., 2020 ). To group data concerning convergent validity with empathy measures and correlate constructs, we used Pearson/Spearman correlation coefficient (r) as the effect size measure ( Duckworth and Kern, 2011 ). In the case of multiple indicators, the largest indicator in absolute values was chosen. Untransformed estimates and inverse variance weighting were used ( Hedges and Olkin, 1985 ). An average coefficient and a 95% confidence interval (95%CI) were calculated for each meta-analysis. Heterogeneity of the measures between studies was verified using Q-statistic and I2 index. The funnel plot was used to assess the publication bias ( Egger et al., 1997 ).

Fifty studies were selected, and 23 different instruments were identified. The instruments most frequently addressed were the Empathy Quotient (EQ; n = 11), IRI ( n = 10), and Questionnaire of Cognitive and Affective Empathy (QCAE; n = 5). Only one or two studies assessed each of the remaining instruments. A total of 60.9% of the instruments were developed in the period included in this review, from 2009 to 2019. The remaining studies were developed before 2009, and the studies assessed new aspects of their psychometric qualities and/or cross-cultural adaptations. Table 1 presents an overview of each instrument.

Overview of the instruments analyzed to assess general empathic capacity in the general population (ranked from most studied to least studied).

SRF, self-report form; HRF, hetero-report form; *new instruments proposed from 2009.

Table 1 shows that most instruments are self-report scales ( n = 21), rated on a Likert scale (70% included five-point scales), with the number of items ranging from one to 80 (median = 23). Three instruments present alternative versions with fewer items [EQ, IRI, and Empathy Assessment Index (EAI)]. In most cases, data were collected face-to-face ( n = 12), while the Active-Empathic Listening Scale (AELS) ( Drollinger et al., 2006 ) was the only instrument with an other-report version. Two instruments consisted of computational tasks with the presentation of photorealistic stimuli: the Multifaceted Empathy Test (MET) ( Dziobek et al., 2008 ) and the Pictorial Empathy Test (PET) ( Lindeman et al., 2018 ). Data concerning the samples used by the different studies are presented in Table 2 .

Characterization of the samples used by the different studies ( N = 50 – ranked from most studied to least studied).

CS, college students; ES, elementary school; HS, high school; NS, non-student; UD, university degree ♀, women; ♂, men; S, sample.

As shown in Table 2 , the smallest sample was composed of 50 participants, and the largest sample had 5.724 participants (mean = 1036.6 ± 1577.5). Regarding age, most studies addressed young/middle-aged adults (median = 24.0); with varied educational levels (college students and individuals with a university degree = 67.3%). As for the countries of origin, European countries predominated ( n = 20), followed by North American countries ( n = 17), Asian ( n = 6), and South American countries ( n = 7).

The instruments’ psychometric proprieties were assessed according to the parameters proposed by Andresen (2000) . The results of which are presented in Tables 3 , ​ ,4 4 and Supplementary Material 2 present raw data concerning these indicators based on reliability and validity criteria (construct and criterion).

Analysis of psychometric qualities by the different instruments, according to the studies analyzed ( n = 50) – Part A.

1-Respondent; 2-Administrative.

Analysis of psychometric qualities by the different instruments according to the studies analyzed ( N = 50) – Part B.

CFA, confirmatory factor analysis; EFA, exploratory factor analysis; ESEM, exploratory structural equation model.

Empathy Quotient

Eleven studies (22.0%) assessed the EQ’s psychometric properties, six of which applied the instrument’s complete version (60 items); three applied the 40-item version (filler items are removed); one study applied the 22-item version, and one the 15-item version.

The Respondent burden criterion was considered satisfactory in all the studies and received grade A; all the versions were brief and well accepted by the target population. Administrative burden also received grade A because the EQ is easy to apply, score, and interpret. None of the studies presented specific normative indicators such as the T score or percentile distribution, only data concerning the mean score ( n = 8), which resulted in grade B.

Regarding the Measurement model criterion, only Kim and Lee (2010 ; EQ-40) and Kosonogov (2014 ; EQ-60) presented kurtosis and asymmetry indicators to show the normality of data distribution. The remaining studies (81.8%) did not report analyses with this purpose, revealing a weakness regarding this psychometric indicator.

Seven studies conducted the EQ cross-cultural adaptation into Korean, Portuguese (Portugal and Brazil), Russian, Turkish, and Chinese. Rodrigues et al. (2011) , Gouveia et al. (2012) , Zhang et al. (2018) , and Zhao et al. (2018) obtained grade A in the Item/instrument bias criterion as they adopted the recommended guidelines for face validity, namely: translation, back translation, peer review, and pretest applied in the target population ( Beaton et al., 2000 ). The Korean and Turkish versions ( Kim and Lee, 2010 ; Kose et al., 2018 ) received grade B because these did not report a pretest. The Russian version ( Kosonogov, 2014 ) obtained grade C because it did not report its procedures. Two other studies ( Preti et al., 2011 and Senese et al., 2016 ) assessed the psychometric quality of the Italian version, using the version previously adapted by Baron-Cohen (2004) , while Redondo and Herrero-Fernández (2018) analyzed the properties of the version previously adapted by Allison et al. (2011) into Spanish.

The internal consistency of the 60-item version presented alpha values that ranged from 0.76 to 0.85; most obtained grade B ( N = 3). Even with a smaller number of items, the short versions maintained alpha values within a similar pattern (0.78 to 0.87). The cumulative alpha for total scale was 0.85 (IC95%: 0.81 – 0.85) with moderate heterogeneity (I2 = 47.96%; Q = 23.866, p = 0.02). The funnel plot showed asymmetry (Egger’s: p < 0.001) (see Supplementary Material 3.1 ). Subgroup analyzes considering the instrument’s different version indicate cumulative alpha values of 0.76 (CI95%: 0.74–0.79; I2 = 7.52%; Q = 2.166, p = 0.34) for the 60-item version, 0.84 (CI95%: 0.78–0.89; I2 = 97.3%; Q = 37.044, p < 0.001) for the 40-item version, and 0.81 (CI95%: 0.74–0.87; I2 = 96.4%; Q = 49.668, p < 0.001) for the 15-item version.

The studies concerning temporal stability used the test-retest methodology ( N = 6), with intervals between 1 and 4 weeks, and indicated excellent indexes (estimated average correlation coefficient: 0.89 (CI95%: 0.83–0.94); I2 = 90.76%; Q = 22.330, p = 0.001; Egger’s: p < 0.001) (see Supplementary Material 3.2 ).

Regarding convergent validity, the studies used the IRI, Self-assessed Empathizing, Questionnaire Measure of Emotional Empathy, and Quotient of Empathic Abilities as a reference and found weak to moderate correlations (most obtained grade B, with correlations between 0.30 and 0.60). The estimated average correlation coefficient was 0.44 (CI95%: 0.36–0.52; I2 = 87.8%; Q = 77.398, p < 0.001; Egger’s: p = 0.59). Other studies adopted instruments that assess correlated constructs such as alexithymia, social desirability, autism symptoms, and theory of mind (predominance of grade B). The pooled correlation estimate for was 0.38 (CI95%: 0.30–0.46; I2 = 93.8%; Q = 194.799, p < 0.001; Egger’s: p < 0.001) (see Supplementary Material 3.3 ).

Divergent validity was mainly verified through instruments assessing specific psychiatric symptoms such as hallucination, delirium, hypomania, and systematization (an individual’s ability to develop a system and analyze its variables, considering underlining rules that guide the system’s behavior) ( N = 4). The values found in these studies ranged from −0.33 and 0.24 and obtained grade A.

Still, in search of evidence of validity with other variables, most studies ( N = 9) assessed differences between genders; women tended to rate higher in empathy than men, especially in the emotional factor (grade A predominated). Only Gouveia et al. (2012) investigated the EQ’s scores concerning age and education. The authors verified that older age was accompanied by a decline in the EQ’s emotional and social subscales. Education was associated with more frequent expressions of empathy in the instrument’s cognitive, emotional, and social subscales. Only one study tested and verified the instrument’s invariance regarding gender ( Senese et al., 2016 ). Predictive validity/responsiveness was not investigated, revealing a gap in the literature.

The exploratory factor analyses presented models with a varied number of factors, which, however, did not explain the significant percentage of data variance (<47.4%) ( Hair et al., 2009 ). The well-established models proposed by Lawrence et al. (2004 ; 3 factors: Cognitive Empathy, Emotional Reactivity and Social Skills −28 items), and Muncer and Ling (2006 ; 3 factors: Cognitive Empathy, Emotional Reactivity, and Social Skills −15 items) were the ones most frequently tested in confirmatory analyses. The results signaled goodness of fit problems for most of the studies; only one-third was rated A in this regard. These two models’ unidimensionality was also tested, presenting contradictory results, while the one-factor model for the 40- and 60-item versions was considered inadequate by the three studies assessing it.

Alternative three-factor models were tested for the 40- and 60-item versions and did not found satisfactory goodness of fit indexes. Other models with a varied number of items and factors were also analyzed ( n = 8). Those that obtained grade A included: 29-item/4-factor model ( Zhang et al., 2018 ), 23-item/with one or 3-factor model ( Redondo and Herrero-Fernández, 2018 ), 25-item/2-factor model, 15-item/one-factor model ( Zhao et al., 2018 ), and 14-item/one-factor model ( Kosonogov, 2014 ).

Regarding the instrument’s format, Wright and Skagerberg (2012) , Senese et al. (2016) , and Zhao et al. (2018) tested the online format, the psychometric indicators of which were similar to the original version (pencil-and-paper format). However, the invariance between the versions was not objectively tested.

Note that Wright and Skagerberg (2012) tested an alternative version of the EQ-40, rewriting negative statements into positive to test the hypothesis that the original format was syntactically more complex and challenging. They verified that response time was shorter in the alternative format; however, the remaining psychometric findings were not the same as in the original version, so that the authors did not recommend its use.

Interpersonal Reactivity Index

Ten studies assessed the psychometric properties of the IRI’s original and alternative versions (with 26, 16, and 15 items). The instrument was considered adequate in terms of Respondent burden and Administrative burden, either due to its brevity or ease of application and interpretation; grade A was obtained.

In terms of normative aspects, as previously observed with the EQ, 70% of the studies only presented data concerning the samples’ mean scores and their respective standard deviations (grade B).

As for the Measurement Model criterion, only the studies by Koller and Lamm (2014) , and Ingoglia et al. (2016) investigated this criterion. The first study assessed floor and ceiling effects, while the latter reported kurtosis and asymmetry indicators to verify the normality of the data distribution. The remaining (80%) did not perform analysis with this purpose, so that there is a lack of studies analyzing items.

Half of the studies addressing the IRI presented its cross-cultural adaptation into different languages (Spanish, Portuguese from Brazil, French, and Russian), in general presenting adequate methodology to assess face validity.

Reliability was verified through internal consistency and temporal stability. Moderate meta-analytic measures of internal consistency were found for each subscale (Empathic Concern: 0.70 (CI95%: 0.67–0.72), I2 = 87.02%, Q = 78.399, p < 0.001, Egger’s: p = 0.14; Fantasy: 0.78 (CI95%: 0.77–0.80), I2 = 77.75%, Q = 49.355, p < 0.001, Egger’s: p = 0.84; Personal Distress: 0.72 (CI95%: 0.70–0.74), I2 = 81,01%, Q = 56.145, p < 0.001, Egger’s: p = 0.93; Perspective Taking: 0.69 (CI95%: 0.67–0.71), I2 = 79.51%, Q = 67.167, p < 0.001, Egger’s: p = 0.05 see Supplementary Material 4.1 ). Test-retest reliability (8 to 12 weeks), even though restricted to two studies, presented excellent indexes (>0.76).

Regarding validity, most studies focused on analyzing the scale’s factorial structure, in which various models were tested using exploratory ( N = 5) and confirmatory factor analyses ( N = 8). Davis’s (1983) original model (1983; 4 factors – Empathic Concern, Fantasy, Perspective Taking, and Personal Distress) was the most frequently tested model, though controversial, and in general unsatisfactory results were found. Four-factor alternative models were also investigated, with slightly superior results [e.g., Braun et al. (2015) –15 items and Formiga et al. (2015) –26 items]. Unidimensional and bidimensional models ( N = 3) were assessed and also presented controversial results.

Convergent validity was performed with other three instruments to assess general empathy and instruments measuring correlated constructs such as positive and negative affect, self-esteem, anxiety, aggression, social desirability, social avoidance, emotional fragility, emotional intelligence, gender roles, and sense of identity. The correlations with correlated constructs tended to be higher (estimated average correlation coefficient: 0.45 (CI95%: 0.34–0.56), I2 = 96.17%, Q = 482.604, p < 0.001, Egger’s: p = 0.02) than the correlations with the construct itself [estimated average correlation coefficient: 0.31 (CI95%: 0.22–0.40), I2 = 75.38%, Q = 43.065, p < 0.001, Egger’s: p = 0.99]. The analysis of subgroups, considering each of the subscales individually, presented the following estimated mean values of correlation with other empathy measures: Empathic Concern: 0.46 (CI95%: 0.27–0.66), Fantasy: 0.26 (CI95%: 0.04–0.49), Personal Distress: 0.25 (CI95%: 0.17–0.34) and Perspective Taking: 0.28 (CI95%: 0.16–0.41) and Personal Distress: 0.25 (CI95%: 0.17–0.34) (see Supplementary Material 4.2 ).

In most cases, validity based on other variables was assessed in terms of gender. However, Gilet et al. (2013) also investigated age differences, reporting that younger individuals tended to be more empathic than older individuals, especially in the Fantasy and Personal Distress subscales. The studies addressing the IRI did not investigate predictive validity or responsiveness. The only alternative to the instrument’s original format (pencil-and-paper) was a computer version addressed by Chrysikou and Thompson (2016) , comparing the equivalence between both (not invariance).

Invariance of the IRI model was verified for sex ( Koller and Lamm, 2014 ; Braun et al., 2015 ; Ingoglia et al., 2016 ; Lucas-Molina et al., 2017 ) and age ( Koller and Lamm, 2014 ; Ingoglia et al., 2016 ).

Questionnaire of Cognitive and Affective Empathy

The studies addressing the QCAE involved its original proposition ( Reniers et al., 2011 ) and well-conducted cross-cultural adaptations into French, Portuguese (Portugal), and Chinese, except for the fact that they did not use a pilot study to check for face validity (predominance of B grade).

The QCAE was considered a brief instrument; its application takes no more than 15 min. Scoring is manual and easy to interpret, rating the highest in terms of Respondent and Administrative burden quality. In general, these studies involved basic constructs of the Classic Psychometric Theory, while no data concerning standardization and item analysis were reported.

The alpha cumulative value for the total scale was 0.86 (CI95%: 0.86–0.87; I2 = 0%; Q = 1.585, p = 0.66; Egger’s: p = 0.64) and for the subscales it ranged from 0.61 (Peripheral Responsivity: CI95%: 0.56–0.66; I2 = 79.79%; Q = 27.311, p < 0.001) to 0.87 (Perspective Taking: CI95%: 0.85–0.88; I2 = 76.19%; Q = 18.741, p = 0.002). For more details see Supplementary Material 5.1 . Test-retest reliability ( r = 0.76) was satisfactory; the latter was only reported by Liang et al. (2019) .

Regarding validity, there was a predominance of studies investigating the scale’s factorial structure ( n = 5). The original study reports a five-factor structure (Perspective Taking, Emotion Contagion, Online Simulation, Peripheral Responsivity, and Proximal Responsivity) and few goodness-of-fit problems (grade A). Later, most studies (75%) confirmed this structure and report adequate indexes (grade A). Some alternative models were investigated, and findings indicate acceptable goodness-of-fit for the QCAE’s first and second-order four-factor structure ( Liang et al., 2019 ), though the instrument’s unidimensionality was not confirmed.

Regarding convergent validity with other empathy measures ( n = 2 studies: Basic Empathy Scale and IRI), correlation ranged from 0.27 to 0.76 and obtained grade A (according to the criterion established, only one correlation above 0.60 was necessary to obtain the highest grade). Instruments were also used to assess correlated constructs (e.g., aggressiveness, alexithymia, impulsivity, interpersonal competence, psychopathy, and social anhedonia, among others). The coefficients in these studies were moderate, and most were graded. The estimated average correlation coefficient was 0.27 (CI95%: 0.20–0.35), I2 = 92.12%, Q = 183.846, p < 0.001, Egger’s: p = 0.04 – see Supplementary Material 5.2 .

Studies addressing known groups analyses (gender) predominated ( N = 3), reinforcing previous studies indicating that women have greater empathic ability than men. None of the studies addressing the QCAE investigated predictive validity or responsiveness.

One of the studies ( Di Girolamo et al., 2017 ) assessed the equivalence between the pencil-and-paper and online formats, and both presented similar psychometric indexes and measurement invariance. Invariance was also verified for sex ( Myszkowski et al., 2017 ; Liang et al., 2019 ).

Active-Empathic Listening Scale

The AELS was proposed in 2006 ( Drollinger et al., 2006 ) for the specific context of the relationship established between seller and customer, but Bodie (2011) proposed its expanded use for interpersonal relationships in general. Even though Bodie (2011) reported that the original items had to be changed and adapted, no information concerning the items analysis was provided, so that the item/instrument bias criterion obtained grade C.

Later, Gearhart and Bodie (2011) expanded the adapted version’s psychometric studies, presenting well-assessed Respondent burden and Administrative burden (grade A). Only Bodie (2011) assessed internal consistency, and the coefficients for the instrument as a whole (>0.86) were considered excellent (grade A).

From the factorial structure perspective, the three-factor model (Sensing, Processing, and Responding) was considered appropriate, specifically for the self-report version (grade A) ( Bodie, 2011 ), which was later confirmed by Gearhart and Bodie (2011) (grade A).

The convergent validity indexes concerning the self-report version indicated that correlations for the correlated constructs (conversational adequacy, interaction implications, social skills; −0.16 to 0.67 – grade A) were more robust than for the general empathy construct (0.15 to 0.44), which were considered moderate (grade B). Only correlations with correlated constructs (conversational adequacy, conversational effectiveness, non-verbal immediacy) were investigated for the other-report version, ranging from 0.15 to 0.75, and considered adequate (grade A). The self-report and other-report versions evidenced invariance of measure.

Studies addressing validity with other variables investigated the relationship between empathy scores and whether an individual is considered a good or poor listener (having an active and emotional interaction or not). Good listeners tended to score higher in empathy. There are no studies addressing the AELS normative data or predictive validity or studies conducting cross-cultural adaptations.

Toronto Empathy Questionnaire

The Toronto Empathy Questionnaire (TEQ) was addressed by two studies between 2009 and 2019: the study that originally proposed it ( Spreng et al., 2009 ) and the study of its cross-cultural adaptation into Turkish ( Totan et al., 2012 ). The process of developing TEQ was adequately described, but no pilot test was reported. A pilot test was implemented during its cross-cultural adaptation, impeding the Item/instrument bias criterion from achieving the maximum grade. On the other hand, due to the instrument’s ease of use and application, the Respondent burden and Administrative burden criteria were assessed and obtained grade A.

The TEQ’s reliability was assessed using internal consistency (α = 0.79 to 0.87; predominance of grade A) and temporal stability (0,73; grade B), which were adequate. In terms of factorial structure, Spreng et al. (2009) conducted two exploratory analyses, and a unidimensional structure was found in both, with factor loadings above 0.37 (grade B). Totan et al. (2012) replicated the TEQ’s unifactorial structure but found problems in three specific items, which led them to retest the model after excluding these items. Both the 16-item and 13-item versions appeared satisfactory in the confirmatory analysis, and the shortest version was recommended.

The TEQ’s convergent validity was verified by comparing other instruments measuring empathy and instruments assessing correlated constructs such as autism, ability to understand the mental states of others, and interpersonal perception. As expected, most correlations between TEQ and other instruments assessing empathy were higher (0.29 to 0.80; grade A) than correlations with correlated constructs (−0.33 to 0.35; grade B).

Finally, other evidence of validity was analyzed, having the gender as a reference, and showed that women scored higher than men. The TEQ studies did not investigate predictive validity or responsiveness and did not report alternative formats or transcultural adaptations.

Empathy Assessment Index

Gerdes et al. (2011) originally proposed the EAI, and Lietz et al. (2011) later assessed its psychometric properties. The authors described the process of instrument development and the theoretical conceptualization of each of the five factors composing it (Affective Response, Perspective Taking, Self-Awareness, Emotion Regulation and Empathic Attitudes); Grade A was granted to the Item/instrument bias criterion.

Like the remaining instruments presented thus far, the EAI was also considered easy to apply, and therefore, the Respondent burden and Administrative burden were rated with the highest grade. Its precision coefficients ranged from 0.30 to 0.83, and temporal stability ranged from 0.59 to 0.85; the retest was applied with a 1-week interval (grade B).

The original study reports that the exploratory factor analysis indicated a 34-item and 6-factor structure (Empathetic Attitudes, Affective Response -happy, Perspective Taking, Affective Response -sad, Perspective Taking-Affective Response and Emotion Regulation), which explained 43.19% of the variance of data (grade B). Later, based on literature reviews and feedback provided by specific community groups and experts in empathy, Lietz et al. (2011) performed factor analyses for a new 48-item version, concluding that the model presenting the best goodness of fit was composed of 17 items and five factors (Affective Response, Perspective Taking, Self-Awareness, Emotion Regulation and Empathic Attitudes) (grade A).

Gerdes et al. (2011) verified the convergent validity of the 34-item version, comparing it with the IRI and the coefficients ranged from 0.48 to 0.75; grade A was obtained. Lietz et al. (2011) investigated convergent validity by comparing the EAI with correlated constructs, such as attention and cognitive emotion regulation. As expected, moderate coefficients were found (−0.40 to 0.51; grade B).

Lietz et al. (2011) verified the EAI’s validity concerning the different sociodemographic variables. The results suggest differences concerning race (Afro- and Latin-Americans tended to present greater empathetic behavior than Caucasians); educational background (social workers presented greater empathy than individuals from the criminal justice, sociology, education, or nursing fields); and the family of origin’s socioeconomic status (poor/working-class individuals presented greater empathetic behavior than middle/high-class individuals). The studies addressing the EAI did not address predictive validity or responsiveness nor reported alternative formats.

Affective and Cognitive Measure of Empathy

Affective and cognitive measure of empathy (ACME) was proposed by Vachon and Lynam (2016) , and later, new validity evidence was presented by Murphy et al. (2018) . Vachon and Lynam did not report the procedures concerning the instrument’s development so that the Item/instrument bias criterion obtained grade C. However, the instrument presented the characteristics necessary to receive grade A in the Respondent burden and Administrative burden criteria. Note that Vachon and Lynam (2016) study obtained grade B in the Norms and standard values criteria because only the means and standard deviations of each of the instrument’s scales were reported according to sex and race for the entire sample.

Its reliability was only investigated through the internal consistency method (>0.85; Vachon and Lynam, 2016 ), indicating a gap concerning temporal stability indicators.

Investigations related to the instrument’s factorial structure and convergent validity were found. Vachon and Lynam (2016) suggested a three-factor structure (Cognitive Empathy, Affective Resonance and Affective Dissonance) with satisfactory goodness-of-fit indexes (grade A) and invariance between genders. However, Murphy et al. (2018) were unable to replicate this model and obtained unsatisfactory goodness-of-fit indexes. Hence, they proposed a five-factor model (two factors based on the items’ polarity – positive and negative items, in addition to Cognitive Empathy, Affective Resonance and Affective Dissonance factors), with presented criteria that obtained grade A.

Convergent validity was verified in relation to IRI (−0.24 to 0.80) and the Basic Empathy Scale (0.40 to 0.65); these criteria obtained grade A. The results indicated grade A for both studies regarding the indexes concerning correlated constructs, such as aggressive behavior, externalizing disorders, and personality pathologies (−0.83 to 0.77).

Remaining Instruments

Other 16 instruments were analyzed by single studies. Seven of these intended to propose new instruments, five intended to obtain additional validity evidence, and four conducted a cross-cultural adaptation of existing instruments.

Except for the MET, all the instruments obtained grade A in the Respondent burden and Administrative burden criteria because they were brief, well-accepted, easy to apply, score and interpret. MET obtained grade B in both items because it is composed of 80 items and its application/scoring requires specific software.

Analysis of the new instruments showed no specific normative indicators were reported for any of them (Norms, standard values, grade B). Reliability verified through internal consistency was investigated in 85.7% of the studies and, in general, presented satisfactory results (grade B). Temporal stability was verified in only 28.6% of the studies and presented positive results (grades A and B).

As for existing instruments, there is a lack of normative data (data reported by 33.3% of the studies were restricted to mean and standard deviation of the total score). Nonetheless, as verified in the studies previously presented, no specific comparison indicators were reported between groups (e.g., T score or percentile).

Note that only two studies addressing these new instruments ( Segal et al., 2013 – Interpersonal and Social Empathy Index and Batchelder et al., 2017 – Empathy Components Questionnaire) reported information concerning how the instruments were developed and obtained grade A. Convergent ( n = 7), factor ( n = 6), discriminant ( n = 5), and predictive ( n = 2) analyses were performed to investigate the instruments’ validity. Regarding the factorial structure, both the instruments proposed before 2009 and those proposed after 2009 obtained grade B, showing that this group of instruments’ factorial structures was confirmed with a few goodness-of-fit problems.

In general, the quality of the results concerning convergent validity was considered moderate (grade B). Correlations with other instruments measuring empathy were similar to the correlations found with instruments measuring correlated constructs. Validity studies with other variables were also restricted to the investigation of gender, corroborating the findings reported in the literature; that is, women tend to be more empathic than men. Hollar (2017) expanded the variables of interest (age and ethnicity) but obtained no satisfactory results.

Among this group of studies, Oceja Fernández et al. (2009) investigated predictive validity concerning the Vicarious Experience Scale; the Sympathy and Vicarious Distress subscales did not present satisfactory indexes for the prediction of elicited empathy and personal anguish. Batchelder et al. (2017) , in turn, report the predictive ability of the Empathy Components Questionnaire concerning the scores obtained in the Social Interests Index (grade B).

Regarding this group of instruments, note that the Pictorial Empathy Test ( Lindeman et al., 2018 ) differs from the remaining. It presents higher ecological validity because it is composed of images of people, while the Single Item Trait Empathy Scale stands out because it is composed of a single item. In general, both presented satisfactory psychometric properties.

As for cross-cultural studies, in general, face validity procedures were in line with the guidelines recommended by Beaton et al. (2000) , and most (75%) obtained grade A. These studies’ psychometric properties were considered satisfactory, while the Culture/language adaptations item obtained grade B.

The instruments’ reliability (internal consistency and temporal stability) was considered acceptable in most studies (grades A and B). However, the cross-cultural study addressing the MET obtained indexes below the expected for the instrument’s cognitive factor, even after decreasing the scale’s number of items.

Six studies investigated the instruments’ factorial structure. The results showed acceptable indexes for the Measure of Empathy and Sympathy, Multidimensional Emotional Empathy Scale, Basic Empathy Scale, The Mexican Empathy Scale, Positive Empathy Scale, and Cognitive, Affective, and Somatic Empathy Scales.

Among this set of studies, Park et al. (2019) conducted a cross-cultural adaptation of the Cognitive, Affective, and Somatic Empathy Scales. This instrument presents a specific scale to assess somatic empathy, which, according to the authors, can be defined as a tendency to imitate and automatically synchronize other peoples’ facial expressions, vocalizations, behaviors, and movements. Only this instrument presented this measure. In general, its psychometric qualities were considered satisfactory.

This review compiled the psychometric findings of 23 instruments available in the literature to assess empathy in the last 10 years. In general, the findings concerning the existent instruments [reliability generalization meta-analyses (Cronbach’s alpha) with values between 0.61 and 0.86] reinforced previous indicators of adequate reliability (e.g., EQ: Baron-Cohen and Wheelwright, 2004 ; Lawrence et al., 2004 ; IRI: Davis, 1980 ; Cliffordson, 2002 ; AELS: Drollinger et al., 2006 ; MxES: Díaz-Loving et al., 1986 ; MDEES: Caruso and Mayer, 1998 ; BES: Jolliffe and Farrington, 2006 ; EI: Falcone et al., 2008 ; MET: Dziobek et al., 2008 ).

On the other hand, the results indicated problems concerning convergent validity and factorial structure, making little progress in the solution and discussion of these impasses, e.g., a low to moderate correlation was found, especially between the EQ, IRI and QCAE and other instruments assessing the empathy construct (meta-analytic measures of correlation between 0.31 and 0.44), while similar or higher values were found when correlating these with different correlated constructs (meta-analytic measures of correlation between 0.27 and 0.45), indicating that the instruments’ clinical validity was greater than theoretical validity. Studies published before the period addressed in this review also indicated these limits concerning convergent validity (e.g., EQ vs. IRI: Lawrence et al., 2004 ; De Corte et al., 2007 ; IRI vs. Hogan Empathy Scale: Davis, 1983 ; AELS vs. IRI: Drollinger et al., 2006 ; BES vs. IRI: Jolliffe and Farrington, 2006 ; MET vs. IRI: Dziobek et al., 2008 ) and factorial structure (e.g., EQ: Lawrence et al., 2004 ; Muncer and Ling, 2006 ; IRI: Siu and Shek, 2005 ; De Corte et al., 2007 ; BES: Jolliffe and Farrington, 2006 ; EI: Falcone et al., 2008 ).

It is important to note that most of the instruments analyzed here did not reach a consensus regarding the best factorial structure, considering that various models were tested. The results concerning the goodness of fit suggest problems related to both the base model (Comparative Fit Index and Tucker Lewis Index below the expected) and population covariance (Root Mean Square Error of Approximation above the expected) ( Bentler, 1990 ; Hu and Bentler, 1999 ; Thompson, 2004 ). These divergences possibly reflect on the analyses of convergent validity with the different instruments measuring empathy, most of which obtained values within moderate limits.

We believe that controversies concerning the multidimensional nature of empathy ( Murphy et al., 2018 ) reflect on the analyses, especially when the target instruments’ subscales are more specifically analyzed. Murphy et al. (2018) widely discuss these aspects and note a lack of consensus regarding the empathy construct and how different authors adopt such a concept when developing instruments. These authors note there is greater consensus regarding the presence of affective and cognitive components; however, the analyses of the bifactor models assessed here (e.g., concerning the IRI) also failed to present satisfactory factor indexes. Given this lack of consensus, Surguladze and Bergen-Cico (2020) stress the need to reconsider and discuss this construct, considering its different dimensions and directly and indirectly related mechanisms.

In addition to what Murphy et al. (2018) state regarding lack of consensus, this review’s findings indicate that some studies do not specify the conceptual model of empathy that grounded the development of the instruments and which would theoretically ground the empirical analysis of the instruments’ internal structure, especially in second-order more complex models and with a varied number of factors. It was the case of both new instruments, proposed during the period covered by this review (for example: QCAE: Reniers et al., 2011 ; QoE: Miguel et al., 2018 ; TEQ: Spreng et al., 2009 ), and older instruments (EQ: Baron-Cohen and Wheelwright, 2004 ; IRI: Davis, 1983 ; MxES: Díaz-Loving et al., 1986 ; EI: Falcone et al., 2008 ). A lack of theoretical models to properly ground the empathy construct and its dimensions possibly explains the restrictions concerning structural validity and lack of convergence between the different instruments.

Regarding the statistical techniques used to investigate the instruments’ structures, Marsh (2018) highlight that newer models, such as the Structural Equations Models ( Gefen et al., 2000 ), can more deeply capture the complexity of the empathy construct and also resolve a series of problems encountered based on the CFA approach (e.g., restricted factor loadings) ( Marsh, 2018 ). Nonetheless, most of the studies opted for adopting confirmatory and exploratory factor analyses so that future studies are needed to invest in these technologies and techniques of analysis. Note that studies based on the Item Response Theory ( Pasquali, 2020 ) can contribute to this impasse, considering that the studies addressed here attempted to improve the factor model by removing specific items.

On the other hand, the construct’s clinical/empirical validity seems to be unanimous. Even though the studies were conducted with non-clinical samples, associations with different correlated constructs are adequate and reinforce the relationship of empathy with different psychopathological and behavioral indicators (e.g., autism: Komeda et al., 2019 , Post-traumatic stress disorder: Feldman et al., 2019 , and Borderline personality disorder: Flasbeck et al., 2019 ). However, for these instruments to be used in a clinical setting, aspects related to predictive evidence, which remain scarce, need to be explored. In this context, normative studies, which were not the target of the psychometric studies addressed here, are also needed.

Cross-cultural studies were an important focus of interest among researchers within this topic. These are relevant studies because they enable generating and/or reinforcing psychological theories that take the cultural context into account ( Gomes et al., 2018 ). Additionally, these studies enable applying the same instrument among different individuals belonging to different contexts and facilitate understanding the similarities and characteristics these groups share ( Borsa et al., 2012 ), which is essential, especially in clinical research.

In general, the results of cross-sectional studies addressing instruments reported psychometric qualities comparable to the original versions, though cultural invariance was not assessed for any of the target instruments. Investigating invariance between different cultural groups answering an instrument is essential to identify whether there are significant differences between scores, and if that is the case, verify whether differences are related to actual differences at a latent trait level or the instruments’ parameters are not equivalent ( Damásio et al., 2016 ).

Regarding new instruments, note that the same few added in terms of Respondent burden and Administrative burden, considering that these aspects, except for the MET, obtained grade A, though were little discriminant. These instruments also innovated little in terms of format and structure. Most were based on self-reported items rated on a Likert scale. The studies also do not seem to overcome the critical points mentioned earlier in psychometric terms.

Interpersonal reactivity index, and more recently, EQ, have been widely used in different clinical studies and applied in different target populations (e.g., Feeser et al., 2015 ; Fitriyah et al., 2020 ). However, despite their popularity, they present weaknesses concerning structural validity and limitations regarding responsiveness, standardization, and bias.

The conclusion is that despite the diversity of the instruments available to assess empathy and many associated psychometric studies, limitations stand out, especially in terms of validity. Hence, as noted by previous reviews that evaluated specific instruments of empathy and/or their performance in specific populations ( Hemmerdinger et al., 2007 ; Yu and Kirk, 2009 ; Hong and Han, 2020 ), no instrument can be currently appointed as the gold standard.

Therefore, this field of study needs to advance in conceptual and theoretical terms. Such an advance will enable the establishment of more robust models to be empirically reproduced by the instruments. Additionally, problems with the internal structure of various instruments can be minimized or resolved using more sophisticated techniques based on the analysis and refinement of items. Normative and predictive studies can improve the validity of evidence of existing studies, favoring greater clinical applicability. Complementary studies of invariance, testing the effect of cultures, and alternative forms of application (especially those using technological resources, such as online and computer applications) are desirable and can expand the reach of instruments. Regarding the proposition of new instruments, there seems to remain a need for instruments with alternative formats to minimize response bias, especially social desirability, a recurrent problem in self-report instruments.

Data Availability Statement

Author contributions.

Both authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

* Articles included in the review.

Funding for this study was provided by Coordination for the Improvement of Higher Education Personnel (Capes); National Council for Scientific and Technological Development (CNPq – Productivity Research Fellows – Process No. 302601/2019-8).

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.781346/full#supplementary-material

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‘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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Scientists Discuss How to Study the Psychology of Collectives, Not Just Individuals

In a set of articles appearing in Perspectives on Psychological Science, an international array of scientists discusses how the study of neighborhoods, work units, activist groups, and other collectives can help us better understand and respond to societal changes.

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APS members weigh in on the biggest opportunities and/or ethical challenges involving AI within the field of psychological science. Will we witness vast and constructive cross-fertilization—or “a dystopian cyberpunk corporation-led hellscape”?

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Audio cues can not only help us to recognize objects more quickly but can even alter our visual perception. That is, pair birdsong with a bird and we see a bird—but replace that birdsong with a squirrel’s chatter, and we’re not quite so sure what we’re looking at. 

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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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A monologue on Empathy : If someone said to me today,’Holy crap, Kristie. Life freakin’ sucks. I’m so broke. And I feel so scared. I’ve never been this far down before. I don’t know how I’m going to make it…’

– I would rarely say: ‘Well where do you live? I can help you find a job….’ That’s fixing it. And no one needs to be ‘fixed’.

– I would rarely IF EVER say: ‘I think you should figure out your life and get your shit together!’ That’s advising and unless they specifically asked for it, they aren’t needing that from me.

– I would rarely IF EVER say: ‘Ohhh shit! How could you let that happen?!?’ That’s interrogating … And they didn’t come looking for the Spanish Inquisition.

– I would rarely IF EVER say: ‘It’s only that way because you aren’t being positive or you aren’t trying hard enough…. You did this to yourself.’ They aren’t looking for an explanation .

– I would rarely IF EVER say: ‘Hey, you shouldn’t see it that way! There are many things in life to be thankful for.’ That would be me correcting them and they are not needing ‘correction’.

– I would rarely IF EVER say: ‘Well, there is much to be learned from this…’ They don’t need an education on what the fuck is happening to them.

– I would rarely say: ‘None of this is your fault.’ They don’t need me to console them.

– I would rarely IF EVER say: ‘Wellllll if you hadn’t quit that job you had then none if this shit might be happening right now…’ They don’t need me to evaluate their lives. And most people hate hearing,’I told you so’.

– I would rarely say: ‘Those FUCKERZ. The 1%. Fuck I wish they would die so we can all be free.’ They don’t need me to commiserate with them as much as I would want to. That serves no one.

– I would rarely IF EVER say: ‘Oh fuck you think you got it bad! You should hear what happened to this one guy I met… etc etc.’ That’s ‘one upping’ them. They don’t need to hear who has it worse than them. I could imagine that that would make people feel shitty for how they feel or feel shitty that they even shared anything with me in the first place.

– I would rarely say: ‘Hey, that reminds me of the time when I was in my early twenties….’ Telling tales distracts people from what is alive in them. And although that may be a great stall tactic it still serves nothing or no one but my furiously ‘telling tales’ thumbs.

– I would rarely say: ‘Omg! That’s so fucking awful!! I feel so bad for you!! What are you going to do?!?’ They don’t need sympathy from me either. Sympathy can dis-able a person further…..

None of these responses is empathetic, although these responses are frequently confused with empathy. To use our capacity for empathy in research and in everyday life what is called for is to listen, to be curious, to try our very best to understand, and of course to care. Demonstrating empathy is never about telling anyone anything, it is about asking and seeking understanding. This is the first step researchers need to take before presuming they know both what the problem and its solution are.

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What Is Empathy?

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.

Verywell / Bailey Mariner

Empathy is the ability to emotionally understand what other people feel, see things from their point of view, and imagine yourself in their place. Essentially, it is putting yourself in someone else's position and feeling what they are feeling.

Empathy means that when you see another person suffering, such as after they've lost a loved one , you are able to instantly envision yourself going through that same experience and feel what they are going through.

While people can be well-attuned to their own feelings and emotions, getting into someone else's head can be a bit more difficult. The ability to feel empathy allows people to "walk a mile in another's shoes," so to speak. It permits people to understand the emotions that others are feeling.

Press Play for Advice on Empathy

Hosted by therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast , featuring empathy expert Dr. Kelsey Crowe, shares how you can show empathy to someone who is going through a hard time. Click below to listen now.

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Signs of Empathy

For many, seeing another person in pain and responding with indifference or even outright hostility seems utterly incomprehensible. But the fact that some people do respond in such a way clearly demonstrates that empathy is not necessarily a universal response to the suffering of others.

If you are wondering whether you are an empathetic person, here are some signs that show that you have this tendency:

• You are good at really listening to what others have to say.
• People often tell you about their problems.
• You are good at picking up on how other people are feeling.
• You often think about how other people feel.
• Other people come to you for advice.
• You often feel overwhelmed by tragic events.
• You try to help others who are suffering.
• You are good at telling when people aren't being honest .
• You sometimes feel drained or overwhelmed in social situations.
• You care deeply about other people.
• You find it difficult to set boundaries in your relationships.

Are You an Empath? Take the Quiz!

Our fast and free empath quiz will let you know if your feelings and behaviors indicate high levels of traits commonly associated with empaths.

Types of Empathy

There are several types of empathy that a person may experience. The three types of empathy are:

• Affective empathy involves the ability to understand another person's emotions and respond appropriately. Such emotional understanding may lead to someone feeling concerned for another person's well-being, or it may lead to feelings of personal distress.
• Somatic empathy involves having a physical reaction in response to what someone else is experiencing. People sometimes physically experience what another person is feeling. When you see someone else feeling embarrassed, for example, you might start to blush or have an upset stomach.
• Cognitive empathy involves being able to understand another person's mental state and what they might be thinking in response to the situation. This is related to what psychologists refer to as the theory of mind or thinking about what other people are thinking.

Empathy vs. Sympathy vs. Compassion

While sympathy and compassion are related to empathy, there are important differences. Compassion and sympathy are often thought to be more of a passive connection, while empathy generally involves a much more active attempt to understand another person.

Uses for Empathy

Being able to experience empathy has many beneficial uses.

• Empathy allows you to build social connections with others . By understanding what people are thinking and feeling, you are able to respond appropriately in social situations. Research has shown that having social connections is important for both physical and psychological well-being.
• Empathizing with others helps you learn to regulate your own emotions . Emotional regulation is important in that it allows you to manage what you are feeling, even in times of great stress, without becoming overwhelmed.
• Empathy promotes helping behaviors . Not only are you more likely to engage in helpful behaviors when you feel empathy for other people, but other people are also more likely to help you when they experience empathy.

Potential Pitfalls of Empathy

Having a great deal of empathy makes you concerned for the well-being and happiness of others. It also means, however, that you can sometimes get overwhelmed, burned out , or even overstimulated from always thinking about other people's emotions. This can lead to empathy fatigue.

Empathy fatigue refers to the exhaustion you might feel both emotionally and physically after repeatedly being exposed to stressful or traumatic events . You might also feel numb or powerless, isolate yourself, and have a lack of energy.

Empathy fatigue is a concern in certain situations, such as when acting as a caregiver . Studies also show that if healthcare workers can't balance their feelings of empathy (affective empathy, in particular), it can result in compassion fatigue as well.

Other research has linked higher levels of empathy with a tendency toward emotional negativity , potentially increasing your risk of empathic distress. It can even affect your judgment, causing you to go against your morals based on the empathy you feel for someone else.

Impact of Empathy

Your ability to experience empathy can impact your relationships. Studies involving siblings have found that when empathy is high, siblings have less conflict and more warmth toward each other. In romantic relationships, having empathy increases your ability to extend forgiveness .

Not everyone experiences empathy in every situation. Some people may be more naturally empathetic in general, but people also tend to feel more empathetic toward some people and less so toward others. Some of the factors that play a role in this tendency include:

• How you perceive the other person
• How you attribute the other individual's behaviors
• What you blame for the other person's predicament
• Your past experiences and expectations

Research has found that there are gender differences in the experience and expression of empathy, although these findings are somewhat mixed. Women score higher on empathy tests, and studies suggest that women tend to feel more cognitive empathy than men.  

At the most basic level, there appear to be two main factors that contribute to the ability to experience empathy: genetics and socialization. Essentially, it boils down to the age-old relative contributions of nature and nurture .

Parents pass down genes that contribute to overall personality, including the propensity toward sympathy, empathy, and compassion. On the other hand, people are also socialized by their parents, peers, communities, and society. How people treat others, as well as how they feel about others, is often a reflection of the beliefs and values that were instilled at a very young age. 

Barriers to Empathy

Some people lack empathy and, therefore, aren't able to understand what another person may be experiencing or feeling. This can result in behaviors that seem uncaring or sometimes even hurtful. For instance, people with low affective empathy have higher rates of cyberbullying .

A lack of empathy is also one of the defining characteristics of narcissistic personality disorder . Though, it is unclear whether this is due to a person with this disorder having no empathy at all or having more of a dysfunctional response to others.

A few reasons why people sometimes lack empathy include cognitive biases, dehumanization, and victim-blaming.

Cognitive Biases

Sometimes the way people perceive the world around them is influenced by cognitive biases . For example, people often attribute other people's failures to internal characteristics, while blaming their own shortcomings on external factors.

These biases can make it difficult to see all the factors that contribute to a situation. They also make it less likely that people will be able to see a situation from the perspective of another.

Dehumanization

Many also fall victim to the trap of thinking that people who are different from them don't feel and behave the same as they do. This is particularly common in cases when other people are physically distant.

For example, when they watch reports of a disaster or conflict in a foreign land, people might be less likely to feel empathy if they think that those who are suffering are fundamentally different from themselves.

Victim Blaming

Sometimes, when another person has suffered a terrible experience, people make the mistake of blaming the victim for their circumstances. This is the reason that victims of crimes are often asked what they might have done differently to prevent the crime.

This tendency stems from the need to believe that the world is a fair and just place. It is the desire to believe that people get what they deserve and deserve what they get—and it can fool you into thinking that such terrible things could never happen to you.

Causes of Empathy

Human beings are certainly capable of selfish, even cruel, behavior. A quick scan of the news quickly reveals numerous unkind, selfish, and heinous actions. The question, then, is why don't we all engage in such self-serving behavior all the time? What is it that causes us to feel another's pain and respond with kindness ?

The term empathy was first introduced in 1909 by psychologist Edward B. Titchener as a translation of the German term einfühlung (meaning "feeling into"). Several different theories have been proposed to explain empathy.

Neuroscientific Explanations

Studies have shown that specific areas of the brain play a role in how empathy is experienced. More recent approaches focus on the cognitive and neurological processes that lie behind empathy. Researchers have found that different regions of the brain play an important role in empathy, including the anterior cingulate cortex and the anterior insula.

Research suggests that there are important neurobiological components to the experience of empathy.   The activation of mirror neurons in the brain plays a part in the ability to mirror and mimic the emotional responses that people would feel if they were in similar situations.

Functional MRI research also indicates that an area of the brain known as the inferior frontal gyrus (IFG) plays a critical role in the experience of empathy. Studies have found that people who have damage to this area of the brain often have difficulty recognizing emotions conveyed through facial expressions .  

Emotional Explanations

Some of the earliest explorations into the topic of empathy centered on how feeling what others feel allows people to have a variety of emotional experiences. The philosopher Adam Smith suggested that it allows us to experience things that we might never otherwise be able to fully feel.

This can involve feeling empathy for both real people and imaginary characters. Experiencing empathy for fictional characters, for example, allows people to have a range of emotional experiences that might otherwise be impossible.

Prosocial Explanations

Sociologist Herbert Spencer proposed that empathy served an adaptive function and aided in the survival of the species. Empathy leads to helping behavior, which benefits social relationships. Humans are naturally social creatures. Things that aid in our relationships with other people benefit us as well.

When people experience empathy, they are more likely to engage in prosocial behaviors that benefit other people. Things such as altruism and heroism are also connected to feeling empathy for others.

Tips for Practicing Empathy

Fortunately, empathy is a skill that you can learn and strengthen. If you would like to build your empathy skills, there are a few things that you can do:

• Work on listening to people without interrupting
• Pay attention to body language and other types of nonverbal communication
• Try to understand people, even when you don't agree with them
• Ask people questions to learn more about them and their lives
• Imagine yourself in another person's shoes
• Strengthen your connection with others to learn more about how they feel
• Seek to identify biases you may have and how they affect your empathy for others
• Look for ways in which you are similar to others versus focusing on differences
• Be willing to be vulnerable, opening up about how you feel
• Engage in new experiences, giving you better insight into how others in that situation may feel
• Get involved in organizations that push for social change

A Word From Verywell

While empathy might be lacking in some, most people are able to empathize with others in a variety of situations. This ability to see things from another person's perspective and empathize with another's emotions plays an important role in our social lives. Empathy allows us to understand others and, quite often, compels us to take action to relieve another person's suffering.

Reblin M, Uchino BN. Social and emotional support and its implication for health .  Curr Opin Psychiatry . 2008;21(2):201‐205. doi:10.1097/YCO.0b013e3282f3ad89

Cleveland Clinic. Empathy fatigue: How stress and trauma can take a toll on you .

Duarte J, Pinto-Bouveia J, Cruz B. Relationships between nurses' empathy, self-compassion and dimensions of professional quality of life: A cross-sectional study . Int J Nursing Stud . 2016;60:1-11. doi:10.1016/j.ijnurstu.2016.02.015

Chikovani G, Babuadze L, Iashvili N, Gvalia T, Surguladze S. Empathy costs: Negative emotional bias in high empathisers . Psychiatry Res . 2015;229(1-2):340-346. doi:10.1016/j.psychres.2015.07.001

Lam CB, Solmeyer AR, McHale SM. Sibling relationships and empathy across the transition to adolescence . J Youth Adolescen . 2012;41:1657-1670. doi:10.1007/s10964-012-9781-8

Kimmes JG, Durtschi JA. Forgiveness in romantic relationships: The roles of attachment, empathy, and attributions . J Marital Family Ther . 2016;42(4):645-658. doi:10.1111/jmft.12171

Kret ME, De Gelder B. A review on sex difference in processing emotional signals . Neuropsychologia . 2012; 50(7):1211-1221. doi:10.1016/j.neuropsychologia.2011.12.022

Schultze-Krumbholz A, Scheithauer H. Is cyberbullying related to lack of empathy and social-emotional problems? Int J Develop Sci . 2013;7(3-4):161-166. doi:10.3233/DEV-130124

Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: From clinical and empirical perspectives . Personal Dis Theory Res Treat . 2014;5(3):323-333. doi:10.1037/per0000061

Decety, J. Dissecting the neural mechanisms mediating empathy . Emotion Review . 2011; 3(1): 92-108. doi:10.1177/1754073910374662

Shamay-Tsoory SG, Aharon-Peretz J, Perry D. Two systems for empathy: A double dissociation between emotional and cognitive empathy in inferior frontal gyrus versus ventromedial prefrontal lesions . Brain . 2009;132(PT3): 617-627. doi:10.1093/brain/awn279

Hillis AE. Inability to empathize: Brain lesions that disrupt sharing and understanding another's emotions . Brain . 2014;137(4):981-997. doi:10.1093/brain/awt317

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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Media Coverage

Student research links charitable giving to empathy | NEW Media Inc.

by Editorial Student · April 16, 2024

If you’re an empathic person, chances are that you’d be more willing to give to charity, according to a Bonduel resident attending University of Wisconsin-Green Bay.

Colton Anderson, a psychology student at the university, teamed up with Ethan Wondrash to look at data from a recent survey and learned that the results that empathy can be a factor in more giving to various causes. Their research garnered enough attention to be part of the Research in the Rotunda event earlier this year in Madison.

“We ended up finding some different and interesting findings about the different aspects of empathy,” Anderson said. “Empathy is pretty complex, and it’s been debated what aspects there are to it. There’s a cognitive and emotional side to empathy, so we basically used a couple of different measures to assess both of those, and we found out that emotional ones were pretty much significant for everything. It’s a pretty long standing finding that emotional empathy predicts charitable giving behaviors.”

Anderson pointed out that the project started out as a simple analysis of data, but then things grew from there.

“We found out that we had a lot of data about empathy, and we had a lot of data about charity, and we tried to connect the dots,” Anderson said. “We wanted to see if there was something significant in those findings.”

Anderson and Wondrash got their data from the Monitoring the Future survey, which asked participants, “If you have at least an average income in the future, how likely is it that you will contribute money to the following organizations?” People who claimed to be empathic showed favor to donating to community charities, citizen lobbies, international relief organizations, charities fighting diseases, minority groups, organizations concerned with population problems and organizations affiliate with environmental groups.

Greater empathy tended to predict higher chances of donating, greater amounts donated and potentially the success of nationwide campaigns, Anderson and Wondrash showed in their research.

The research showed that empathic people were less likely to break out their wallets when it came to religious organizations or political parties, according to Anderson. He noted that this is not a result that was found in previous research.

“It basically said that, if you’re better at emotional recognition, you’re less likely to give to religious or political charities specifically,” Anderson said.

Wondrash said that a lot of time has been spent trying to determine why empathic people shy away from religious or political giving. It’s believed that those two types of giving are considered affiliative, while the other types are humanitarian in nature.

Anderson and Wondrash said they want to find out if their discovery is just a single finding in the survey of 289 UW-Green Bay students done last year or if there’s a trend that can be permanently assessed. They are conducting more research now, but it’s questionable if it will be completed by the time both students graduate this spring.

“This is something we’ll have to replicate again, because this is just our initial findings,” Wondrash said, noting that the UW-Green Bay campus is mostly female and that the survey focused on students ages 18-20. “We’re still trying to make sense of what we’ve found.”

Being able to participate in the Research in the Rotunda was an honor for both students. Anderson noted presenting his findings outside the school setting was a first for him.

“It was really interesting to interact with all the different politicians and researchers and things like that,” Anderson said. “We had a couple of different people who stopped over that were senators and a couple that were professors and even a couple of students who wanted to check us out.”

“A lot of people were really curious about this question,” Wondrash added. “This is something that has already been found, but the specifics of these questions, what types of charities and what kinds of people are more willing to give, when we get into that, people have more questions because it’s more interesting because it’s a more specific question.”

Source: Student research links charitable giving to empathy | NEW Media Inc.

Tags: CAHSS Psychology

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New EY US Consulting study: employees overwhelmingly expect empathy in the workplace, but many say it feels disingenuous

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The majority (86%) of employees believe empathetic leadership boosts morale while 87% of employees say empathy is essential to fostering an inclusive environment.

As many employees face downsizings, restructurings and a looming global recession, most say that empathic leadership is a desired attribute but feel it can be disingenuous when not paired with action, according to the 2023 Ernst & Young LLP ( EY US )  Empathy in Business Survey .

The study of more than 1,000 employed US workers examines how empathy affects leaders, employees, and operations in the workplace. The survey follows the initial EY Consulting analysis of empathy in 2021 and finds workers feel that mutual empathy between company leaders and employees leads to increased efficiency (88%), creativity (87%), job satisfaction (87%), idea sharing (86%), innovation (85%) and even company revenue (83%).

“A  transformation’s success  or failure is rooted in human emotions, and this research spotlights just how critical empathy is in leadership,” said  Raj Sharma , EY  Americas Consulting  Vice Chair. “Recent years taught us that leading with empathy is a soft and powerful trait that helps empower employers and employees to collaborate better, and ultimately create a culture of accountability.”

The evolving state of empathy in the workplace

There are many upsides to empathetic leadership in the workplace, including:

• Inspiring positive change within the workplace (87%)
• Mutual respect between employees and leaders (87%)
• Increased productivity among employees (85%)
• Reduced employee turnover (78%)

“Time and again we have found through our research that in order for businesses to successfully transform, they must put humans at the center with empathetic leadership to create transparency and provide employees with psychological safety,” said  Kim Billeter , EY Americas  People Advisory Services  Leader. “Empathy is a powerful force that must be embedded organically into every aspect of an organization, otherwise the inconsistency has a dramatic impact on the overall culture and authenticity of an organization.”

In fact, half (52%) of employees currently believe their company’s efforts to be empathetic toward employees are dishonest ― up from 46% in 2021, and employees increasingly report a lack of follow-through when it comes to company promises (47% compared to 42% in 2021).

To fulfill the authenticity equation, previous EY research indicates offering flexibility is essential. In the 2022 EY US Generation Survey, 92% of employees surveyed across all four workplace generations said that company culture has an impact on their decision to remain with their current  employer.

Lead with empathy  now  to combat the workplace challenges ahead

While leaders may experience lower employee attrition rates now when compared to the Great Resignation, a resurgence is brewing. Many economists expect a soft landing from the looming recession and with it may come turnover, particularly if employees already feel disconnected from their employer or from each other.

In fact, failing to feel a sense of belonging at work or connection with coworkers is a growing reason why employees quit their jobs. About half (50% and 48% in 2021) left a previous job because they didn’t feel like they belonged, and more employees now say they left a previous job because they had difficulty connecting with colleagues (42% vs. 37% in 2021).

“What happens outside of work has a direct impact on how people show up. It’s no longer enough for leaders to think of a person in one dimension – as an employee or as a professional within the organization,” said  Ginnie Carlier , EY Americas Vice Chair – Talent. “Leading with empathy helps move from the transactional and to the transformational Human Value Proposition, where people feel supported both personally and professionally.”

2023 EY Empathy in Business Survey methodology

EY US  commissioned a third-party vendor to conduct the 2023 EY Empathy in Business Survey, following the 2021 Empathy in Business Survey. The survey among 1,012 Americans who are employed, either full-time or part-time, was completed between October 23 and November 6, 2022. At the total level, the study has a margin of error of +/- 3 percentage points at the 95% confidence level.

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Grizzly bear conservation is as much about human relationships as it is the animals

Associate Professor of Human Dimensions of Natural Resources, University of Montana

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Alexander L. Metcalf has received funding from the National Fish and Wildlife Foundation, the National Science Foundation, the Richard King Mellon Foundation, the Pennsylvania Department of Conservation and Natural Resources, the Montana Department of Fish, Wildlife and Parks, the US Geological Survey, and the US Department of Agriculture Forest Service. Dr. Metcalf is an advisor to the Swan Valley Connections board of directors.

University of Montana provides funding as a member of The Conversation US.

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Montanans know spring has officially arrived when grizzly bears emerge from their dens . But unlike the bears, the contentious debate over their future never hibernates. New research from my lab reveals how people’s social identities and the dynamics between social groups may play a larger role in these debates than even the animals themselves.

Social scientists like me work to understand the human dimensions behind wildlife conservation and management. There’s a cliché among wildlife biologists that wildlife management is really people management, and they’re right. My research seeks to understand the psychological and social factors that underlie pressing environmental challenges. It is from this perspective that my team sought to understand how Montanans think about grizzly bears.

To list or delist, that is the question

In 1975, the grizzly bear was listed as threatened under the Endangered Species Act following decades of extermination efforts and habitat loss that severely constrained their range . At that time, there were 700-800 grizzly bears in the lower 48 states, down from a historic 50,000 . Today, there are about 2,000 grizzly bears in this area, and sometime in 2024 the U.S. Fish and Wildlife Service will decide whether to maintain their protected status or begin the delisting process.

Listed species are managed by the federal government until they have recovered and management responsibility can return to the states. While listed, federal law prevents hunting of the animal and destruction of grizzly bear habitat. If the animal is delisted, some states intend to implement a grizzly bear hunting season .

People on both sides of the delisting debate often use logic to try to convince others that their position is right. Proponents of delisting say that hunting grizzly bears can help reduce conflict between grizzly bears and humans . Opponents of delisting counter that state agencies cannot be trusted to responsibly manage grizzly bears.

But debates over wildlife might be more complex than these arguments imply.

Identity over facts

Humans have survived because of our evolved ability to cooperate . As a result, human brains are hardwired to favor people who are part of their social groups , even when those groups are randomly assigned and the group members are anonymous .

Humans perceive reality through the lens of their social identities. People are more likely to see a foul committed by a rival sports team than one committed by the team they’re rooting for. When randomly assigned to be part of a group, people will even overlook subconscious racial biases to favor their fellow group members.

Leaders can leverage social identities to inspire cooperation and collective action . For example, during the COVID-19 pandemic, people with strong national identities were more likely to physically distance and support public health policies.

But the forces of social identity have a dark side, too. For example, when people think that another “out-group” is threatening their group, they tend to assume members of the other group hold more extreme positions than they really do . Polarization between groups can worsen when people convince themselves that their group’s positions are inherently right and the other group’s are wrong. In extreme instances, group members can use these beliefs to justify immoral treatment of out-group members .

Empathy reserved for in-group members

These group dynamics help explain people’s attitudes toward grizzly bears in Montana . Although property damage from grizzly bears is extremely rare, affecting far less than 1% of Montanans each year , grizzly bears have been known to break into garages to access food , prey on free-range livestock and sometimes even maul or kill people .

People who hunt tend to have more negative experiences with grizzly bears than nonhunters – usually because hunters are more often living near and moving through grizzly bear habitat.

In a large survey of Montana residents, my team found that one of the most important factors associated with negative attitudes toward grizzly bears was whether someone had heard stories of grizzly bears causing other people property damage. We called this “vicarious property damage.” These negative feelings toward grizzly bears are highly correlated with the belief that there are too many grizzly bears in Montana already.

But we also found an interesting wrinkle in the data . Although hunters extended empathy to other hunters whose properties had been damaged by grizzly bears, nonhunters didn’t show the same courtesy. Because property damage from grizzly bears was far more likely to affect hunters, only other hunters were able to put themselves in their shoes. They felt as though other hunters’ experiences may as well have happened to them, and their attitudes toward grizzly bears were more negative as a result.

For nonhunters, hearing stories about grizzly bears causing damage to hunters’ property did not affect their attitudes toward the animals.

Identity-informed conservation

Recognizing that social identities can play a major role in wildlife conservation debates helps untangle and perhaps prevent some of the conflict. For those wishing to build consensus, there are many psychology-informed strategies for improving relationships between groups .

For example, conversations between members of different groups can help people realize they have shared values . Hearing about a member of your group helping a member of another group can inspire people to extend empathy to out-group members.

Conservation groups and wildlife managers should take care when developing interventions based on social identity to prevent them from backfiring when applied to wildlife conservation issues. Bringing up social identities can sometimes cause unintended division. For example, partisan politics can unnecessarily divide people on environmental issues .

Wildlife professionals can reach their audience more effectively by matching their message and messengers to the social identities of their audience . Some conservation groups have seen success uniting community members who might otherwise be divided around a shared identity associated with their love of a particular place. The conservation group Swan Valley Connections has used this strategy in Montana’s Swan Valley to reduce conflict between grizzly bears and local residents.

Group dynamics can foster cooperation or create division, and the debate over grizzly bear management in Montana is no exception. Who people are and who they care about drives their reactions to this large carnivore. Grizzly bear conservation efforts that unite people around shared identities are far more likely to succeed than those that remind them of their divisions.

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Empathy, Humility, Action: Driving Change with Deepa Iyer, Sr. Director of Market Research and Data Science at Fossil Group The Consumer Insights Podcast

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Perinatal Substance Use May Shape How Strongly Mothers Feel Toward Infants

Substance use during pregnancy and postpartum may impact areas of the brain associated with what psychologists and neuroscientists call “affective empathy,” or the emotional response experienced as a result of others' emotions, a new study suggests.

Researchers exposed both mothers who used substances during the perinatal period [start of pregnancy until one year after birth], and those who didn’t, to pictures of happy and sad infant faces and sounds of crying babies. The types of substances used among the former group of mothers varied, but the most common substance was tobacco (70%), followed by alcohol (30%), cannabis (20%), and cocaine (20%).

Mothers were presented with these stimuli while undergoing functional magnetic resonance imaging (fMRI), which measures brain activity. fMRI revealed that brain regions associated with affective empathy were less activated in response to the infant stimuli in mothers who used substances than mothers who did not.

The researchers published their findings in the Journal of Psychiatric Research in March 2024.

“Moms who use substances deserve support and help,” says Li Yan McCurdy, PhD , postdoctoral fellow in Yale’s Department of Radiology & Biomedical Imaging and the study’s first author. “Being able to identify these similarities and differences is important for helping us find ways to support these moms in caregiving.”

Cognitive empathy versus affective empathy

Empathy can be divided into subcategories including cognitive empathy and affective empathy. Cognitive empathy refers to one’s ability to identify emotions that others are experiencing. This type of empathy is linked to brain regions such as the medial prefrontal cortex.

Affective empathy, on the other hand, refers to the emotions one feels in response to various cues. “This is a measure of how emotional you personally feel in response to someone’s emotions, for example how happy you feel when looking at someone who’s happy,” McCurdy explains. The brain regions associated with affective empathy include the inferior frontal gyrus, insula, and amygdala.

Mothers rate emotional intensity of infant cues and own feelings in response

McCurdy’s team used previously published data from a 2020 study led by Helena Rutherford, PhD , associate professor in the Yale Child Study Center, who is also the new study’s principal investigator. The dataset included 39 mothers who had used substances during the perinatal period and 42 who did not.

All of the participants looked at images of happy and sad infants and listened to sounds of infants crying while undergoing fMRI. Half of the cues were from unknown infants and half were the mother’s own baby. After the scan, researchers asked the participants to provide a “think” and a “feel” rating.

For the “think” rating, the researchers asked the participants to evaluate how happy or sad they thought the infant was feeling for each cue. This was a proxy for measuring the mother’s cognitive empathy. The researchers also asked the mothers to rate how strongly each cue made them feel. This was the “feel” rating, which was a proxy for affective empathy.

Maternal substance use associated with less affective empathy

McCurdy’s team reanalyzed this dataset to better understand how maternal substance use during the perinatal period might impact mothers’ cognitive empathy and affective empathy. Based on the subjective ratings and neural activity, levels of cognitive empathy did not significantly differ between groups—the mothers’ perceptions of how strongly each infant was feeling were comparable. And the brain regions associated with cognitive empathy showed similar activation.

On the other hand, mothers who used substances reported feeling less intensely in response to the infants, especially toward sad cues. “When they heard an infant cry or when they saw a picture of a sad infant face, they reported their affective empathy as being less intense,” McCurdy explains. The fMRI scans also showed that brain regions associated with affective empathy were less activated in this group.

Interestingly, however, when the cue was an image of the participant’s own smiling infant, there was no significant difference in affective empathy ratings between the two groups. “It seems there’s something quite unique about seeing your own happy baby that makes moms who use substances feel equally happy compared to moms who don’t,” says McCurdy. “In terms of developing interventions, perhaps seeing your smiling baby can be a source of reward and motivation.”

McCurdy highlights that the data only include measures of how mothers feel and think about infant stimuli and does not directly measure maternal behavior. “Future studies are needed to link these responses to infant stimuli with caregiving abilities,” she says.

“Based on these data alone, we also cannot ascertain whether these differences in maternal responses observed are a result of the substance use or are simply associated with it,” says Rutherford. “It’s possible that feeling less intensely particularly towards sad infant stimuli may actually be adaptive as it allows mothers who use substances to not feel overwhelmed when interacting with their crying baby.”

McCurdy hopes these insights will help inform efforts to support mothers struggling with substance use. “There’s a lot of stigma around substance use, and this stigma is unfortunately amplified for mothers who use substances,” says McCurdy. “It’s important that we continue studying this population because understanding how to best support their caregiving and maternal behavior is immensely important in helping them be the best moms they can be”.

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