Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting. (+info)
The importance of empathy in the enablement of patients attending the Glasgow Homoeopathic Hospital.
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BACKGROUND: Patient enablement in general practice is known to be limited by consultation length. However, the processes within the consultation that lead to enablement are not well understood. AIMS: To investigate patient enablement in a setting where time is less of a constraint than in primary care, in order to determine the importance of other factors in enablement. DESIGN OF STUDY: Exploratory questionnaire-based study. SETTING: Two hundred consecutive outpatients attending four doctors at the Glasgow Homoeopathic Hospital, an NHS-funded integrated complementary and orthodox medicine unit. METHOD: Information was collected on enablement and a range of other factors, including the patients expectations, their perception of the doctors empathy, and the doctors own confidence in the doctor-patient relationship. RESULTS: Although there were many factors that correlated with enablement, multi-regression analysis showed patients expectation, doctor's empathy (as perceived by the patient), and doctor's own confidence in the therapeutic relationship to be the three key factors. Together they accounted for 41% of the variation in enablement, with empathy being the single most important factor (66% of the explained variation in enablement). CONCLUSION: Patient enablement at the Glasgow Homoeopathic Hospital is mainly related to the patients perception of the doctor's empathy. (+info)
The systemizing quotient: an investigation of adults with Asperger syndrome or high-functioning autism, and normal sex differences.
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Systemizing is the drive to analyse systems or construct systems. A recent model of psychological sex differences suggests that this is a major dimension in which the sexes differ, with males being more drawn to systemize than females. Currently, there are no self-report measures to assess this important dimension. A second major dimension of sex differences is empathizing (the drive to identify mental states and respond to these with an appropriate emotion). Previous studies find females score higher on empathy measures. We report a new self-report questionnaire, the Systemizing Quotient (SQ), for use with adults of normal intelligence. It contains 40 systemizing items and 20 control items. On each systemizing item, a person can score 2, 1 or 0, so the SQ has a maximum score of 80 and a minimum of zero. In Study 1, we measured the SQ of n = 278 adults (114 males, 164 females) from a general population, to test for predicted sex differences (male superiority) in systemizing. All subjects were also given the Empathy Quotient (EQ) to test if previous reports of female superiority would be replicated. In Study 2 we employed the SQ and the EQ with n = 47 adults (33 males, 14 females) with Asperger syndrome (AS) or high-functioning autism (HFA), who are predicted to be either normal or superior at systemizing, but impaired at empathizing. Their scores were compared with n = 47 matched adults from the general population in Study 1. In Study 1, as predicted, normal adult males scored significantly higher than females on the SQ and significantly lower on the EQ. In Study 2, again as predicted, adults with AS/HFA scored significantly higher on the SQ than matched controls, and significantly lower on the EQ than matched controls. The SQ reveals both a sex difference in systemizing in the general population and an unusually strong drive to systemize in AS/HFA. These results are discussed in relation to two linked theories: the 'empathizing-systemizing' (E-S) theory of sex differences and the extreme male brain (EMB) theory of autism. (+info)
The doctor-patient relationship in US primary care.
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Changes in the organization of primary care in the UK are driven by a need to improve access and availability, but doctor-patient relationships may suffer. To investigate the importance of such relationships in a different setting, we analysed focus-group data obtained in a primary care facility in the USA (Rochester, NY). The findings pointed to three key factors in these relationships-namely, an asymmetry of perceptions on the two sides, belying the notion of a meeting of experts; the importance on both sides of 'liking'; and the value set by both parties on development of trust. The last two of these factors are probably related to continuity of care, now under threat. (+info)
Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas.
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How do we empathize with others? A mechanism according to which action representation modulates emotional activity may provide an essential functional architecture for empathy. The superior temporal and inferior frontal cortices are critical areas for action representation and are connected to the limbic system via the insula. Thus, the insula may be a critical relay from action representation to emotion. We used functional MRI while subjects were either imitating or simply observing emotional facial expressions. Imitation and observation of emotions activated a largely similar network of brain areas. Within this network, there was greater activity during imitation, compared with observation of emotions, in premotor areas including the inferior frontal cortex, as well as in the superior temporal cortex, insula, and amygdala. We understand what others feel by a mechanism of action representation that allows empathy and modulates our emotional content. The insula plays a fundamental role in this mechanism. (+info)
What imitation tells us about social cognition: a rapprochement between developmental psychology and cognitive neuroscience.
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Both developmental and neurophysiological research suggest a common coding between perceived and generated actions. This shared representational network is innately wired in humans. We review psychological evidence concerning the imitative behaviour of newborn human infants. We suggest that the mechanisms involved in infant imitation provide the foundation for understanding that others are 'like me' and underlie the development of theory of mind and empathy for others. We also analyse functional neuroimaging studies that explore the neurophysiological substrate of imitation in adults. We marshal evidence that imitation recruits not only shared neural representations between the self and the other but also cortical regions in the parietal cortex that are crucial for distinguishing between the perspective of self and other. Imitation is doubly revealing: it is used by infants to learn about adults, and by scientists to understand the organization and functioning of the brain. (+info)
The manifold nature of interpersonal relations: the quest for a common mechanism.
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It has been proposed that the capacity to code the 'like me' analogy between self and others constitutes a basic prerequisite and a starting point for social cognition. It is by means of this self/other equivalence that meaningful social bonds can be established, that we can recognize others as similar to us, and that imitation can take place. In this article I discuss recent neurophysiological and brain imaging data on monkeys and humans, showing that the 'like me' analogy may rest upon a series of 'mirror-matching' mechanisms. A new conceptual tool able to capture the richness of the experiences we share with others is introduced: the shared manifold of intersubjectivity. I propose that all kinds of interpersonal relations (imitation, empathy and the attribution of intentions) depend, at a basic level, on the constitution of a shared manifold space. This shared space is functionally characterized by automatic, unconscious embodied simulation routines. (+info)
Perceived parental acceptance-rejection, family-related factors, and socio-economic status of families of adolescent heroin addicts.
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AIM: To compare adolescent heroin addicts and non-addicts with respect to their perceived parental acceptance and rejection, family factors (structure of the family, parents' marital status, and psychopathological disorders in the family), socio-economic status, and subjective appraisal of their family relations. METHODS: Fifty-two heroin addicts aged between 17 and 21, were compared with a group of 52 non-addicts of the same age. The comparison group was selected from an ad-hoc sample of high-school juniors and seniors and first- and second-year university students. Only participants who reported never to have taken any drugs were selected for the group of non-addicts. The perceived parental behavior of mothers and fathers was assessed by the 32-item version of Rohner's Parental Acceptance-rejection Questionnaire. Three other questionnaires were constructed to collect information on family factors, socio-economic status, subjective appraisal of family relations, and drug usage. RESULTS: The addicts perceived their mothers as more rejecting (p=0.018 for total score), more aggressive (p=0.007), and showing more undifferentiated rejection (p=0.001) than non-addicts. The addicts perceived their fathers as more rejecting then their mothers (p=0.002 for total score), less warm and accepting (p<0.001), and more neglecting (p=0.001). In comparison with non-addicts, the addicts evaluated the relationships with their mothers (p=0.001) and general satisfaction with their families (p=0.021) as poorer. Adolescent addicts mostly came from intact families. In the addicts' primary families (mother, father, and siblings), there was significantly higher incidence of addiction (p=0.041), schizophrenia (p=0.022), and suicide or attempted suicide (p=0.012). Addicts' families belonged to higher income groups then non-addicts (p=0.021). Addicts' fathers were on average less educated than non-addicts' fathers (p=0.040); typically to a high school level. The education level of addicts' mothers was similar to that of non-addicts' mothers (p=0.091), typically they were educated to a high school level. CONCLUSION: The results of this research indicate the importance of parental rearing practices, especially mothers', on adolescent drug abuse and addiction. As addicts perceived their mothers as more rejecting than non-addicts, mothers' rejection could be one of the major risk factors for developing drug addiction. (+info)