On the proliferation of the empathy concept in healthcare and medical education research.

OBJECTIVE: To offer a critique of empathy concept usage in healthcare and medical education research. METHODS: Analysis of current usage and suggestions for authors and researchers. RESULTS: Empathy is often undefined or inconsistently defined, and "empathy" as represented in research covers an unmanageably wide and varied range of intentions, attitudes, emotions, and behaviors. The ubiquitous use of "empathy" as a vague and often undefined umbrella term hinders comprehension and, therefore, scientific progress. Patients are rarely asked directly about empathy; instead, measures of so-called perceived empathy contain descriptive items that could as well be called quality of care, patient-centeredness, or patient satisfaction. CONCLUSIONS: Although "empathy" in medical care is widely valued by researchers, educators, and practitioners, the empathy concept as used in the published literature is overused and unclear, and potentially damaging to scholarship, medical education, and ultimately healthcare. The vague term empathy should be replaced as much as possible with concrete descriptions of what is actually measured, experimentally manipulated, or taught. PRACTICE IMPLICATIONS: Identifying patients' own empathy definitions will improve medical education and medical care through clarifying what clinical behaviors will best fulfill patients' needs and desires. This approach allows for greater specificity and personalized care delivery.

It looks like construct validity, but look again: Comment on Clutterbuck et al. (2021) and recommendations for test developers in the broad "empathy" domain.

Conceptual flaws can undermine even rigorous test development efforts, especially in the broad empathy and social cognition domains, which are characterized by measure proliferation and inconsistently used construct terms. We discuss these issues, focusing on a new instrument of "mentalizing" as a case study. Across several studies, Clutterbuck et al. (2021a) developed the Four-Item Mentalising Index (FIMI). They described it as the first self-report measure of mentalizing ability and suggested that it offers substantial advances for research and assessment. As we demonstrate with conceptual arguments and empirical data, the FIMI embodies several major problems that are common in this area of research. Using the FIMI as a case study, we underline the importance for test developers of attending to the nonnegotiable necessity of discriminant validity analyses, the challenge of choosing appropriate convergent validity measures, and the difficulties of navigating the jingle-jangle jungle of empathy and social cognition construct terms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

How do laypeople define empathy?

The term "empathy" is popular, yet fuzzy. How laypeople define it has not been investigated. In Study 1, we analyzed 99 participants' free narratives describing their personal definition, and in Study 1 (N = 191) and Study 2 (N = 351), we asked participants to rate a list of specific behaviors and tendencies for how well each one matched their personal definition. Out of 10 coded components, perspective taking was mentioned most often and personal distress (anxious reactivity in emotional situations) was never mentioned. Item ratings revealed four Empathy Concept factors: Prosocial Emotional Response, Interpersonal Perceptiveness, Other Perspective, and Anxious Reactivity. Other Perspective and Prosocial Emotional Response were most highly endorsed while Anxious Reactivity showed the lowest endorsement. Individuals varied widely in their endorsements of the factors. These results demonstrate that laypeople hold a multifactorial set of definitions of empathy and differ widely from one another in which ones they endorse.

What is clinical empathy? Perspectives of community members, university students, cancer patients, and physicians.

OBJECTIVES: To explore what undergraduates, community members, oncology patients, and physicians consider empathic behavior in a physician. METHODS: 150 undergraduates, 152 community members, 95 physicians, and 89 oncology patients rated 49 hypothetical physician behaviors for how well they fit their personal definition of physician empathy. Dimensions of empathy were explored and compared across groups. RESULTS: Three dimensions of empathy were Conscientious and Reassuring, Relationship Oriented, and Emotionally Involved. Relationship Oriented was the most strongly endorsed, followed by Emotionally Involved, with Conscientious and Reassuring coming in last. There were no group differences for Conscientious and Reassuring, but the Relationship Oriented factor was more endorsed by the clinical groups (physicians and patients) than the non-clinical groups. The Emotionally Involved factor was endorsed by physicians notably more than by patients. CONCLUSION: What is considered clinical empathy is not the same across individuals and stakeholder groups. PRACTICE IMPLICATIONS: Physicians and patients differ in how much they include the physicians' emotionality and emotion-related actions in their definition of empathy. Communication training for physicians that emphasizes behaviors associated with empathy (listening, understanding a person's feelings and perspectives, and showing interest in and concern for the whole person) may enhance patients' perception of clinical empathy.

Gratitude increases third-party punishment.

Third-party punishment occurs when a perpetrator of a transgression is punished by another person who was not directly affected by the transgression (i.e. a third-party). Given gratitude's demonstrated ability to enhance both cooperation and the value people place on future-rewards, its capacity to increase third-party punishment - a phenomenon theorised to increase future cooperative behaviour - was investigated. In two experiments, participants were randomly assigned to experience one of three emotional states (i.e. gratitude, happiness, or neutrality) prior to making decisions about how much of a previous financial endowment they would spend to punish a person who transgressed against another at differing degrees within the context of a dictator game. As expected, punishment expenditures decreased for all participants as a dictator's decision became fairer. Of primary interest, however, participants who felt grateful, as compared to those who felt neutral or happy, engaged in significantly more third-party punishment across dictator splits that were not altruistic in nature.

The Grateful Don't Cheat: Gratitude as a Fount of Virtue.

Gratitude has been linked to behaviors involving the exchange of resources; it motivates people to repay debts to benefactors. However, given its links to self-control-itself a necessary factor for repaying debts-the possibility arises that gratitude might enhance other virtues unrelated to exchange that depend on an ability to resist temptation. Here, we examined gratitude's ability to function as a "parent" virtue by focusing on its ability to reduce cheating. Using real-time behavior-based measures of cheating, we demonstrated that gratitude, as opposed to neutrality and the more general positive emotional state of happiness, reduces cheating in both a controlled laboratory setting (N = 156) and a more anonymous online setting (N = 141). This finding suggests that not all moral qualities need to be studied in silos but, rather, that hierarchies exist wherein certain virtues might give rise to seemingly unrelated others.