Empatia (parte I): contribuições para a abordagem centrada na pessoa / Empathy (part I): contributions to a person-centered approach / Empatía (parte I): contribuciones a un enfoque centrado en la persona

Introdução: Este artigo explora o tema da empatia na relação médico-paciente. Objetivo: Contribuir para o aperfeiçoamento das habilidades de comunicação clínica ao revisar o entendimento e a aplicação da empatia na prática clínica. Métodos: Trata-se de uma revisão não sistemática dos principais livros utilizados na comunicação clínica sobre o tema da empatia. O recorte metodológico compreendeu as seguintes etapas: (1) amostra intencional da literatura; (2) coleta e leitura de dados ­ i.e., extração de fragmentos dos textos; (3) análise do conteúdo, com o foco na definição, importância e instrumentalização para a aplicação prática; (4) seleção e síntese, para facilitar a compreensão e a contextualização sobre o tema; e (5) comparação e ponderação do conteúdo selecionado. Resultados: A abrangência com que a empatia foi trabalhada na literatura selecionada resultou em três níveis de densidade empática: baixa, moderada e alta. Assim, a baixa densidade empática limitou-se mais à definição e importância do tema; a densidade moderada incorporou algum exemplo de como aplicar a empatia, porém de forma fragmentada; e a alta densidade empática abordou o tema de modo mais completo, facilitando a instrumentalização na prática clínica. Há concordância na literatura analisada de que a prática da empatia reflete-se na melhoria do cuidado médico, entretanto seu exercício permanece no campo racional. Ao exemplificar a aplicação prática da empatia, os autores sugerem que o médico adote uma postura isenta de julgamentos, ao mesmo tempo que propõem um exercício imaginativo, de adivinhação dos sentimentos/emoções do paciente. Apesar de os autores de alta densidade empática compreenderem a importância das emoções e nomeá-las no processo, percebe-se a necessidade de um desdobramento e aprofundamento a partir desse ponto. Conclusões: Por se tratar de um assunto complexo, com vários matizes, a empatia é abordada de diferentes formas na literatura selecionada. Isso evidencia sua riqueza e originalidade, ao mesmo tempo que apresenta lacunas para sua aplicação na prática clínica.

Introduction: This article explores the theme of empathy in the doctor-patient relationship. Objective: To contribute to the improvement of clinical communication skills by reviewing the understanding and application of empathy in clinical practice. Methods: A non-systematic review of the main books used in clinical communication on the topic of empathy. The methodological approach consisted in the following steps: (1) An intentional sample of the literature; (2) Data collection and reading, i.e., extracting fragments from texts; (3) Content analysis, focusing on definition, importance and instrumentalization for practical application; (4) Selection and synthesis to facilitate understanding and contextualization on the topic; and (5) Comparison and ponderance of the selected content. Results: The scope within which empathy was worked on in the selected literature resulted in three levels of empathic density: low, moderate, and high. Thus, low empathic density was limited to definition and importance; moderate density incorporated some examples of how to apply empathy in a fragmented way; high empathic density addressed the topic more fully, facilitating instrumentation in clinical practice. There is agreement in the literature analyzed that the practice of empathy reflects on the improvement of medical care. However, its exercise remains in the rational field. By exemplifying the practical application of empathy, the authors suggest that the physician adopt a non-judgmental posture, while proposing an imaginative exercise of guessing the patient's feelings/emotions. Although high-density empathy authors understand the importance of emotions and name them in the process, there is a need for an unfolding and deepening from this point on. Conclusions: Empathy is a complex subject with several nuances and is approached in different ways in the selected literature. This evidences its richness and originality, at the same time that it presents gaps for the application of empathy in clinical practice.

Introducción: Este artículo explora el tema de la empatía en la relación médico-paciente. Objetivo: contribuir a la mejora de las habilidades de comunicación clínica mediante la revisión de la comprensión y aplicación de la empatía en la práctica clínica. Método: se trata de una revisión no sistemática de los principales libros utilizados en comunicación clínica sobre el tema de la empatía. El enfoque metodológico comprendió los siguientes pasos: (1) Una muestra intencional de la literatura; (2) Recopilación y lectura de datos, es decir, extracción de fragmentos de textos; (3) Análisis de contenido, centrándose en definición, importancia e instrumentalización para la aplicación práctica; (4) Selección y síntesis para facilitar la comprensión y contextualización sobre el tema; y (5) Comparación y ponderación del contenido seleccionado. Resultados: el alcance con el que se trabajó la empatía en la literatura seleccionada tuvo como resultado tres niveles de densidad empática: baja, moderada y alta. Así, la baja densidad empática se limitaba más a la definición y la importancia; densidad moderada, incorporó algún ejemplo de cómo aplicar la empatía, pero de manera fragmentada; alta densidad empática se acercó del tema de manera más completa, facilitando la instrumentación en la práctica clínica. Existe acuerdo en la literatura analizada en que la práctica de la empatía se refleja en la mejora de la atención médica. Sin embargo, su ejercicio queda en el campo racional. Al ejemplificar la aplicación práctica de la empatía, los autores sugieren que el médico adopte una postura no crítica, al tiempo que propone un ejercicio imaginativo de adivinar los sentimientos/emociones del paciente. Si bien los autores de alta densidad empática entienden la importancia de las emociones y las nombran en el proceso, existe la necesidad de un desdoblamiento y profundización a partir de este punto. Conclusiones: Por tratarse de un tema complejo y con varios matices, la empatía es abordada de diferentes maneras en la literatura seleccionada. Esto evidencia su riqueza y originalidad, al mismo tiempo que presenta vacíos para la aplicación de la empatía en la práctica clínica.

The Relationship Between Brain Activation for Taking Others' Perspective and Interoceptive Abilities in Autism Spectrum Disorder: An fMRI Study.

Objectives: In this functional magnetic resonance imaging study, we aimed to investigate the differences in brain activation between individuals with autism spectrum disorder (ASD) and typically developing (TD) individuals during perspective taking. We also examined the association between brain activation and empathic and interoceptive abilities. Methods: During scanning, participants from the ASD (n=17) and TD (n=22) groups were shown pain stimuli and asked to rate the level of the observed pain from both self- and other-perspectives. Empathic abilities, including perspective taking, were measured using an empathic questionnaire, and three dimensions of interoception were assessed: interoceptive accuracy, interoceptive sensibility, and interoceptive trait prediction errors. Results: During self-perspective taking, the ASD group exhibited greater activation in the left precuneus than the TD group. During other-perspective taking, relative hyperactivation extended to areas including the right precuneus, right superior frontal gyrus, left caudate nucleus, and left amygdala. Brain activation levels in the right superior frontal gyrus while taking other-perspective were negatively correlated with interoceptive accuracy, and those in the left caudate were negatively correlated with perspective taking ability in the ASD group. Conclusion: Individuals with ASD show atypical brain activation during perspective taking. Notably, their brain regions associated with stress reactions and escape responses are overactivated when taking other-perspective. This overactivity is related to poor interoceptive accuracy, suggesting that individuals with ASD may experience difficulties with the self-other distinction or atypical embodiment when considering another person's perspective.

Perceived and Actual Norms, and Norm Misperceptions in Explaining Participant Roles in Bullying.

Bullying norms have been shown to affect adolescents' decisions on different behaviors in bullying situations, but little is known about the differential contribution of perceived and actual bullying norms as well as their agreement. The present study investigated the effects of perceived and actual norms, along with norm misperceptions in participant roles in bullying. A sample of 890 students (337 fourth-, 223 fifth-, and 320 sixth-graders; Female 48%; Mage = 11.98, SDage = 0.82) from 34 classrooms in South Korean elementary schools was assessed at two time points: at the beginning (Wave 1) and at the end of the semester (Wave 2). Multilevel modeling results indicated that empathy as well as perceived and actual anti-bullying norms had unique effects on different participant roles in bullying. The agreement between perceived and actual norms also varied across classes, and bullying, victimization, and bystanding were found to be higher in classes where individuals misperceived the actual anti-bullying norms. Adolescents were more likely to defend in response to their empathy in classes with higher anti-bullying norms, while they were less likely to bystand in response to their empathy in classes where individuals accurately perceived the actual anti-bullying norms. These findings underscore that intervention programs can focus on correcting adolescents' erroneous perceptions and convictions about peers' anti-bullying attitudes to alleviate bullying and its negative consequences.

Feasibility of a cinematic-virtual reality training program about opioid use disorder for osteopathic medical students: a single-arm pre-post study.

CONTEXT: Opioid use disorder (OUD) has a considerable morbidity and mortality in the United States. Healthcare providers are key points of contact for those with OUD; however, some providers may hold stigma toward OUD. Stigma toward OUD can lead to lower quality of care and more negative health outcomes. Thus, new trainings designed to reduce stigma toward OUD while increasing empathy are critical. We created a web-based cinematic virtual reality (cine-VR) training program on OUD for osteopathic medical students. OBJECTIVES: The aim of this pilot study was to assess changes in stigma toward OUD and empathy before and after the online cine-VR training program on OUD. METHODS: We employed a single-arm, pre- and posttest pilot study to assess changes in stigma toward OUD and empathy. Osteopathic medical students from one large medical school in the Midwest with three campuses were invited to participate in the online cine-VR training. Participants completed two surveys before and after the cine-VR training. We performed paired t tests to examine changes in stigma toward OUD and empathy scores before and after the cine-VR OUD training program. RESULTS: A total of 48 participants completed the training. We observed a decrease in stigma toward OUD posttraining (t=4.402, p<0.001); this change had a Cohen's d of 0.64, indicating a medium effect. We also observed an increase in participants' empathy scores posttraining (t=-2.376, p=0.023), with a Cohen's d of 0.40 signifying a small effect. CONCLUSIONS: Findings from this pilot study suggest that the online cine-VR training may reduce stigma toward OUD while increasing empathy. Future research employing a randomized controlled trial design with a larger, more diverse sample and a proper attention control condition is needed to confirm the effectiveness of the online cine-VR training. If confirmed, this cine-VR training may be an accessible approach to educating osteopathic medical students about OUD.

Parental Warmth, Friendship Quality, Empathy and Bystander Defending Behavior in Cyberbullying Among Adolescents in China.

Adolescents' bystander defending behavior in cyberbullying contributes to reducing the harm done to cyberbullying victims. This study examined the relationships and underlying mechanisms of parental warmth, friendship quality, empathy and bystander defending behavior in cyberbullying among 848 Chinese adolescents (43.986% girls, mean age = 14.960 years old [SD = 1.398]). The results showed that parental warmth, friendship quality and empathy were all positively correlated with bystander defending behavior in cyberbullying among adolescents. Both friendship quality and empathy played a mediating role between parental warmth and bystander defending behavior in cyberbullying, indicating that parental warmth was associated with increased bystander defending behavior through higher levels of friendship quality and empathy, respectively. Friendship quality and empathy also played a chain mediating role between these two, indicating that parental warmth was linked to increased bystander defending behavior by first associating with higher level of friendship quality and subsequently with greater empathy. These results suggest that high degrees of parental warmth, friendship quality and empathy may all increase the likelihood of bystander defending behavior in cyberbullying among adolescents. This study provides practical implications for improving adolescent bystander defending behavior in cyberbullying.

The impact of an aging simulation program for dental students in two community dental clinics.

PURPOSE: Clinicians who have not experienced the difficulties that come with aging or disability may be unable to relate to the limitations and experiences of afflicted patients, which is necessary to improve patient-provider connection and treatment outcomes. The purpose of this study was to test the effectiveness of an aging-simulation experience on improving dental students' awareness of aging-related limitations, examine the students' perceptions, and assess planned patient-care modifications based on the aging-simulation experience. METHODS: A total of 78 dental students who rotated through two extramural clinic sites from August 2021 through October 2022 completed pre-simulation surveys, donned aging simulators in the dental operatory, initiated pre-defined tasks and their corresponding modifications, completed a post-simulation survey, and completed a reflection questionnaire containing structured and open-ended questions. Quantitative responses were analyzed using descriptive frequencies and paired sample t-tests, whereas thematic analyses were used to interpret free-text portion of the reflection questionnaire. RESULTS: Student awareness of the impact of the four aging-related disabilities improved after the experience. Visual impairment was identified as the most difficult symptom to experience during simulation. Students reported increased feelings of empathy and acknowledged the effectiveness of clinical practice modifications to accommodate elderly patients with limitations. Students also expressed intentions to make similar modifications in their future clinical practice and the need for exposure to longer periods of simulated experiences to further clinical practice modifications for elderly patients. CONCLUSION: The aging-simulation experience is an effective tool for raising dental students' awareness of aging-related difficulties, the need for clinical practice modifications, and increasing empathy.

Characteristics of pain empathic networks in healthy and primary dysmenorrhea women: an fMRI study.

Pain empathy enables us to understand and share how others feel pain. Few studies have investigated pain empathy-related functional interactions at the whole-brain level across all networks. Additionally, women with primary dysmenorrhea (PDM) have abnormal pain empathy, and the association among the whole-brain functional network, pain, and pain empathy remain unclear. Using resting-state functional magnetic resonance imaging (fMRI) and machine learning analysis, we identified the brain functional network connectivity (FNC)-based features that are associated with pain empathy in two studies. Specifically, Study 1 examined 41 healthy controls (HCs), while Study 2 investigated 45 women with PDM. Additionally, in Study 3, a classification analysis was performed to examine the differences in FNC between HCs and women with PDM. Pain empathy was evaluated using a visual stimuli experiment, and trait and state of menstrual pain were recorded. In Study 1, the results showed that pain empathy in HCs relied on dynamic interactions across whole-brain networks and was not concentrated in a single or two brain networks, suggesting the dynamic cooperation of networks for pain empathy in HCs. In Study 2, PDM exhibited a distinctive network for pain empathy. The features associated with pain empathy were concentrated in the sensorimotor network (SMN). In Study 3, the SMN-related dynamic FNC could accurately distinguish women with PDM from HCs and exhibited a significant association with trait menstrual pain. This study may deepen our understanding of the neural mechanisms underpinning pain empathy and suggest that menstrual pain may affect pain empathy through maladaptive dynamic interaction between brain networks.

Mind reading dysfunctions in patients with obstructive sleep apnoea: A neuropsychological approach.

Obstructive sleep apnoea syndrome (OSAS) is a prevalent sleep-related breathing disorder that has been extensively studied for its effects on cognitive functions. However, little attention has been given to investigating Mind Reading (MR) skills in patients with OSAS. In this study, we employed a neuropsychological approach to thoroughly assess various facets of MR skills in patients with OSAS. Forty-two patients with untreated moderate or severe OSAS (AHI ≥15; 30 men, 12 women) and 16 healthy controls (7 men and 9 women), matched by age, were enrolled. To assess MR skills, we used: (i) The Story-based Empathy Task (SET), which includes three experimental conditions: identifying intentions (SET-IA), emotional states (SET-EA), and a control condition for inferring causality reactions (SET-CI); (ii) the Ekman 60 Faces Test (Ek60), which measures emotion recognition from facial expressions. Our findings revealed that patients with OSAS exhibit deficits in emotion-related MR skills, while their ability to make inferences about the cognitive states of social partners remains largely preserved. This finding corroborates previous evidence indicating that social cognition, particularly MR skills, may be one of the cognitive domains affected by OSAS. It emphasizes the significance of investigating social cognition and the relationship between MR skills and social functioning as a new and intriguing area of research in patients with OSAS.

A study of latent profile analysis of empathic competence and factors influencing it in nursing interns: a multicenter cross-sectional study.

Background: Empathy, as one of the fundamental principles of nursing professionalism, plays a pivotal role in the formation and advancement of the nursing team. Nursing interns, as a reserve force within the nursing team, are of significant importance in terms of their ability to empathize. This quality is not only directly related to the degree of harmony in the nurse-patient relationship and the enhancement of patient satisfaction, but also plays a pivotal role in the promotion of the quality of nursing services to a new level. Aim: The objective of this study was to gain a deeper understanding of the current state of nursing interns' empathic abilities. To this end, we sought to examine empathic performance under different profile models and to identify the key factors influencing these profile models. Methods: The study utilized 444 nursing interns from 11 tertiary general hospitals in Inner Mongolia as research subjects. The study employed a number of research tools, including demographic characteristics, the Jefferson Scale of Empathy, and the Professional Quality of Life Scale. A latent profile model of nursing interns' empathy ability was analyzed using Mplus 8.3. The test of variability of intergroup variables was performed using the chi-square test. Finally, the influencing factors of each profile model were analyzed by unordered multi-categorical logistic regression analysis. Results: The overall level of empathy among nursing interns was found to be low, with 45% belonging to the humanistic care group, 43% exhibiting low empathy, and 12% demonstrating high empathy. The internship duration, empathy satisfaction, secondary traumatic stress, only child, place of birth, and satisfaction with nursing were identified as factors influencing the latent profiles of empathy in nursing interns (p < 0.05). Conclusion: There is considerable heterogeneity in nursing interns' ability to empathize. Consequently, nursing educators and administrators should direct greater attention to interns with lower empathy and develop targeted intervention strategies based on the influences of the different underlying profiles.

Empathy among autistic and non-autistic adolescents: The importance of informant effects.

Empathy is the ability to recognize the emotions of others (cognitive empathy) and to share in those emotions while maintaining a self-other distinction (emotional empathy). Previous research often, but not always, showed that autistic adults and children have lower levels of overall and cognitive empathy than non-autistic individuals. Yet how empathy manifests during adolescence, a developmental period marked by physiological, social, and cognitive change, is largely unclear. As well, we aimed to compare self versus parents' perceptions regarding adolescents' empathy. To do so, parents (N = 157) of 10-16-year-olds (N = 59 autistic) and their children (N = 133) completed empathy questionnaires. Adolescents also completed a measure of mental state recognition (Reading the Mind in the Eyes Test; RMET) and parents reported on their child's autistic traits. The tasks were completed twice ~six months apart. We found that autistic adolescents reported having lower empathic concern and higher personal distress than their non-autistic peers, whereas parents of autistic adolescents perceived them as having overall lower levels of empathy. Performance on the mental state recognition task of autistic and non-autistic adolescents' was comparable. The gap between self and parent reports regarding adolescents' empathy was explainable by parent-reported autistic traits, mainly communication difficulties. Empathy remains stable across the study's two time points. Thus, the findings do not support previous views of autistic people as having less empathy and these are possibly explainable by informant effects.

Belief in a just world and fair behavior among clinical nurses: a moderated mediation model of empathy and observer justice sensitivity.

BACKGROUND: Exploration of the relationship between nursing staffs' justice in belief world and fair behavior is important to promote equity and access to health services in health organizations, as well as to enhance the quality of care. In order to further dissect the influencing factors of fair behavior among clinical nurses, the current study aims to investigate how belief in a just world influences the fair behavior among nurses. Based on the belief in a just world theory, the empathy-altruism theory and the protective-protective model, the current study aimed to provide a deeper understanding of the effect of belief in a just world on fair behavior by investigating the mediating role of empathy and the moderating role of observer justice sensitivity. METHOD: This was a cross-sectional study. 571 registered clinical nurses were included from five hospitals in Fuzhou through a convenience sampling method. Measurements included Chinese translations of belief in a just world scale, empathy scale, observer justice sensitivity scale, fair behavior scale. SPSS 22.0 was used to describe descriptive statistics and the variables' Pearson correlation coefficient. SPSS PROCESS macro Model 4 and model 14 were used to examine the mediation and the moderation between the relationship of belief in a just world and fairness behavior. RESULT: The results shower that fairness behavior was positively correlated with one's belief in a just world (r = 0.26, p < 0.01); (2)empathy mediated the relationship between belief in a just world and fair behavior. The mediation model explains 20.83%; (3) Observer justice sensitivity moderated the relationship between empathy and fair behavior. CONCLUSIONS: Belief in a just world, empathy, and observer justice sensitivity were motivations for nurses' fair behavior. Nursing administrators should focus on cultivating nurses' belief in a just world, their empathy abilities, and positive qualities of justice sensitivity to enhance fair behavior in a healthcare setting.

Tele-health coaches' responses to clients' emotional cues and concerns and engagement with the Bump to Baby and Me Intervention.

OBJECTIVE: To explore the relationship between health coaches' responses to emotional cues/concerns and women's subsequent engagement with the health coaching mHealth platform. METHODS: 24 face-to-face video-mediated initial conversations between participants and their health coaches were coded using the VR-CoDES-P method. Women with high risk of developing Gestational Diabetes Mellitus were selected from the study, based on their engagement with the smartphone health coaching platform. 12 women with very low engagement and 12 women with high engagement were identified. RESULTS: In interactions with women with high goal engagement, coaches had significantly more counseling codes with prior other codes and no instances of non-explicit response codes that reduce space for further disclosure. Analysis showed that interactions with women with high goal engagement were more frequently met by the coach with affect-acknowledging and empathic responses prior to the counseling speech act. CONCLUSION: High goal engagement among women with Gestational Diabetes Mellitus may appear to be associated with coaches facilitating the frequent use of empathy. PRACTICE IMPLICATIONS: Findings can draw coaches' attention to the impact that their counseling has on goal engagement, increasing the opportunity for intervention to be person-centered and effective.

Understanding the support for gender-based harassment perpetrators: the role of closeness and empathy.

Introduction: Gender-based harassment is a pressing social challenge urgently demanding eradication. While social movements emphasize supporting victims, societal responses sometimes lean toward exculpating perpetrators. This study examines two factors influencing this exoneration: closeness to perpetrators and empathy focus. Methods: A total of 345 participants took part in an experimental design to assess how closeness to perpetrators (close vs. distant) and empathy focus (on the perpetrator vs. victim vs. control) impact the moral justification of harassment and the dehumanization of both parties. Results and discussion: Results indicate that closeness and empathizing with perpetrators lead to greater leniency-more moral justification and less dehumanization of the perpetrator. Heightened moral justification for close perpetrators is mediated by increased empathy toward them and decreased empathy for victims, and reduced dehumanization of close perpetrators corresponds to heightened empathy toward them. This research highlights how closeness and empathy, two initially positive factors, can foster tolerance toward gender harassment.

An Empathy and Arts Curriculum During a Pediatrics Clerkship: Impact on Student Empathy and Behavior.

Introduction: Empathy is critical within medicine and improves patient outcomes and satisfaction. Empathy declines during the clerkship years due to the hidden curriculum, where students observe emotional distancing and desensitization by providers. Studies show arts curricula can preserve empathy but are limited by sample bias and preclerkship occurrence. We implemented and evaluated a brief pediatric clerkship arts curriculum to improve empathic behaviors. Methods: We created two 1-hour required small-group sessions for pediatric clerkship medical students. The first session paired arts observation techniques with various paintings. The students then applied these techniques to video-based simulated patient interactions in the second session. We used the Toronto Empathy Questionnaire (TEQ) and an empathy behavior checklist (EBC) as pre/post assessments to gauge self-reported empathy and empathetic behaviors. We compared responses of learners who attended the sessions (curriculum group) to learners unable to attend (control group). Results: Thirty-four students participated in the curriculum; 19 were in the control group. Neither the control nor the curriculum group had a significant change in pre/post TEQ scores. Students with pre-TEQ scores less than 45 who participated in the curriculum had significant improvement in post-TEQ scores compared to their control group counterparts (p = .02). On the EBC, there was a significant difference between the curriculum and control groups for those who explored more about the child/family's experience (p < .05). Discussion: Our work suggests that a brief clerkship arts curriculum is useful for improving self-reported empathy ratings and empathetic skills, particularly for students identified as having below-average empathy.

The role of psychological formulation in inpatient settings in supporting staff empathy and therapeutic optimism for adults diagnosed with borderline personality disorder: A pre- and post-vignette study.

WHAT IS KNOWN ON THE SUBJECT?: Psychological formulation brings together a service user story and expertise, with psychological knowledge, research, and practitioners clinical experience to make sense of a service users' presentation (thinking about their difficulties but also strengths). Evidence into the effectiveness of formulation is largely anecdotal, qualitative, or small scale. Although this is very valuable research, there is not a lot of research which quantitatively evidences the role of formulation for service users or services. Quantitative evidence that does exist is also conflicting. Considering how widely psychological formulation is used, and the governing guidelines that recognize this as a core competency for psychological practitioners, it is important to continue to add to the evidence base. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Psychological formulation can increase staff empathy and hope. This could help service users to feel more understood and hopeful. Formulation; however, did not impact feelings of personal distress in staff. This research may suggest a need for the two distinct processes (i.e. team formulation and reflective practice) to support all components of empathy within inpatient services. Psychological formulation could support the provision of psychologically informed care within inpatient services, of which promotes effective care delivery. ABSTRACT: OBJECTIVES: National Health Service (NHS) values, such as empathy and therapeutic optimism, are integral when supporting service users with complex mental health presentations. There is some evidence to suggest that psychological formulation can increase empathy and optimism in healthcare professionals. This study, therefore, aimed to investigate whether a psychological formulation of a hypothetical service user with a complex presentation, typically labelled with a diagnosis of borderline personality disorder (BPD), increased empathy and therapeutic optimism in professionals working in mental health inpatient services. METHOD: Sixty-six mental health professionals working in NHS inpatient services took part in a pre- and post-vignette study. Participants were asked to read a case vignette about a hypothetical service user, with a diagnostic label of BPD, and complete questionnaires capturing levels of empathy and therapeutic optimism. Participants were then randomized into two conditions and either asked to read the same information again (control condition) or read a psychological formulation based on the same hypothetical service user (intervention condition). The findings were analysed using a series of ANCOVAs/ANCOHETs. RESULTS: Two constructs of empathy (i.e. perspective taking and empathic concern), and therapeutic optimism significantly increased following exposure to the psychological formulation when compared to the control group condition. CONCLUSION: This study warrants further replication. These initial findings; however, indicate that psychological formulation can significantly increase the ability to perspective take, display empathic concern, and hold therapeutic optimism towards service users with a presentation associated with a diagnosis of BPD.

Developing culturally competent physicians: Empathy, inclusivity, moral distress training and ethical reflections during the Medicine Clerkship.

PURPOSE: We aimed to develop a tool that would allow assessment of ethics competency and moral distress during the Internal Medicine Clerkship and to introduce curricular changes that could empower students to better address ethical dilemmas and challenges encountered during the clerkship. MATERIALS AND METHODS: A structured ethics assignment was introduced where students could reflect on impactful stressful scenarios and address questions related to emotional responses, identified ethical issues, management themes, and professional obligations. A 4-tiered grading rubric and individual narrative feedback was provided for each assignment, and small-group debriefing sessions were introduced for reflective thought and future planning. De-identified assignments were analyzed and classified into subgroups according to 5 main ethical issue subgroups and 10 specific management themes. Assignments were also analyzed for the presence of moral distress. RESULTS: 357 students completed the reflective ethics activities. The most commonly identified ethical issues were related to Shared Medical Decision Making (>40%), Primary of Patient Welfare challenges, (>20%), and Social/Organizational dilemmas. Management themes often pertained to Patient Wishes/Legal Obligations, Professional Behaviors, and Limited Resources. 87% of assignments demonstrated moral distress. CONCLUSION: Medical school is a stressful time and challenges are augmented during clinical years. Our reflective activity demonstrated significant exposures to ethical dilemmas, reviewed earlier principles of ethics training, and provided a safe forum in which to discuss these important aspects of healthcare. We captured powerful images of challenging situations eliciting moral distress, and students greatly appreciated the activity. We encourage future investigations that support student well-being and enable smooth transitions into residency training.

Understanding Others' Distress Through Past Experiences: The Role of Memory Engram Cells in Observational Fear.

For individuals to survive and function in society, it is essential that they recognize, interact with, and learn from other conspecifics. Observational fear (OF) is the well-conserved empathic ability of individuals to understand the other's aversive situation. While it is widely known that factors such as prior similar aversive experience and social familiarity with the demonstrator facilitate OF, the neural circuit mechanisms that explicitly regulate experience-dependent OF (Exp OF) were unclear. In this review, we examine the neural circuit mechanisms that regulate OF, with an emphasis on rodent models, and then discuss emerging evidence for the role of fear memory engram cells in the regulation of Exp OF. First, we examine the neural circuit mechanisms that underlie Naive OF, which is when an observer lacks prior experiences relevant to OF. In particular, the anterior cingulate cortex to basolateral amygdala (BLA) neural circuit is essential for Naive OF. Next, we discuss a recent study that developed a behavioral paradigm in mice to examine the neural circuit mechanisms that underlie Exp OF. This study found that fear memory engram cells in the BLA of observers, which form during a prior similar aversive experience with shock, are reactivated by ventral hippocampal neurons in response to shock delivery to the familiar demonstrator to elicit Exp OF. Finally, we discuss the implications of fear memory engram cells in Exp OF and directions of future research that are of both translational and basic interest.

Harnessing the power of empathy, visual art and patient narratives to improve health literacy: An exploratory study.

ISSUE ADDRESSED: Health-related information can often be overwhelming for consumers, frequently infused with complex medical terminology that is difficult to understand and apply. Historically empathic connection, art and narratives have played key roles in communicating with diverse populations however collectively have received little recognition as a modality to improve health literacy. This study aimed to investigate the empathetic connection between art and patient narratives with a view to improve health literacy in the wider community. METHODS: Nine recently discharged patients and one carer from a regional hospital were paired with 10 tertiary visual arts students for interview. Each narrative was transformed into visual art and exhibited at a community art gallery. The Empathy Quotient (EQ), Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and self-completed questionnaires assessed empathy and functional well-being. Health literacy was evaluated through community response surveys post-exhibition exposure. RESULTS: Student artist participants' EQ Cognitive Empathy (EQ-CE) scores were associated with 'Emotional Reactivity' (EQ-ER) (p = .038). SF-36 scores revealed that role limitations due to physical health and emotional problems had the greatest impact on patient/carer participant's life at the time. The SF-36 General Health domain was associated with the EQ-ER total score (p = .044). Exhibition surveys revealed that 96.9% of observers had learnt something new about illness or injury. SO WHAT?: Although a relatively small study, our findings suggest patient/carer narratives and visual art is a simple yet effective modality for health service organisations to facilitate affective learning and improve health literacy when engaging with consumers.

An Exploratory Study of the Potential of Online Counseling for University Students by a Human-Operated Avatar Counselor.

Recently, the use of digital technologies, such as avatars and virtual reality, has been increasingly explored to address university students' mental health issues. However, there is limited research on the advantages and disadvantages of counselors using avatars in online video counseling. Herein, 25 university students were enrolled in a pilot online counseling session with a human counselor-controlled avatar, and asked about their emotional experiences and impressions of the avatar and to provide qualitative feedback on their communication experience. Positive emotions during the session were associated with impressions of the avatar's intelligence and likeability. The anthropomorphism, animacy, likeability, and intelligent impressions of the avatar were interrelated, indicating that the avatar's smile and the counselor's expertise in empathy and approval may have contributed to these impressions. However, no associations were observed between participant experiences and their prior communication with avatars, or between participant experiences and their gender or the perceived gender of the avatar. Accordingly, recommendations for future practice and research are provided. Accumulating practical and empirical findings on the effectiveness of human-operated avatar counselors is crucial for addressing university students' mental health issues.