Motivation and emotion/Book/2015/Empathy and emotional well-being

Overview
Empathy is an emotion which allows humans to understand other's emotional state on an affective and cognitive level. Empathy involves taking another’s perspective, understanding why they are motivated in their actions and to vicariously experience what they experience.

 Trevithick described empathy as being able to “put ourselves in the person’s place… [so] we can feel and understand another person’s emotions, thoughts, actions and motives. Empathy involves trying to understand, as carefully and sensitively as possible the nature of another person’s experience, their own unique point of view and what meaning this conveys for that individual" (as cited in Grant, 2014).

Empathy is essential for humans to understand, identify, accurately communicate and be sympathetic with each other. Empathy allows us to understand others' actions, commiserate with them, predict how they will feel and know when to express our concern or sympathy. Without empathy, people would see little problem in lying to another person, breaking their trust or inflicting pain or violence upon them. When a person experiences the emotional transformation produced by empathy, they find such selfish behaviour reprehensible.

When examining empathy and its role in human life, it is evident that empathy is a prerequisite for many functions which contribute to subjective well-being. These functions could include socialisation, co-operation, emotional support and intimate relationships. In addition, empathy contributes to a communal sense of well-being by promoting pro-social behaviour. Empathy is also a mediator of stress on a personal level, understanding others and one’s own emotion is linked to lower personal distress (Birnie, Speca, & Carlson, 2009).


 * What are the various dimensions of empathy?
 * What is the relationship between empathy and well-being?
 * How does empathy relate to one’s own well-being?
 * How does empathy relate to interpersonal well-being?
 * How is empathy used to achieve success in therapy and counselling and improve others well-being?
 * What disorders are caused by dysfunctional empathy?

What is empathy?
The exact definition of empathy is debated by researchers. For this reason is it important to properly define empathy in any academic literature. Three main components are agreed upon between most definitions and are described in Table 1 (Lamm et al, 2007).

Table 1.

The three different aspects of empathy.

Empathy is divided into high order empathic responses and lower order empathic responses (Lamm et al, 2007). Cognitive empathy is considered to be a higher order empathic response since it requires the ability to make complex intellectual judgments. Cognitive empathy is also based upon the Theory of Mind, thus requiring higher mental capabilities (Blair, 2005). Being a higher order function, cognitive empathy is not as emotionally involved as affective empathy.

Affective empathy is considered to be a lower order aspect of empathy and involves feeling the emotional state of another person on a base level without considering context. Affective empathy is also related to emotional contagion, wherein similar emotional states spread from one person to another. A good example of affective empathy is displayed in Figure 1.

Quiz 1: Cognitive or affective empathy?
{Gary knows that his employee Jill is under a lot of stress at work due to several deadlines that are swiftly approaching. Unfortunately there is nothing Gary can do to ease Jill’s workload, and Gary knows that other employees have an equal amount of work to do as well. Gary’s lack of action maybe seem cold-hearted to some, but in the end it is not his responsibility to comfort his employees. What kind of empathy is Gary displaying? +Cognitive empathy. -Affective empathy.
 * type=""}

{5 year-old Ben sees his sister Jackie fall and scrap her knee while playing baseball. Feeling how much Jackie must be hurting, Ben decides to give her a hug to help her feel better. Ben has just responded to Jackie’s emotional state with an appropriate response (See Figure 1). What kind of empathy is Ben displaying? -Cognitive empathy. +Affective empathy.
 * type=""}

 If you wish to test your own level of empathy, this quiz from the University of California combines measures from several valid tests of empathy (including the Interpersonal Reactivity Index).

Antecedents


Now that empathy has been defined, it is appropriate to examine how empathy arises. Blair (2005) describes "motor empathy", also called "mimicry", as a fourth aspect of empathy, although this is still debated among researchers. More commonly, mimicry is considered an antecedent that causes empathy. In fact, mimicry and being able to cognitively understand another frame of mind are the two main mechanisms through which people come to experience empathy for others.

Mimicry
Mimicry involves the viewing and replication by one person's facial expression, tone of voice and posture of another person. Mimicry allows one to recreate another's emotional state, thereby vicariously experiencing their emotions. Mirror neurons are activated when observing another's emotions, which causes the corresponding emotional networks to become excited and the same emotion to become present in viewer's emotional state (Blair, 2005; Iacoboni, 2009). The facial feedback hypothesis may also explain the presence of emotions when mimicking facial expression. Looking at facial expressions, such as in Figure 2, will provoke an empathetic when viewed.

Perspective taking
Perspective taking involves the ability to suspend ones own emotions and to image how another person may feel. Perspective taking does not involve feeling another's emotions, rather simply understanding how another person feels. Perspective taking is emotionally neutral.

What empathy is not
Empathy has suffered from a lack of an operational definition. Many researchers of empathy have defined empathy differently and thus, there can be a lot of confusion about what is and is not empathy. The most confusion comes from the similarities between empathy and compassion. Empathy and compassion are different constructs for several reasons. Psychologist Paul Bloom described empathy as a cold-blooded understanding of how another person feels (Harris, 2015). Empathy does not imply altruism or goodwill towards that person. It seems great empathy is possessed by the best people as well as the worst. For instance, con-men, bullies, shysters and manipulators all understand how their victims feel. Cognitive empathy allows these unscrupulous characters to carry out their actions. However in this case, cognitive empathy towards another is purely instrumental. Compassion, by comparison with empathy, contains altruistic motivation. In short, compassion causes someone to want to help another, empathy simply allows another to understand them.

 The TED talks below outline examples of cognitive empathy as well as empathy and compassion: An experiment in Cognitive Empathy ,Compassion and the true meaning of empathy

This podcast includes a conversation with author and cognitive psychologist Paul Bloom, discussing the dark side of empathy: The Virtues of Cold Blood

Empathy and emotional well-being
Empathy’s relationship with well-being is well recorded, and the majority of literature agrees in most cases that high empathy is associated with high subjective well-being (Wei, Liao, Ku & Shaffer, 2011; Bandura et al. 2003; Greason & Cashwell, 2009). More specifically, empathy is a general contributor to psychosocial functioning. Bandura et al. (2003) reported medium correlations between empathetic efficacy (or the ability to understand other people's emotion) and efficacy in academics, pro-social behaviour, and managing negative emotions. Within the same study, high correlations between empathetic efficacy and efficacy in regulating positive and negative emotions were found (Bandura et al, 2003). These relations are only correlated and not causal, therefore empathy as a source self-efficacy is not implied. Investigating causal relationships between empathy and various aspects of personality could be a possible research subject for future studies.



Empathy's effect on social needs and behaviour
Socialisation has long been considered a basic psychological need of human beings (Maslow, 1943). Humans naturally feel an innate desire to belong, socialise and experience caring, intimate relationships. Therefore, socialisation is a factor in maintaining one's well-being. Empathy is one of the primary skills needed in order to maintain long term commitment in personal relationships. Overall, empathy is predictive of a higher level of social functioning (Baron-Cohen & Wheelwright, 2004). Individuals who lack empathy, such as people with autism, often find socialisation particularly difficult (Blair, 2005; Baron-Cohen & Wheelwright, 2004). Therefore, the relationship between empathy and socialisation is a mediator of well-being. The continuing discussion will look at both positive social aspects of empathy as well as negative aspects of socialisation resulting from lack of empathy, particularly in children.

Empathy and pro-social behaviour
Pro-social behaviour is defined as any behaviour which is voluntary and intended to help another. In Figure 3 a women provides aid to a homeless man, is a good example of pro-social behaviour. The assumed relationship between empathy and pro-social behaviour follows the basic notion that more empathy produces more pro-social behaviour. Although, this may not always be true as evident in studies involving children and antisocial behaviour, as well as studies of borderline personality disorder (Blair, 2005; Dziobek et al., 2011).

Rieffe et al. (2010), in a study of empathy and children, recorded pro-social behaviour and attention to others feelings was positively correlated with age. As a child grew older and developed empathetic skills they were more likely to engage in behaviour to help others. Baron-Cohen and Wheelwright (2004) found that boys with higher empathy were more likely to defend bullying victims from those bullying them. Although not always, empathy is linked to such pro-social behaviour.

Empathy is a requirement for socialisation as well as a product of socialisation. Clay and de Waal (2013) found that within bonobo ape populations there is a strong correlated between empathy and the social environment as an infant. Bonobos reared by their mothers developed greater empathy than orphaned bonobos, which did not display as developed empathy. Bonobos with higher empathy displayed a higher level of effective emotional regulation and social competence. Clay and de Waal's (2013) findings highlight the connection between empathetic ability and socio-emotional competence as well as the need for socialisation at a young age.

Gano-Overway et al. (2009) examined a youth sport group and found that engaging in social activities lead to greater emotional regulation, pro-social values and empathy. A caring social climate is successful in fostering these skills. The use of reasoning by adults to encourage caring was particularly effective in increasing the likelihood of children engaging in pro-social behaviour. The likelihood of pro-social behaviour is related to the level of positivity and caring within the environment (Gano-Overway et al., 2009). If socialisation occurred in an environment that was inherently uncaring the chances that the children would feel the urge to contribute pro-social behaviours is unlikely (Gano-Overway et al., 2009).

Aggression and empathy
Research surrounding disruptive disorder among children and empathy have yielded mixed results. Some studies show a correlation between low empathy and aggression (Findlay, Girardi & Coplan, 2006) and others do not (Lovett & Sheffield, 2007). The variety of findings is attributed to poor operational definition of empathy (Lovett & Sheffield, 2007).

Children with Autism Spectrum Disorder often lack the cognitive empathy and cannot succinctly regulate their emotions. As a result they become distressed and even aggressive (Pouw, Rieffe, Oosterveld, Huskens & Stockmann, 2013). Typical children develop cognitive empathy and are able to regulate their emotions and suppress aggressive outbursts (Rieffe, Ketelaar & Wiefferink, 2010).

Lovett and Sheffield (2007) suggested aggressive children lack self-regulation skills, but not necessarily empathy. Although commonly empathy is considered as being a positive emotion, empathy can cause personal distress which an aversive feeling within the person to escape the situation. Someone with high empathy and low self-regulation may become aggressive when faced with personal distress (Lovett & Sheffield, 2007).

Mediator of stress
Empathy has been found to be a barrier against personal distress and a predictor of other forms of stress, such as secondary trauma stress. Birnie, Speca and Carlson (2009) used a mindfulness based stress reduction program in order to decrease stress. Within Birnie's et al. (2009) study, empathy was found to have a significant association with improving psychological functioning, specifically increasing perspective taking decreased personal distress. Empathy was also a predictor of self-compassion and altruistic motivations to help others, essentially suggesting that compassion and altruism were unlikely without empathy.

A study by Passalacqua and Segrin (2010) found that stress also acts on empathy. The study looked at medical students who were undertaking a long-call shift. Within the long-call shift, stress would build towards the end of the shift and empathy towards patients dropped. The findings suggest that stress affects empathy just as much as empathy may affect stress. It also suggests that increased personal distress lowers compassion and the ability to take another's perspective.

Marner, S. (2008) examined different empathy styles and the effect these had on witnessing aggression within workers at a psychiatric hospital. Empathy styles referred to an individuals preferred method of empathising with others, such as taking their perspective or emotionally resonating with them. It was found that cognitive empathy was more likely to result in depersonalisation. Affective empathy was likely to result in personal distress and secondary trauma i.e. trauma experienced by coming into second-hand contact with aggression. Surprisingly there is little research about correlations between post-traumatic stress disorder and empathy. This is a possible field of research that could improve our understanding of empathy.

Empathetic counselling
Empathy is viewed as a crucial part of success in social work, counselling and doctor-patient interaction (Grant, 2014; Greason & Cashwell, 2009; Rogers, 2007). Elliott, Bohart, Watson and Greenberg (2011) have found that empathy is a moderately strong predictor of therapy outcome. Therefore, empathy is a significant aspect of successful therapy and emotional well-being within the client. In particular, Carl Rogers proclaimed empathy as a central part of connecting with a client and achieving therapeutic success and change within the client (Clark, 2007). Rogers argued that when the practitioner resonated with the client's emotional experience they were able to form the client-counsellor bond that was necessary to communicate and provide effective therapy (Clark, 2007). In Rogers view, the sustained connection between the client and counsellor was central to the healing process; empathy was the prime tool for establishing this connection. Knowledge of this connection must be made visible for the client in order to be effective. In this way, trust is built by the client understanding the counsellors resonating emotional state.

During the 1960s and 1970s counselling shifted from an attitudinal view of the client’s perspective to an empathic non-judgemental view (Clark, 2007). The shift in the counselling paradigm allowed clients to better understand and reflect on their own emotions. The ability of the counsellor to reflect the clients emotions was directly related to the clients ability to objectively examine their own emotions from a more salient view. In addition, allowing the client to divulge their personal distress in a supporting and empathetic environment gave them the sense of being understood and helped develop their therapeutic change (Clark, 2007).

Despite the significant benefits of empathy in a therapeutic relationship, empathy can also be a detractor from the therapist’s mental health (Greason & Cashwell, 2009; Passalacqua & Segrin, 2010). Excessive affective empathy can result in burnout, personal distress and apathy towards the client. Rogers (2007) outlined a solution to this problem, which he termed “accurate empathy”. Accurate empathy differs from unrestrained empathetic emotion, which is natural when empathising. Accurate empathy promotes empathetic communication while not becoming entangled in the emotional experience. In short, accurate empathy requires addition emotional regulation and mindfulness.

Thomas and Otis (2010) reported that emotional burnout is not caused by witnessing personal distress but by a lack of emotional boundaries or unprocessed emotions caused by the experience. Grant (2014) suggests personal reflection is a possible factor in the ability of people to process emotions and maintain accurate empathy. While acknowledging the nature of empathy and possible detrimental effects, Grant (2014) found that social workers who were able to develop empathetic reflection, perspective taking and empathetic concern may actually be less likely to incur psychological distress in the long run, as well as be more effective at their job.

Dysfunctional empathy and psychological disorders
Empathy contributes to well-being through social interaction, emotional regulation and therapeutic bonds. However, a lack of empathy can impact a person’s well-being by excluding them from these benefits. A lack of empathy is evident in disorders such as anti-social personality disorder, borderline personality disorder and autism spectrum disorder.

Anti-social personality disorder and psychopathy
Psychopathy is a psychological function defined by dysfunctional empathic responses (Blair, 2005). Psychopaths show reduced autonomic arousal when viewing distressed or upset faces, showing lack of affective empathy. The reason may be an inability to recognise facial expressions. Children with psychopathic traits find it difficult to recognise sad facial expression and adults with psychopathy are unable to recognise fearful faces in others (Blair, 2005).

Dadds et al (2012) examined the theoretical relationship between eye contact at a young age and the development of empathy. It was found that children who rated high in callous-unemotional personality traits made less eye contact with their parents, particularly their mothers or attachment figures. The inability to make eye contact with an attachment figure may be one of the first causes inhibiting the development of empathy.

Borderline personality disorder
Borderline personality disorder (BPD) is characterised by instable moods, relationships, and behaviour. The pattern of behaviour often persists for years and is associated with unstable early socialisation (Dziobek et al., 2011). People with borderline personality disorder often rate highly in empathetic responses, such as personal distress and emotional contagion. However, these emotional responses are low order and immature emotional responses and are self-focused rather than outwardly focused (Dziobek et al., 2011).

Dziobek et al. (2011) examined BPD and empathy, specifically looking at neuronal structures activity. They found that the Superior Temporal Sulcus (STS) and Anterior Insular Cortex had significantly lower activity in individuals with Borderline Personality disorder. The STS relates to social cognition and the Insular Cortex is known for subjective emotional experience. They also found that subjects with BPD actually had an increase in affective empathy, however this increase actually results in personal distress for the person. Dziobek et al. (2011) noted that low personal distress was useful and required for more mature emotional empathy, but it was maladaptive in this context.

In summary, for those with BPD a mis-attribution of other emotions and high personal distress from overactive affective empathy cause dysfunctional emotional responses.

Autism spectrum disorder
Autism Spectrum Disorder is defined by impaired development in social functioning and communication. Impaired Theory of Mind has been demonstrated to exist within children with autism (Blair, 2005). In addition, there is evidence of motor empathy (mimicry) dysfunction due to superior temporal cortex debilitation (Blair, 2005). There are suggestions that the innate inability to recognise facial expression is a factor, however this theory needs more research before it can be confirmed (Blair, 2005).

Conclusion
Empathy is clearly a necessary psychological function for humans to successfully integrate together. Without empathy, relationships, cooperation and altruism would be difficult, if not impossible, and humans would be motivated purely by self-centred thoughts and goals. Although with empathy, many compassionate and generous actions and motivations become possible. However empathy also allows people to bully, intimidate, and con others for their own gain.

In addition to the positive aspects of empathy, individuals with too much affective empathy become burdened under the weight of others emotions and become distressed. Empathy, like justice, is blind, and allows great compassion as well as malevolence and destruction.

Without empathy, peoples social functioning breaks down, as seen in individuals with borderline personality disorder, anti-social personality disorder, and autism spectrum disorder. Thus empathy is ultimately crucial for human’s well-being and psychological functioning. Empathy reaches all aspects of the human condition and a person’s subjective well-being hinges on their ability to relate to others, manage their emotions, commit to altruistic actions and to understand themselves.

 Quick Summary:

Empathy is correlated with increased well-being.

Empathy is crucial for psycho-social functioning and the ability to relate to others is connected with our emotional well-being.

High empathy is correlated with emotional regulation, particularly negative and positive affect regulation.

Empathetic responses are a prerequisite for pro-social behaviour, although compassion is also important.

Empathy is developed through social exposure at a young age.

Dysfunctional empathy is an underlying factor in several personality disorders.

Take Home Message:

Developing great empathy is crucial to maintaining subjective well-being in life, those with great empathy integrate and socialise better with others.

To develop great empathy, caring and supportive environments where-in children socialise and co-operate with others are important.

Well developed empathy and a caring environment is important in increasing pro-social behaviour and compassion towards others.