Can Clinical Empathy Survive? Distress, Burnout, and Malignant Duty in the Age of Covid‐19

A. Anzaldua & J. Halpern

Hastings Report

Jan-Feb 2021 22-27.

Abstract

The Covid‐19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid‐19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid‐19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid‐19 intensification of burnout can serve as a wake‐up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.

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The Dynamics of Clinical Empathy

Clinical empathy, a specific form of empathy that has therapeutic impact in the medical setting and is professionally sustainable, was first conceptualized by one of us, Jodi Halpern, as emotionally engaged curiosity. Her work challenged the expectation that physicians should limit themselves to detached cognitive empathy, showing how affective resonance, when redirected into curiosity about the patient, is essential for therapeutic impact. Halpern's interactive model of affective and cognitive empathy has been supported by empirical research, including findings regarding improved diagnosis, treatment adherence, and coping as well as studies of specific diseases (for example, about improved diabetes outcomes), though more research is needed to precisely identify the specific ways that affective resonance and cognitive curiosity contribute to meeting specific clinical needs. This model is also supported by neuroscientific findings showing how affective attunement improves cognitive empathy.

Models of compassion in medical care add valuable practices of mindfulness but do not emphasize an individualized appreciation of each patient's predicament. We thus work with Halpern's model, which emphasizes using emotional resonance to inform imagining the world from each patient's perspective. Halpern defines the cognitive aim of imagining each patient's perspective as “curiosity” because the practice of clinical empathy as engaged curiosity is founded on the recognition that each patient brings their own distinct world, with a unique set of values and needs that the physician cannot presume to know. This is a subtle but vital point. 

The info is here.

Strategic Regulation of Empathy

Weisz, E., & Cikara, M. 

(2020, October 9).

https://doi.org/10.31234/osf.io/2kr46

Abstract

Empathy is an integral part of socio-emotional well-being, yet recent research has highlighted some of its downsides. Here we examine literature that establishes when, how much, and what aspects of empathy promote specific outcomes. After reviewing a theoretical framework which characterizes empathy as a suite of separable components, we examine evidence showing how dissociations of these components affect important socio-emotional outcomes and describe emerging evidence suggesting that these components can be independently and deliberately modulated. Finally, we advocate for a new approach to a multi-component view of empathy which accounts for the interrelations among components. This perspective advances scientific conceptualization of empathy and offers suggestions for tailoring empathy to help people realize their social, emotional, and occupational goals.

From Concluding Remarks

Early research on empathy regarded it as a monolithic construct. This characterization ultimately gave rise to a second wave of empathy-related research, which explicitly examined dissociations among empathy-related components.Subsequently, researchers noticed that individual components held different predictive power over key outcomes such as helping and occupational burnout. As described above, however, there are many instances in which these components track together in the real world, suggesting that although they can dissociate, they often operate in tandem.

Because empathy-related components rely on separable neural systems, the field of social neuroscience has already made significant progress toward the goal of characterizing instances when components do (or do not) track together.  For example, although affective and cognitive channels can independently contribute to judgments of others emotional states, they also operate in synchrony during more naturalistic socio-emotional tasks.  However, far more behavioral research is needed to characterize the co-occurrence of components in people’s everyday social interactions.  Because people differ in their tendencies to engage distinct components of empathy, a better understanding of the separability and interrelations of these components in real-world social scenarios can help tailor empathy-training programs to promote desirable outcomes.  Empathy-training efforts are on average effective (Hedges’ g = 0.51) but generally intervene on empathy as a whole (rather than specific components). 

Moral “foundations” as the product of motivated social cognition: Empathy and other psychological underpinnings of ideological divergence in “individualizing” and “binding” concerns

Strupp-Levitsky M, et al.

PLoS ONE 15(11): e0241144. 

https://doi.org/10.1371/journal.pone.0241144

Abstract

According to moral foundations theory, there are five distinct sources of moral intuition on which political liberals and conservatives differ. The present research program seeks to contextualize this taxonomy within the broader research literature on political ideology as motivated social cognition, including the observation that conservative judgments often serve system-justifying functions. In two studies, a combination of regression and path modeling techniques were used to explore the motivational underpinnings of ideological differences in moral intuitions. Consistent with our integrative model, the “binding” foundations (in-group loyalty, respect for authority, and purity) were associated with epistemic and existential needs to reduce uncertainty and threat and system justification tendencies, whereas the so-called “individualizing” foundations (fairness and avoidance of harm) were generally unrelated to epistemic and existential motives and were instead linked to empathic motivation. Taken as a whole, these results are consistent with the position taken by Hatemi, Crabtree, and Smith that moral “foundations” are themselves the product of motivated social cognition.

Concluding remarks

Taken in conjunction, the results presented here lead to several conclusions that should be of relevance to social scientists who study morality, social justice, and political ideology. First, we observe that so-called “binding” moral concerns pertaining to ingroup loyalty, authority, and purity are psychologically linked to epistemic and, to a lesser extent, existential motives to reduce uncertainty and threat. Second, so-called “individualizing” concerns for fairness and avoidance of harm are not linked to these same motives. Rather, they seem to be driven largely by empathic sensitivity. Third, it would appear that theories of moral foundations and motivated social cognition are in some sense compatible, as suggested by Van Leeuween and Park, rather than incompatible, as suggested by Haidt and Graham and Haidt. That is, the motivational basis of conservative preferences for “binding” intuitions seems to be no different than the motivational basis for many other conservative preferences, including system justification and the epistemic and existential motives that are presumed to underlie system justification.

The research is here.

Strategic Regulation of Empathy.

Weisz, E., & Cikara, M. (2020, October 9).

https://doi.org/10.31234/osf.io/2kr46

Abstract

Empathy is an integral part of socio-emotional well-being, yet recent research has highlighted some of its downsides. Here we examine literature that establishes when, how much, and what aspects of empathy promote specific outcomes. After reviewing a theoretical framework which characterizes empathy as a suite of separable components, we examine evidence showing how dissociations of these components affect important socio-emotional outcomes and describe emerging evidence suggesting that these components can be independently and deliberately modulated. Finally, we advocate for a new approach to a multi-component view of empathy which accounts for the interrelations among components. This perspective advances scientific conceptualization of empathy and offers suggestions for tailoring empathy to help people realize their social, emotional, and occupational goals.

From the Conclusion

The goal of this review has been to evaluate the burgeoning literature on how components of empathy—in isolation or in concert—differentially affect key outcomes including prosocial behavior, relationship quality, occupational burnout, and negotiation. As such, an important takeaway from this review is that components of empathy can be leveraged to facilitate attainment of important goals. A second takeaway is that in order to effectively intervene on empathy in service of promoting specific outcomes, it is important to understand how these components track together (or not) in people’s everyday experiences. Relatedly, the field of empathy would benefit from thoroughly characterizing the structural and temporal relationships among these components to better understand how they work together (or in isolation) to drive key outcomes. 

Thus it seems that the time is right for the field of empathy research to enter anew wave, which explicitly examines the spontaneous separation or co-occurrence of dissociable empathy-related components, especially in behavioral—both laboratory and field—experiments. Several social neuroscience studies have indicated that this is an important aspect of empathy-related inquiry; as such, it is a promising next step for empathy-related research in more naturalistic contexts. The next wave of empathy research is in position to make incredibly important discoveries about when and for whom specific empathic components reliably predict behavioral outcomes, and to understand how empathy can be regulated to help people realize critical social, emotional and occupational goals.

Oncologist Pays for Patient's Meds: A 'Boundary' Crossed?

Nic Mulcahy

medscape.com

Originally posted 4 Nov 20

It was an act of kindness: while overseeing a patient through a round of chemotherapy, an oncology fellow at Johns Hopkins University's Kimmel Comprehensive Cancer Center in Baltimore, Maryland, paid a modest amount of money (about $10) for that patient's antiemetic medication and retrieved it from the center's pharmacy.

Co-fellow Arjun Gupta, MD, witnessed the act and shared it with the world September 23 on Twitter.

"Just observed a co-fellow pay the co-pay for a patient's post-chemo nausea meds at the pharmacy, arrange them in a pill box, and deliver them to the patient in the infusion center. So that the patient could just leave after chemo."

Healthcare professionals applauded the generosity. "Phenomenal care," tweeted Carolyn Alexander, MD, a fertility physician in Los Angeles.

It's a common occurrence, said others. "Go ask a nurse how many times they've done it. I see it happen weekly," tweeted Chelsea Mitchell, PharmD, an intensive care unit pharmacist in Memphis, Tennessee.

Lack of universal healthcare brings about these moments, claimed multiple professionals who read Gupta's anecdote. "#ThisIsDoctoring. This is also a shameful indictment of our medical system," said Mary Landrigan-Ossar, MD, an anesthesiologist at Children's Hospital, Boston, Massachusetts.

However, one observer called out something no one else had ― that paying for a patient's medication is not allowed in some facilities.

The info is here.

Cracking the Code of Sustained Collaboration

Francesca Gino

Harvard Business Review

Originally published Nov 2019

Ask any leader whether his or her organization values collaboration, and you’ll get a resounding yes. Ask whether the firm’s strategies to increase collaboration have been successful, and you’ll probably receive a different answer.

“No change seems to stick or to produce what we expected,” an executive at a large pharmaceutical company recently told me. Most of the dozens of leaders I’ve interviewed on the subject report similar feelings of frustration: So much hope and effort, so little to show for it.

One problem is that leaders think about collaboration too narrowly: as a value to cultivate but not a skill to teach. Businesses have tried increasing it through various methods, from open offices to naming it an official corporate goal. While many of these approaches yield progress—mainly by creating opportunities for collaboration or demonstrating institutional support for it—they all try to influence employees through superficial or heavy-handed means, and research has shown that none of them reliably delivers truly robust collaboration.

What’s needed is a psychological approach. When I analyzed sustained collaborations in a wide range of industries, I found that they were marked by common mental attitudes: widespread respect for colleagues’ contributions, openness to experimenting with others’ ideas, and sensitivity to how one’s actions may affect both colleagues’ work and the mission’s outcome. Yet these attitudes are rare. Instead, most people display the opposite mentality, distrusting others and obsessing about their own status. The task for leaders is to encourage an outward focus in everyone, challenging the tendency we all have to fixate on ourselves—what we’d like to say and achieve—instead of what we can learn from others.

The info is here.

The U.S. Has an Empathy Deficit—Here’s what we can do about it.

Judith Hall and Mark Leary

Scientific American

Originally poste 17 Sept 20

Here are two excerpts:

Fixing this empathy deficit is a challenge because it is not just a matter of having good political or corporate leaders or people treating each other with good will and respect. It is, rather, because empathy is a fundamentally squishy term. Like many broad and complicated concepts, empathy can mean many things. Even the researchers who study it do not always say what they mean, or measure empathy in the same way in their studies—and they definitely do not agree on a definition. In fact, there are stark contradictions: what one researcher calls empathy is not empathy to another.

When laypeople are surveyed on how they define empathy, the range of answers is wide as well. Some people think empathy is a feeling; others focus on what a person does or says. Some think it is being good at reading someone’s nonverbal cues, while others include the mental orientation of putting oneself in someone else’s shoes. Still others see empathy as the ability or effort to imagine others’ feelings, or as just feeling “connected” or “relating” to someone. Some think it is a moral stance to be concerned about other people’s welfare and a desire to help them out. Sometimes it seems like “empathy” is just another way of saying “being a nice and decent person.” Actions, feelings, perspectives, motives, values—all of these are “empathy” according to someone.

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Whatever people think empathy is, it’s a powerful force and human beings need it. These three things might help to remedy our collective empathy deficit:

Take the time to ask those you encounter how they are feeling, and really listen. Try to put yourself in their shoes. Remember that we all tend to underestimate other people’s emotional distress, and we’re most likely to do so when those people are different from us.

Remind yourself that almost everyone is at the end of their rope these days. Many people barely have enough energy to handle their own problems, so they don’t have their normal ability to think about yours.

The info is here.

A Failure of Empathy Led to 200,000 Deaths. It Has Deep Roots.

Olga Khazan

The Atlantic

Originally published 22 September 20

Here is an excerpt:

Indeed, doctors follow a similar logic. In a May paper in the New England Journal of Medicine, a group of doctors from different countries suggested that hospitals consider prioritizing younger patients if they are forced to ration ventilators. “Maximizing benefits requires consideration of prognosis—how long the patient is likely to live if treated—which may mean giving priority to younger patients and those with fewer coexisting conditions,” they wrote. Perhaps, on a global scale, we’ve internalized the idea that the young matter more than the old.

The Moral Machine is not without its criticisms. Some psychologists say that the trolley problem, a similar and more widely known moral dilemma, is too silly and unrealistic to say anything about our true ethics. In a response to the Moral Machine experiment, another group of researchers conducted a comparable study and found that people actually prefer to treat everyone equally, if given the option to do so. In other words, people didn’t want to kill the elderly; they just opted to do so over killing young people, when pressed. (In that experiment, though, people still would kill the criminals.) Shariff says these findings simply show that people don’t like dilemmas. Given the option, anyone would rather say “treat everybody equally,” just so they don’t have to decide.

Bolstering that view, in another recent paper, which has not yet been peer-reviewed, people preferred giving a younger hypothetical COVID-19 patient an in-demand ventilator rather than an older one. They did this even when they were told to imagine themselves as potentially being the older patient who would therefore be sacrificed. The participants were hidden behind a so-called veil of ignorance—told they had a “50 percent chance of being a 65-year-old who gets to live another 15 years, and a 50 percent chance of dying at age 25.” That prompt made the participants favor the young patient even more. When told to look at the situation objectively, saving young lives seemed even better.

The article is here.

Neural signatures of prosocial behaviors

Bellucci, G., Camilleri, J., and others
Neuroscience & Biobehavioral Reviews
Volume 118, November 2020, Pages 186-195

Abstract

Prosocial behaviors are hypothesized to require socio-cognitive and empathic abilities—engaging brain regions attributed to the mentalizing and empathy brain networks. Here, we tested this hypothesis with a coordinate-based meta-analysis of 600 neuroimaging studies on prosociality, mentalizing and empathy (∼12,000 individuals). We showed that brain areas recruited by prosocial behaviors only partially overlap with the mentalizing (dorsal posterior cingulate cortex) and empathy networks (middle cingulate cortex). Additionally, the dorsolateral and ventromedial prefrontal cortices were preferentially activated by prosocial behaviors. Analyses on the functional connectivity profile and functional roles of the neural patterns underlying prosociality revealed that in addition to socio-cognitive and empathic processes, prosocial behaviors further involve evaluation processes and action planning, likely to select the action sequence that best satisfies another person’s needs. By characterizing the multidimensional construct of prosociality at the neural level, we provide insights that may support a better understanding of normal and abnormal social cognition (e.g., psychopathy).

Highlights

• A psychological proposal posits prosociality engages brain regions of the mentalizing and empathy networks.

• Our meta-analysis provides only partial support to this proposal.

• Prosocial behaviors engage brain regions associated with socio-cognitive and empathic abilities.

• However, they also engage brain regions associated with evaluation and planning.

Conclusions

Taken together, we found a set of brain regions that were consistently activated by prosocial behaviors. These activation patterns partially overlapped with mentalizing and empathy brain regions, lending support to the hypothesis based on psychological research that socio-cognitive and empathic abilities are central to prosociality. However, we also found that the vmPFC and, in particular, the dlPFC were preferentially recruited by prosocial acts, suggesting that prosocial behaviors require the involvement of other important processes. Analyses on their functional connectivity profile and functional roles suggest that the vmPFC and dlPFC might be involved in valuation and planning of prosocial actions, respectively. These results clarify the role of mentalizing and empathic abilities in prosociality and provides useful insights into the neuropsychological processes underlying human social behaviors. For instance, they might help understand where and how things go awry in different neural and behavioral disorders such as psychopathy and antisocial behavior (Blair, 2007).

The research is here.

Our morally unserious president on display in Kenosha

Michael Sean Winters
National Catholic Reporter
Originally posted 4 September 20

President Donald Trump went to Kenosha, Wisconsin, this week to "survey the property damage" according to a White House transcript. He spoke a lot about law and order and very little about justice, as if the concepts are not necessarily related. To him, they probably are not.

A morally serious person would begin any examination of the damage in Kenosha with a look at an MRI of Jacob Blake's shattered torso. Blake was shot seven times in the back — reports said he was shot at "point blank range," but that phrase covers a range of distances — the gun only a few feet from his body. The video made the shooting look like a public execution.

Donald Trump is not a morally serious person.

A morally serious person would continue his survey of the damage in Kenosha by visiting with the family of Jacob Blake, especially his three young sons who witnessed the shooting. They are ages 3, 5 and 8, and the trauma to which they were exposed is horrific to contemplate. A morally serious person would express sympathy with the family and the community, mindful of how much more shocking the shocking video of Blake's shooting was if you knew the victim.

Donald Trump is not a morally serious person.

A morally serious person would understand that, while it is entirely fitting for the nation's chief magistrate to mourn the death of Aaron "Jay" Danielson, the 39-year old Trump supporter gunned down on the streets of Portland, Oregon, it is wrong to mourn his death publicly without mentioning the shooting of Blake, on the very day you are going to Kenosha. Such uneven treatment epitomizes the very reason it is still necessary to remind the nation that Black lives matter.

Donald Trump is not a morally serious person.

A morally serious person would inquire into the legacy of racism, structural racism, in Kenosha and elsewhere, the racism that made the shooting of Blake horrifying but not surprising. A morally serious person would not take refuge in chatter about "a few bad apples" but confront the police culture that permits such bad apples to poison the bushel. A morally serious person would work, and work hard, at finding ways to ameliorate the effects of racism and call fellow citizens to that deep examination of conscience every episode of police brutality against Black men demands.

Donald Trump is not a morally serious person.

The info is here.

Personality and prosocial behavior: A theoretical framework and meta-analysis

Thielmann, I., Spadaro, G., & Balliet, D. (2020).
Psychological Bulletin, 146(1), 30–90.
https://doi.org/10.1037/bul0000217

Abstract

Decades of research document individual differences in prosocial behavior using controlled experiments that model social interactions in situations of interdependence. However, theoretical and empirical integration of the vast literature on the predictive validity of personality traits to account for these individual differences is missing. Here, we present a theoretical framework that identifies 4 broad situational affordances across interdependent situations (i.e., exploitation, reciprocity, temporal conflict, and dependence under uncertainty) and more specific subaffordances within certain types of interdependent situations (e.g., possibility to increase equality in outcomes) that can determine when, which, and how personality traits should be expressed in prosocial behavior. To test this framework, we meta-analyzed 770 studies reporting on 3,523 effects of 8 broad and 43 narrow personality traits on prosocial behavior in interdependent situations modeled in 6 commonly studied economic games (Dictator Game, Ultimatum Game, Trust Game, Prisoner’s Dilemma, Public Goods Game, and Commons Dilemma). Overall, meta-analytic correlations ranged between −.18 ≤ ρ̂ ≤ .26, and most traits yielding a significant relation to prosocial behavior had conceptual links to the affordances provided in interdependent situations, most prominently the possibility for exploitation. Moreover, for several traits, correlations within games followed the predicted pattern derived from a theoretical analysis of affordances. On the level of traits, we found that narrow and broad traits alike can account for prosocial behavior, informing the bandwidth-fidelity problem. In sum, the meta-analysis provides a theoretical foundation that can guide future research on prosocial behavior and advance our understanding of individual differences in human prosociality.

Conclusion

Individual differences in prosocial behavior have consistently been documented over decades of research using economic games – and personality traits have been shown to account for such individual variation. The present meta-analysis offers an affordance-based theoretical framework that can illuminate which, when, and how personality traits relate to prosocial behavior across various interdependent situations. Specifically, the framework and meta-analysis identify a few situational affordances that form the basis for the expression of certain traits in prosocial behavior. In this regard, the meta-analysis also shows that no single trait is capable to account for individual variation in prosocial behavior across the variety of interdependent situations that individuals may encounter in everyday social interactions.  Rather, individual differences in prosocial behavior are best viewed as a result of traits being expressed in response to certain situational features that influence the affordances involved in interdependent situations. In conclusion, research on individual differences in prosocial behavior – and corresponding trait conceptualizations – should consider the affordances
provided in interdependent situations to allow for a complete understanding of how personality can shape the many aspects of human prosociality.

Empathy is both a trait and a skill. Here's how to strengthen it.

Kristen Rogers
CNN.com
Originally posted 24 June 20

Here is an excerpt:

Types of empathy

Empathy is more about looking for a common humanity, while sympathy entails feeling pity for someone's pain or suffering, Konrath said.

"Whereas empathy is the ability to perceive accurately what another person is feeling, sympathy is compassion or concern stimulated by the distress of another," Lerner said. "A common example of empathy is accurately detecting when your child is afraid and needs encouragement. A common example of sympathy is feeling sorry for someone who has lost a loved one."

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A "common mistake is to leap into sympathy before empathically understanding what another person is feeling," Lerner said. Two types of empathy can prevent that relationship blunder.

Emotional empathy, sometimes called compassion, is more intuitive and involves care and concern for others.

Cognitive empathy requires effort and more systematic thinking, so it may lead to more empathic accuracy, Lerner said.  It entails considering others' and their perspectives and imagining what it's like to be them, Konrath added.

Some work managers and colleagues, for example, have had to practice empathy for parents juggling remote work with child care and virtual learning duties, said David Anderson, senior director of national programs and outreach at the Child Mind Institute….   But since the outset of the pandemic in March, that empathy has faded — reflecting the notion that cognitive empathy does take effort.

It takes work to interpret what someone is feeling by all of his cues: facial expressions, tones of voice, posture, words and more. Then you have to connect those cues with what you know about him and the situation in order to accurately infer his feelings.

"This kind of inference is a highly complex social-cognitive task" that might involve a variation of mental processes, Lerner said.

The info is here.

Our Minds Aren’t Equipped for This Kind of Reopening

TessWilkinson-Ryan
The Atlantic
Originally published 6 July 20

Here is the conclusion:

At the least, government agencies must promulgate clear, explicit norms and rules to facilitate cooperative choices. Most people congregating in tight spaces are telling themselves a story about why what they are doing is okay. Such stories flourish under confusing or ambivalent norms. People are not irrevocably chaotic decision makers; the level of clarity in human thinking depends on how hard a problem is. I know with certainty whether I’m staying home, but the confidence interval around “I am being careful” is really wide. Concrete guidance makes challenges easier to resolve. If masks work, states and communities should require them unequivocally. Cognitive biases are the reason to mark off six-foot spaces on the supermarket floor or circles in the grass at a park.

For social-distancing shaming to be a valuable public-health tool, average citizens should reserve it for overt defiance of clear official directives—failure to wear a mask when one is required—rather than mere cases of flawed judgment. In the meantime, money and power are located in public and private institutions that have access to public-health experts and the ability to propose specific behavioral norms. The bad judgments that really deserve shaming include the failure to facilitate testing, failure to protect essential workers, failure to release larger numbers of prisoners from facilities that have become COVID-19 hot spots, and failure to create the material conditions that permit strict isolation. America’s half-hearted reopening is a psychological morass, a setup for defeat that will be easy to blame on irresponsible individuals while culpable institutions evade scrutiny.

The info is here.

Superethics Instead of Superintelligence: Know Thyself, and Apply Science Accordingly

Pim Haselager & Giulio Mecacci (2020)
AJOB Neuroscience, 11:2, 113-119
DOI: 10.1080/21507740.2020.1740353

Abstract

The human species is combining an increased understanding of our cognitive machinery with the development of a technology that can profoundly influence our lives and our ways of living together. Our sciences enable us to see our strengths and weaknesses, and build technology accordingly. What would future historians think of our current attempts to build increasingly smart systems, the purposes for which we employ them, the almost unstoppable goldrush toward ever more commercially relevant implementations, and the risk of superintelligence? We need a more profound reflection on what our science shows us about ourselves, what our technology allows us to do with that, and what, apparently, we aim to do with those insights and applications. As the smartest species on the planet, we don’t need more intelligence. Since we appear to possess an underdeveloped capacity to act ethically and empathically, we rather require the kind of technology that enables us to act more consistently upon ethical principles. The problem is not to formulate ethical rules, it’s to put them into practice. Cognitive neuroscience and AI provide the knowledge and the tools to develop the moral crutches we so clearly require. Why aren’t we building them? We don’t need superintelligence, we need superethics.

The article is here.

Suicide attempt survivors’ recommendations for improving mental health treatment for attempt survivors.

Melanie A. Hom and others
Psychological Services. 
Advance online publication.
https://doi.org/10.1037/ser0000415

Abstract

Research indicates that connection to mental health care services and treatment engagement remain challenges among suicide attempt survivors. One way to improve suicide attempt survivors’ experiences with mental health care services is to elicit suggestions directly from attempt survivors regarding how to do so. This study aimed to identify and synthesize suicide attempt survivors’ recommendations for how to enhance mental health treatment experiences for attempt survivors. A sample of 329 suicide attempt survivors (81.5% female, 86.0% White/Caucasian, mean age = 35.07 ± 12.18 years) provided responses to an open-ended self-report survey question probing how treatment might be improved for suicide attempt survivors. Responses were analyzed utilizing both qualitative and quantitative techniques. Analyses identified four broad areas in which mental health treatment experiences might be improved for attempt survivors: (a) provider interactions (e.g., by reducing stigma of suicidality, expressing empathy, and using active listening), (b) intake and treatment planning (e.g., by providing a range of treatment options, including nonmedication treatments, and conducting a thorough assessment), (c) treatment delivery (e.g., by addressing root problems, bolstering coping skills, and using trauma-informed care), and (d) structural issues (e.g., by improving access to care and continuity of care). Findings highlight numerous avenues by which health providers might be able to facilitate more positive mental health treatment experiences for suicide attempt survivors. Research is needed to test whether implementing the recommendations offered by attempt survivors in this study might lead to enhanced treatment engagement, retention, and outcomes among suicide attempt survivors at large.

Here is an excerpt from the Discussion:

On this point, this study revealed numerous recommendations for how providers might be able to improve their interactions with attempt survivors. Suggestions in this domain aligned with prior studies on treatment experiences among suicide attempt survivors. For instance, recommendations that providers not stigmatize attempt survivors and, instead, empathize with them, actively listen to them, and humanize them, are consistent with aforementioned studies (Berglund et al., 2016; Frey et al., 2016; Shand et al., 2018; Sheehan et al., 2017; Taylor et al., 2009). This study’s findings regarding the importance of a collaborative therapeutic relationship are also consistent with previous work (Shand et al., 2018). Though each of these factors has been identified as salient to treatment engagement efforts broadly (see Barrett et al., 2008, for review), several suggestions that emerged in this study were more specific to attempt survivors. For example, ensuring that patients feel comfortable openly discussing suicidal thoughts and behaviors and taking disclosures of suicidality seriously are suggestions specifically applicable to the care of at-risk individuals. These recommendations not only support research indicating that asking about suicidality is not iatrogenic (see DeCou & Schumann, 2018, for review), but they also underscore the importance of considering the unique needs of attempt survivors. Indeed, given that most participants provided a recommendation in this area, the impact of provider-related factors should not be overlooked in the provision of care to this group.

Friends or foes: Is empathy necessary for moral behavior?

Jean Decety and Jason M. Cowell
Perspect Psychol Sci. 2014 Sep; 9(4): 525–537.
doi: 10.1177/1745691614545130

Abstract

The past decade has witnessed a flurry of empirical and theoretical research on morality and empathy, as well as increased interest and usage in the media and the public arena. At times, in both popular and academia, morality and empathy are used interchangeably, and quite often the latter is considered to play a foundational role for the former. In this article, we argue that, while there is a relationship between morality and empathy, it is not as straightforward as apparent at first glance. Moreover, it is critical to distinguish between the different facets of empathy (emotional sharing, empathic concern, and perspective taking), as each uniquely influences moral cognition and predicts differential outcomes in moral behavior. Empirical evidence and theories from evolutionary biology, developmental, behavioral, and affective and social neuroscience are comprehensively integrated in support of this argument. The wealth of findings illustrates a complex and equivocal relationship between morality and empathy. The key to understanding such relations is to be more precise on the concepts being used, and perhaps abandoning the muddy concept of empathy.

From the Conclusion:

To wrap up on a provocative note, it may be advantageous for the science of morality, in the future, to refrain from using the catch-all term of empathy, which applies to a myriad of processes and phenomena, and as a result yields confusion in both understanding and predictive ability. In both academic and applied domains such medicine, ethics, law and policy, empathy has become an enticing, but muddy notion, potentially leading to misinterpretation. If ancient Greek philosophy has taught us anything, it is that when a concept is attributed with so many meanings, it is at risk for losing function.

The article is here.

How to talk someone out of bigotry

Brian Resnick
vox.com
Originally published 29 Jan 20

Here is an excerpt:

Topping and dozens of other canvassers were a part of that 2016 effort. It was an important study: Not only has social science found very few strategies that work, in experiments, to change minds on issues of prejudice, but even fewer tests of those strategies have occurred in the real world.

Typically, the conversations begin with the canvasser asking the voter for their opinion on a topic, like abortion access, immigration, or LGBTQ rights. Canvassers (who may or may not be members of the impacted community) listen nonjudgmentally. They don’t say if they are pleased or hurt by the response. They are supposed “to appear genuinely interested in hearing the subject ruminate on the question,” as Broockman and Kalla’s latest study instructions read.

The canvassers then ask if the voters know anyone in the affected community, and ask if they relate to the person’s story. If they don’t, and even if they do, they’re asked a question like, “When was a time someone showed you compassion when you really needed it?” to get them to reflect on their experience when they might have felt something similar to the people in the marginalized community.

The canvassers also share their own stories: about being an immigrant, about being a member of the LGBTQ community, or about just knowing people who are.

It’s a type of conversation that’s closer to what a psychotherapist might have with a patient than a typical political argument. (One clinical therapist I showed it to said it sounded a bit like “motivational interviewing,” a technique used to help clients work through ambivalent feelings.) It’s not about listing facts or calling people out on their prejudicial views. It’s about sharing and listening, all the while nudging people to be analytical and think about their shared humanity with marginalized groups.

The info is here.

Effect of Psilocybin on Empathy and Moral Decision-Making

Thomas Pokorny, Katrin H Preller, & others
International Journal of Neuropsychopharmacology, 
Volume 20, Issue 9, September 2017, Pages 747–757
https://doi.org/10.1093/ijnp/pyx047

Abstract

Background
Impaired empathic abilities lead to severe negative social consequences and influence the development and treatment of several psychiatric disorders. Furthermore, empathy has been shown to play a crucial role in moral and prosocial behavior. Although the serotonin system has been implicated in modulating empathy and moral behavior, the relative contribution of the various serotonin receptor subtypes is still unknown.

Methods
We investigated the acute effect of psilocybin (0.215 mg/kg p.o.) in healthy human subjects on different facets of empathy and hypothetical moral decision-making using the multifaceted empathy test (n=32) and the moral dilemma task (n=24).

Results
Psilocybin significantly increased emotional, but not cognitive empathy compared with placebo, and the increase in implicit emotional empathy was significantly associated with psilocybin-induced changed meaning of percepts. In contrast, moral decision-making remained unaffected by psilocybin.

Conclusions
These findings provide first evidence that psilocybin has distinct effects on social cognition by enhancing emotional empathy but not moral behavior. Furthermore, together with previous findings, psilocybin appears to promote emotional empathy presumably via activation of serotonin 2A/1A receptors, suggesting that targeting serotonin 2A/1A receptors has implications for potential treatment of dysfunctional social cognition.

Empathy in the Age of the EMR

Danielle Ofri
The Lancet

Here is an excerpt:

Keeping the doctor-patient connection from eroding in the age of the EMR is an uphill battle. We all know that the eye contact that Fildes depicts is a critical ingredient for communication and connection, but when the computer screen is so demanding of focus that the patient becomes a distraction, even an impediment—this is hopelessly elusive.

Recently, I was battling the EMR during a visit with a patient who had particularly complicated medical conditions. We hadn’t seen each other in more than a year, so there was much to catch up on. Each time she raised an issue, I turned to the computer to complete the requisite documentation for that concern. In that pause, however, my patient intuited a natural turn of conversation. Thinking that it was now her turn to talk, she would bring up the next thing on her mind. But of course I wasn’t finished with the last thing, so I would say, “Would you mind holding that thought for a second? I just need to finish this one thing…”

I’d turn back to the computer and fall silent to finish documenting. After a polite minute, she would apparently sense that it was again her turn in the conversation and thus begin her next thought. I was torn because I didn’t want to stop her in her tracks, but we’ve been so admonished about the risks inherent in distracted multitasking that I wanted to focus fully on the thought I was entering into the computer. I know it’s rude to cut someone off, but preserving a clinical train of thought is crucial for avoiding medical error.

The info is here.

Empathy choice in physicians and non-physicians

Daryl Cameron and Michael Inzlicht
PsyArXiv
Originally created on September 11, 2019

Abstract

Empathy in medical care has been one of the focal points in the debate over the bright and dark sides of empathy. Whereas physician empathy is sometimes considered necessary for better physician-patient interactions, and is often desired by patients, it also has been described as a potential risk for exhaustion among physicians who must cope with their professional demands of confronting acute and chronic suffering. The present study compared physicians against demographically matched non-physicians on a novel behavioral assessment of empathy, in which they choose between empathizing or remaining detached from suffering targets over a series of trials. Results revealed no statistical differences between physicians and non-physicians in their empathy avoidance, though physicians were descriptively more likely to choose empathy. Additionally, both groups were likely to perceive empathy as cognitively challenging, and perceived cognitive costs of empathy associated with empathy avoidance. Across groups, there were also no statistically significant differences in self-reported trait empathy measures and empathy-related motivations and beliefs. Overall, these results suggest that physicians and non-physicians were more similar than different in terms of their empathic choices and in their assessments of the costs and benefits of empathy for others.

Conclusion:

In summary, do physicians choose empathy, and should they do so?  We find that physicians do not how a clear preference to approach or avoid empathy.  Nevertheless, they do perceive empathy to be cognitively taxing, entailing effort, aversiveness, and feelings of inefficacy, and these perceptions associated with reduced empathy choice.  Physicians who derived more satisfaction and less burnout from helping were more likely to choose empathy, and so too if they believed that empathy is good, and useful, for medical practice.  More generally, in the current work, physicians did not show statistically meaningful differences from demographically matched controls in trait empathy, empathy regulation behavior, motivations to approach or avoid empathy, or beliefs about empathy’s use for medicine.  Although it has often been suggested that physicians exhibit different levels of empathy due to the demands of medical care, the current results suggest that physicians are much like everyone else, sensitive to the relevant costs and benefits of empathizing.

The research is here.