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.

Impairment of affective and cognitive empathy in high functioning autism is mediated by alterations in emotional reactivity.

Empathy impairments are considered a key aspect of autism-spectrum disorders (ASD). Previous research consistently shows reduced cognitive empathy, but findings on affective empathy vary, possibly due to experimental design variations (e.g., stimulus modality, social distance) and individual psychological factors (e.g., perceptual abilities, emotional reactivity). This study aims to clarify deficits in affective and cognitive empathy in ASD by addressing these contributing factors. Empathy was examined in 34 autistic individuals and 33 typically developed controls (TDCs) through the Textual Empathy Test (TET). The TET was developed to assess emotional responses when imagining oneself (emotional reactivity) as compared to a target person (friend, stranger) in emotional situations presented via short verbal descriptions. Participants rated emotional states of the target person (cognitive empathy) as well as their own emotional responses when imagining the target person in that situation (affective empathy). Ratings were interpreted relative to normative mean values through standardized regression coefficients. Results showed that high-functioning autism was associated with lower cognitive and affective empathy irrespective of social distance as well as with decreased emotional reactivity compared to controls. Moreover, emotional reactivity mediated the impact of ASD on both empathic components. In summary, altered emotional reactivity may underlie impaired empathy in autistic individuals.

Cognitive control: exploring the causal role of the rTPJ in empathy for pain mediated by contextual information.

Empathy determines our emotional and social lives. Research has recognized the role of the right temporoparietal junction (rTPJ) in social cognition; however, there is less direct causal evidence for its involvement in empathic responses to pain, which is typically attributed to simulation mechanisms. Given the rTPJ's role in processing false beliefs and contextual information during social scenarios, we hypothesized that empathic responses to another person's pain depend on the rTPJ if participants are given information about people's intentions, engaging mentalizing mechanisms alongside simulative ones. Participants viewed videos of an actress freely showing or suppressing pain caused by an electric shock while receiving 6 Hz repetitive transcranial magnetic stimulation (rTMS) over the rTPJ or sham vertex stimulation. Active rTMS had no significant effect on participants' ratings depending on the pain expression, although participants rated the actress's pain as lower during rTPJ perturbation. In contrast, rTMS accelerated response times for providing ratings during pain suppression. We also found that participants perceived the actress's pain as more intense when they knew she would suppress it rather than show it. These results suggest an involvement of the rTPJ in attributing pain to others and provide new insights into people's behavior in judging others' pain when it is concealed.

The oxytocinergic system and racial ingroup bias in empathic neural activity.

Studies have indicated that the human brain exhibits a more robust neural empathic response towards individuals of the same racial ingroup than those of the outgroup. However, the impact of the oxytocinergic system on the dynamic connectivity between brain regions involved in racial ingroup bias in empathy (RIBE) and its implications for real-life social interaction intention remains unclear. To address this gap, we employed functional magnetic resonance imaging (fMRI) to investigate RIBE-modulated neural activities and the influence of the oxytocinergic system at both neural and behavioral levels. Participants homozygous for the A/A and G/G genotypes of the oxytocin receptor gene (OXTR) rs53576 polymorphism underwent scanning while making judgments about painful versus non-painful stimuli in same-race versus other-race scenarios following either oxytocin (OT) or placebo treatment. The results revealed greater activity in the anterior cingulate cortex (ACC) and anterior insula (AI) in response to same-race compared to other-race models in the G/G group but not in the A/A group. RIBE also modulated the connections between bilateral AI and the ACC, and the effect of OT on this modulatory effect was moderated by genotype rs53576 and interpersonal trust. Moreover, more extensive changes in AI-ACC connections were associated with higher levels of revenge intention in the low interpersonal trust group. Overall, our findings suggest a pivotal role of the oxytocinergic system in the RIBE-modulated neural activities and revenge intention in human interactions with the modulatory effect of interpersonal trust.

Synchrony within, synchrony without: establishing the link between interpersonal behavioural and brain-to-brain synchrony during role-play.

Interpersonal synchrony is a crucial construct in understanding social interactions, which has been used in clinical studies to measure the quality of the therapeutic alliance. However, there is a lack of studies investigating the correlation between synchrony expressed on different levels: behavioural and neurophysiological. Furthermore, there are no studies that examine how the implementation of psychodramatic role-playing techniques, when individuals adopt the persona of a different character, may influence intrinsic biobehavioural synchrony between two parties. The present study, therefore, aims to uncover the relationship between behavioural and brain-to-brain synchrony across different role-playing techniques and elucidate the impact of these synchronies on participants' levels of anxiety and empathy. By using functional near-infrared imaging and behavioural coding in a dyadic role-playing paradigm (n = 41 dyads), the study found correlations between behavioural and brain-to-brain synchrony during naturalistic conversations, but not during role-play, implying a qualitative change in interpersonal synchrony when implementing role-playing techniques. Additionally, the study noted significant contributions of both behavioural and brain-to-brain synchrony as well as peripheral factors such as dyadic sex make-up and role immersion in predicting dyadic anxiety and empathy changes. Findings call for future studies to consider role-playing scenarios as a qualitatively different form of social interaction.

Emotional engagement with close friends in adolescence predicts neural correlates of empathy in adulthood.

Empathy requires the ability to understand another's point of view and is critical for motivating a person to help others. However, little is known about the link between experiences of empathic emotional engagement in close friendships during adolescence and neural correlates of empathy in adulthood. Beginning in 1998, N = 88 participants drawn from a demographically diverse community sample were observed annually from ages 13 to 21 and rated on the amount of emotional engagement displayed toward a close friend during a support task. At approximately age 24, participants underwent functional brain imaging while a partner or stranger was under distress. Contrary to predictions, greater emotional engagement with close friends during adolescence corresponded prospectively with reduced temporal pole activity (a region associated with cognitive empathy and perspective taking) while observing threats directed at others. Results have implications for understanding the neurodevelopmental roots of empathy.

The Moderating Effect of Sex on Autistic Trait Emotional Intelligence, Alexithymia, and Empathy.

Autism spectrum disorder (ASD) is associated with differences in social communication, and these differences are related to trait emotional intelligence (TEI), alexithymia, and empathy. Autism is known to present differently in males and females, but research on sex differences in TEI, alexithymia, and empathy is largely relegated to non-autistic people. Therefore, the current research sought to explore individual relationships between autistic characteristics and TEI, alexithymia, and empathy, as well as the possible influence of sex in these relationships. In the current study, autistic and non-autistic adults reported on their autistic characteristics, TEI, alexithymia, and empathy. Based on previous research, it was hypothesized that more autistic characteristics would be associated with less TEI, more alexithymia, and less empathy, and that these relationships would be more prominent amongst males. More autistic characteristics were associated with greater challenges across the three areas of interest. However, only the relationship between TEI and autistic characteristics was moderated by sex, such that males demonstrated higher support needs related to TEI than females. Results from this analysis indicate that adults with more autistic characteristics, regardless of diagnostic status, demonstrate differences in TEI, alexithymia, and empathy. The current analysis may offer additional context to the evolving understanding of empathy and autism by suggesting that TEI and alexithymia could account for differences in empathy. Moreover, sex seems to play a role in the relationship between autistic characteristics and TEI such that differences are especially prominent for males.

Empathic Conversational Agent Platform Designs and Their Evaluation in the Context of Mental Health: Systematic Review.

BACKGROUND: The demand for mental health (MH) services in the community continues to exceed supply. At the same time, technological developments make the use of artificial intelligence-empowered conversational agents (CAs) a real possibility to help fill this gap. OBJECTIVE: The objective of this review was to identify existing empathic CA design architectures within the MH care sector and to assess their technical performance in detecting and responding to user emotions in terms of classification accuracy. In addition, the approaches used to evaluate empathic CAs within the MH care sector in terms of their acceptability to users were considered. Finally, this review aimed to identify limitations and future directions for empathic CAs in MH care. METHODS: A systematic literature search was conducted across 6 academic databases to identify journal articles and conference proceedings using search terms covering 3 topics: "conversational agents," "mental health," and "empathy." Only studies discussing CA interventions for the MH care domain were eligible for this review, with both textual and vocal characteristics considered as possible data inputs. Quality was assessed using appropriate risk of bias and quality tools. RESULTS: A total of 19 articles met all inclusion criteria. Most (12/19, 63%) of these empathic CA designs in MH care were machine learning (ML) based, with 26% (5/19) hybrid engines and 11% (2/19) rule-based systems. Among the ML-based CAs, 47% (9/19) used neural networks, with transformer-based architectures being well represented (7/19, 37%). The remaining 16% (3/19) of the ML models were unspecified. Technical assessments of these CAs focused on response accuracies and their ability to recognize, predict, and classify user emotions. While single-engine CAs demonstrated good accuracy, the hybrid engines achieved higher accuracy and provided more nuanced responses. Of the 19 studies, human evaluations were conducted in 16 (84%), with only 5 (26%) focusing directly on the CA's empathic features. All these papers used self-reports for measuring empathy, including single or multiple (scale) ratings or qualitative feedback from in-depth interviews. Only 1 (5%) paper included evaluations by both CA users and experts, adding more value to the process. CONCLUSIONS: The integration of CA design and its evaluation is crucial to produce empathic CAs. Future studies should focus on using a clear definition of empathy and standardized scales for empathy measurement, ideally including expert assessment. In addition, the diversity in measures used for technical assessment and evaluation poses a challenge for comparing CA performances, which future research should also address. However, CAs with good technical and empathic performance are already available to users of MH care services, showing promise for new applications, such as helpline services.

The empathy and stress mindset of healthcare workers: the chain mediating roles of self-disclosure and social support.

The hospital is a workplace full of stressful events for healthcare workers (HCWs) due to unpredictable changes in their daily routines. Perceptions of stressful events (stress mindset) have a significant impact on an individual's health and well-being. However, few studies have reported the factors and potential counter mechanisms influencing these perceptions. This study aimed to evaluate the relationship between empathy, self-disclosure, social support, and stress mindset of HCWs, and to explore the mechanism of empathy on stress mindset. Five hundred and eight HCWs (35.2% men and 64.8% women) completed the Interpersonal Reactivity Index (IRI), the Distress Disclosure Index (DDI), the Social Support Rating Scale (SSRS), the Stress Mindset Measure (SMM), and demographic questionnaires online in China. The results showed that empathy was positively linked with stress mindset and positively correlated with self-disclosure and social support. In the multiple mediating model, self-disclosure and social support mediated the association between empathy and stress mindset sequentially. The results imply that empathy, self-disclosure, and social support play a significant role in the formation of HCWs' stress mindset. These findings have substantial ramifications for reducing stress and creating successful government interventions to fortify stress mindset in healthcare.

Can similarity of autistic traits promote neural synchronization?

People with similar levels of autistic traits are reported to exhibit better interactions than those with larger differences in autistic traits. However, whether this "similarity effect" exists at the neural level remains unclear. To address this gap, the present study employed functional near-infrared spectroscopy (fNIRS) hyperscanning technology to assess inter-brain synchronization (IBS) during naturalistic conversations among dyads with three types of autistic trait combinations (20 high-high, 22 high-low, and 18 low-low dyads). The results revealed that the high-high dyads exhibited significantly lower IBS in the right temporoparietal junction (rTPJ) region compared to the low-low dyads, with no significant differences observed between the high-low group and the other two groups. Moreover, though dyadic differences in conversation satisfaction were positively correlated with dyadic autistic trait differences, IBS only showed a significant negative correlation with the dyadic average autistic trait scores and no significant correlation with the dyadic difference scores of autistic traits. These findings suggest that dyads with high autistic traits may have shared feelings about conversations, but cannot produce IBS through successful mutual prediction and understanding.

Exploring the bidirectional relationship between job burnout and empathy in nurses: A longitudinal study.

OBJECTIVES: This study explored the bidirectional relationship between job burnout and empathy among Chinese nurses. METHODS: A nurse cohort was assessed longitudinally in 2020 (T1) and 2022 (T2). Participants completed the Maslach Burnout Inventory (MBI)-Human Services Survey and the Jefferson Scale of Empathy-Health Professionals. RESULTS: Out of the 1090 nurses who participated in both assessments, 551 (50.6 %) exhibited job burnout. Nurses with no burnout, discontinued burnout, and newly developed burnout groups had higher levels of empathy than the persistent burnout group. There is a bidirectional negative association between empathy and job burnout, particularly in the depersonalization and low personal accomplishment. Notably, empathy did not predict the emotional exhaustion from burnout, but heightened emotional exhaustion predicted diminished empathy. CONCLUSION: The findings suggest a significant bidirectional negative association between empathy and job burnout, especially in depersonalization and low personal accomplishment. Notably, nurses without burnout, discontinued burnout, and newly developed burnout exhibited higher levels of empathy, emphasizing the potential impact of addressing and mitigating burnout on fostering empathetic behavior. PRACTICE IMPLICATIONS: Interventions targeting both burnout and empathy are vital for nurses. Recognizing and addressing burnout can positively impact fostering empathetic behavior in nursing practice.

Empathy Toward Artificial Intelligence Versus Human Experiences and the Role of Transparency in Mental Health and Social Support Chatbot Design: Comparative Study.

BACKGROUND: Empathy is a driving force in our connection to others, our mental well-being, and resilience to challenges. With the rise of generative artificial intelligence (AI) systems, mental health chatbots, and AI social support companions, it is important to understand how empathy unfolds toward stories from human versus AI narrators and how transparency plays a role in user emotions. OBJECTIVE: We aim to understand how empathy shifts across human-written versus AI-written stories, and how these findings inform ethical implications and human-centered design of using mental health chatbots as objects of empathy. METHODS: We conducted crowd-sourced studies with 985 participants who each wrote a personal story and then rated empathy toward 2 retrieved stories, where one was written by a language model, and another was written by a human. Our studies varied disclosing whether a story was written by a human or an AI system to see how transparent author information affects empathy toward the narrator. We conducted mixed methods analyses: through statistical tests, we compared user's self-reported state empathy toward the stories across different conditions. In addition, we qualitatively coded open-ended feedback about reactions to the stories to understand how and why transparency affects empathy toward human versus AI storytellers. RESULTS: We found that participants significantly empathized with human-written over AI-written stories in almost all conditions, regardless of whether they are aware (t196=7.07, P<.001, Cohen d=0.60) or not aware (t298=3.46, P<.001, Cohen d=0.24) that an AI system wrote the story. We also found that participants reported greater willingness to empathize with AI-written stories when there was transparency about the story author (t494=-5.49, P<.001, Cohen d=0.36). CONCLUSIONS: Our work sheds light on how empathy toward AI or human narrators is tied to the way the text is presented, thus informing ethical considerations of empathetic artificial social support or mental health chatbots.

Scale of self-perceived listening, empathy, and presence (LEP) abilities in associate degree nursing students for aging care.

This cross-sectional study involved 341 fifth-year associate degree nursing students who completed an online questionnaire survey from May 1 to July 31, 2020. Out of these, 196 effective responses were received, with participants' ages ranging from 19 to 29 years. Most were female, the eldest in their families, and had experience living with grandparents. They had also completed long-term care or elderly nursing courses, and had experience in practicing, volunteering, and caring for elders. The average scores for all listening and empathy items were above 4.0. The LEP self-perception abilities scale demonstrated expert content validity with a score of .94 and an internal consistency Cronbach's α of .96. Construct validity was confirmed with factor loadings ranging from .73 to .92, explaining 67.03% of the variance, indicating strong construct validity.

Social exclusion: differences in neural mechanisms underlying direct versus vicarious experience.

Social exclusion stands as a source of social discord and holds substantial research value. Prior investigations on social exclusion have overlooked the interactive relationship between the excluded individuals and the observers. Hence, this study comparatively explores the neural mechanisms underlying the psychological responses of two distinct roles within the same social exclusion context. A total of 35 pairs (19 pairs of females) participated in the experiment. Within each pair, one individual assumed the role of a socially excluded participant (target), while the other acted as a social exclusion observer. Targets engaged in an online ball-passing game where controlled ball allocations to the participants created an exclusion scenario. Meanwhile, observers spectated the targets playing the game. Throughout the ball-passing activity, functional near-infrared spectroscopy (fNIRS) recorded the blood oxygen data in the prefrontal cortex (PFC) and temporoparietal junction (TPJ) of both participants. Our findings revealed varied levels of rejection sensitivity elicited by direct or observed social exclusion experiences. Additionally, distinct patterns of neural activation were observed: targets displayed conditional differences in the medial prefrontal cortex (mPFC), while male observers exhibited conditional activation differences in the mPFC, and female observers showed conditional activation differences in the right dorsolateral prefrontal cortex (dlPFC). This study juxtaposes the behavioral and neural activation variances between targets and observers within the same social context, offering a novel perspective on investigating the neural mechanisms of social exclusion.

Empathy development through game-based learning: An investigative study on nursing professionals.

BACKGROUND: Empathy is at the core of patient-centred care. Evidence has continually found that empathy helps foster therapeutic relationships and is essential in the delivery of quality healthcare. In India, many factors are barriers to empathy for nursing professionals. OBJECTIVES: DESIGN AND METHODS: The IDEO design thinking process was followed to design the game. A focus group discussion with 18 nurses helped identify relevant scenarios and barriers to empathy. A scenario of an interaction between a nurse and a cancer patient was identified to create the game. The game mechanics, rubrics, and scenarios were built based on feedback from diverse professionals consisting of doctors, nurses, and UX designers. A learner feedback form assessing usability, contextual specificity, engagement, and perceived learnability was created and its reliability was tested. The game was tested on 60 nurses, followed by administration of the learner feedback form. To assess changes in empathy, an empathy scale was administered before the intervention and seven days after the intervention on 20 nurses. RESULTS: The learner feedback form was found to have Cronbach's Alpha >0.70, and therefore reliable. The responses to the learner feedback form were analysed using the Chi Square test and were found to be positive and statistically significant (p-value<0.001). The differences in pretest and posttest empathy scores were analysed using the Wilcoxon Signed Ranks test and were found to be statistically significant as well (p-value<0.001). CONCLUSIONS: The positive response to the learner feedback form, and the improvement in empathy scores after the intervention, indicates that games have a potential role in teaching empathy to Nursing Professionals.

Empathy as a Mediator of the Relation between Peer Influence and Prosocial Behavior in Adolescence: A Meta-Analysis.

During adolescence, empathy and prosocial behavior contribute to the establishment of positive interpersonal relationships and social connections, promoting holistic development in youth. A substantial amount of research has provided compelling evidence that there is a relationship between peer relationships and empathy and prosocial behavior. Empathy, as a key mediating factor, links the influence of peers with prosocial behavior in adolescents, yet there is currently a lack of robust meta-analytic evidence regarding this mediating role. This study employed a two-stage structural equation modeling approach to synthesize existing research on peer influence, empathy, and prosocial behavior during adolescence. Systematic searches were conducted across three databases (PubMed, Web of Science, and PsycINFO), identifying a total of 49 studies, with a systematic assessment of study quality. The results indicated that empathy plays a mediating role between peer influence and prosocial behavior. Positive peer influence is positively correlated with empathy and prosocial behavior, while negative peer influence is negatively correlated with empathy and prosocial behavior, and empathy is positively correlated with prosocial behavior. This meta-analysis demonstrates that during adolescence, empathy mediates the connection between peer influence and prosocial behavior, representing a potential process that can explain the relationship between peer influence and prosocial behavior.

Exploring the potential of pantomime games in medical education: Non-verbal exercise.

The primary educational challenge in medical education is the lack of focus on non-verbal communication skills, such as body language, facial expressions, and gestures. This gap is crucial, particularly in multicultural and multilingual contexts where non-verbal cues can bridge language barriers and enhance understanding between healthcare professionals and patients. To address this, our wave explores the potential of integrating art, specifically pantomime games, into medical education as a non-verbal exercise. Inspired by ancient drama and role-play, pantomime games offer an innovative methodology for enhancing non-verbal communication skills. These games help students develop observation, empathy, and ambiguity tolerance-skills essential for effective healthcare delivery. Incorporating art and game-based learning into medical curricula has improved visual perception, personal reflection, and student engagement. The benefits of this integration extend globally, fostering emotional intelligence, creative thinking, and cross-cultural understanding. Educational games create a safe environment for students to experiment, learn from mistakes, and gain practical experience, ultimately reducing training time and instructor load. Moreover, non-verbal communication training can enhance professor-student interactions, improving feedback quality and learning outcomes. To implement these innovations, clear guidelines and effective facilitation are crucial. Educators should provide supportive environments for experimentation and learning, using minimal materials such as open spaces and simple props. High-resource settings can leverage AI technologies for feedback and create mobile applications to modernize the approach. This wave advocates for a student-centered, multimodal communication and learning environment, highlighting the transformative potential of integrating performing arts into medical education to prepare future healthcare providers better.

Exploring the link between empathy, stress, altruism, and loneliness in university students during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: Empathy has been associated with a range of positive outcomes, including social connection, pro-social behavior, and mental health. Nonetheless, acknowledging the multidimensional aspects of empathy, budding research indicates that sometimes empathy may precipitate negative health outcomes. AIM: In the present paper, we explore the extent to which the multidimensional aspects of empathy-as measured by the Interpersonal Reactivity Index-may relate to the experience of increased stress during the COVID-19 pandemic. We also examine potential behavioral moderators (altruism) and social mediators (loneliness) of any such effect. METHOD: We conducted a cross-sectional survey study of 2595 Danish university students and implemented linear regression analyses to determine the relationships between our key variables. RESULTS: In both crude and adjusted regression models, our findings indicate positive associations between the IRI subscales Fantasy, Empathic Concern, and Personal Distress on self-reported stress and loneliness. Perspective Taking was marginally and inversely associated with stress but not loneliness. Altruism did not moderate these associations, but loneliness did mediate the effects of Fantasy, Empathic Concern, and Personal Distress on stress. DISCUSSION: Our results emphasize the importance of conceptualizing empathy in multi-dimensional terms. Further, our study highlights the potential negative health consequences of empathy in certain settings. These results may help focus future research in this area and feed into mental health interventions.

Exploring the interplay of parenting styles, basic empathy, domestic violence, and bystander behavior in adolescent school bullying: a moderated mediation analysis.

Introduction: This study investigates how parental styles, basic empathy, and family violence influence adolescents' bystander behaviors in school bullying. Methods: A survey was conducted with 1,067 students from three middle schools in southern China. Multifactor logistic regression and a moderated mediation model were employed to analyze the relationships between positive and negative parental styles, basic empathy, and bystander behaviors. Results: The study found significant correlations and predictive relationships: Positive parental styles were strongly associated with increased basic empathy (r = 0.29, p < 0.01) and behaviors that protect victims (r = 0.29, p < 0.01). In contrast, negative parental styles correlated positively with behaviors that support bullying (r = 0.12, p < 0.01) and instances of family violence (r = 0.62, p < 0.01). Basic empathy negatively predicted behaviors that promote bullying (ß = -0.098, p < 0.01) and positively predicted protective behaviors toward victims (ß = 0.249, p < 0.001). Furthermore, family violence weakened the positive effects of positive parental styles on both empathy (ß = -0.075, p < 0.001) and protective behaviors (ß = -0.025, p < 0.01). Conclusion: The findings indicate that positive parental styles indirectly promote adolescents' victim protector behaviors by enhancing their basic empathy, underscoring the importance of emotional cultivation. Meanwhile, family violence weakens the positive impact of these parental styles on basic empathy and protective behaviors, harming adolescents' emotional security and behavioral norms.