Background: Empathy is essential to forming strong patient-physician relationships that enable physicians to provide better healthcare. In the medical education literature, empathy consists of cognitive, affective, behavioural, and moral domains. Studies have measured declines in empathy during medical training. Researchers speculate that factors within formal, informal, and hidden curricula contribute to empathic decline. Several frameworks suggest that empathy in the moral domain (i.e., the inner motivation to accept patients unconditionally, commit to understanding patients, and help patients achieve their needs) is the most fundamental to the empathic response. Studying the factors that influence moral empathy during training is important to developing insights into the reasons for the demonstrated declines in resident empathy. Methods: Descriptive phenomenology was used to address the research objective. Medical residents from various specialties participated in lightly structured interviews concerning their experiences. Interview transcripts were inductively and collaboratively analyzed to construct a preliminary set of factors that influence moral empathy. These factors informed the creation of a script for a verbatim theatre play that was performed for an audience of residents, educators, learners, researchers, and scholars. Following the play, audience participants completed a survey that served as a member-check of the factors that contributed to the final construction of factors. Results: The results were constructed as three categories under which seven factors are nested. These categories are: Innate Capacity, Previous Personal Encounters, and Specific Patient Encounters. With the exception of a few, most factors do not directly influence residents’ moral empathy but rather challenge their ability to act on their moral empathy. Discussion: These results offer unique insights into the declines in empathy that have been previously reported in the medical education literature, while also highlighting a moral-behavioural tension that has implications for competency-based medical education, the four-factor model of empathy, and the assessment of empathy in medical education. Future work may build on the results of this study to develop an assessment tool for moral empathy and to elucidate the relationships between the domains of empathy in order to arrive at a more refined conceptualization of the construct. / Thesis / Master of Science (MSc) / Empathy—the ability to comprehend the experiences of others—is an important tool that enables physicians to build relationships with patients, which helps them provide better healthcare. Studies have shown that empathy declines during medical training due to a variety of factors. Frameworks describing the empathic response suggest that one’s inner motivation to accept patients unconditionally, commit to understanding patients, and help patients achieve their needs may be fundamental to providing clinical care with empathy. As such, the goal of this study was to explore the factors that influence these inner motivations of residents in order to gain insights about the evidence that purports residents to demonstrate less empathy as they progress in their training. To address this objective, 10 medical residents from various specialties were interviewed about their experiences, the data were analyzed by way of a descriptive phenomenological methodology, and the initial findings were presented as a verbatim theatre play as a means of member-checking the proposed results. After viewing the play, an audience of medical residents, educators, learners, researchers, and scholars provided feedback through a survey that contributed to the final conclusions of the study. In this regard, the study shows that, apart from a few factors, residents’ inner motivations to be empathic are not significantly influenced during medical training. Rather, certain factors associated with residency affect their ability to deliver on their inner motivations. This study offers insights into the role of motivation in empathic decline, assessment of empathy during medical training, and potential significance of a tension between one’s motivation to be empathic and the opportunities that they are afforded to be empathic during residency.

This paper is written in special acknowledgement and recognition of oppressed minority groups including, but not limited to, those of Black, Indigenous, and Asian persons. All lives do not matter until Black, Red, and Yellow lives matter. / Obama once spoke of his desire to see empathetic individuals appointed to the position of Supreme Court Justice of the United States. His desire was met by many with resistance as people voiced concerns regarding the unreliability of beliefs founded on empathy and possible negative consequences that may come about. Concerns regarding unreliability are the product of our inability to access the ‘privileged information’ or the actual thoughts and perspectives of those we intend to empathize with. Attempts to form empathic beliefs, in the absence of this information, could lead to various harms to the very groups we intend to empathize with. Stereotyping, bias, and claims of sincerely ‘knowing’ the unique circumstances of those very different from ourselves can all lead to the justification of actions with harmful consequences. In my thesis I wish to address these concerns by acknowledging that most practical sources of knowledge (those we make use of and depend on regularly), such as those predicated on notions of cause and effect, have similar risks associated with them. Theories such as gravity and evolution remain theories and yet via the establishment of best practices and diligent communities, we are able to minimize the dissemination of false knowledge claims and their respective harms. In my paper I acknowledge this and explain how empathy can be dealt with in a similar fashion, while also reducing potential harms to others and allowing us to take advantage of the many benefits empathic knowledge has to offer. In the same way that we still continue to make use of our understanding of gravity to improve our lives and society by building aircrafts, we can make use of empathy to improve the ability of individual social and moral agents, as well as society as a whole. Under this pragmatic approach even the legal system can reap the benefits of empathic knowledge claims, so long as we, moving forward, work to collectively discern how to best ensure the validity of empathic knowledge claims. / Thesis / Master of Philosophy (MA) / Obama once spoke of his desire to see empathetic individuals appointed to the position of Supreme Court Justices of the United States. His desire was met by many with resistance as people voiced concerns regarding the unreliability of beliefs founded on empathy and possible negative consequences that may come about. In my thesis I wish to address these concerns by acknowledging that most useful sources of knowledge have similar risks associated with them, and yet via the establishment of best practices and diligent communities we are able to minimize the dissemination of false knowledge claims and their respective harms. In my paper I acknowledge this and explain how empathy can be dealt with in a similar fashion, while also reducing potential harms to others and allowing us to take advantage of the many benefits empathic knowledge has to offer.

Yes / Mentalizing (otherwise known as ‘theory of mind’) involves a special process that is adapted for predicting and explaining the behaviour of others (targets) based on inferences about targets’ beliefs and character. This research investigated how well participants made inferences about an especially apposite aspect of character, empathy. Participants were invited to make inferences of self‐rated empathy after watching or listening to an unfamiliar target for a few seconds telling a scripted joke (or answering questions about him/herself or reading aloud a paragraph of promotional material). Across three studies, participants were good at identifying targets with low and high self‐rated empathy but not good at identifying those who are average. Such inferences, especially of high self‐rated empathy, seemed to be based mainly on clues in the target's behaviour, presented either in a video, a still photograph or in an audio track. However, participants were not as effective in guessing which targets had low or average self‐rated empathy from a still photograph showing a neutral pose or from an audio track. We conclude with discussion of the scope and the adaptive value of this inferential ability.

Little is known about the complex processes leading to prosocial behavior. However, theories suggests that empathy, empathic responding, and emotion regulation abilities, may all contribute to the presence or absence of prosocial behavior. While theoretical papers demonstrate relationships between these constructs, researchers to date have only focused on small aspects of this complex relationship (e.g., the relationship between sympathy and emotion regulation, the relationship between empathy and prosocial behavior). This study proposed a complex model whereby empathy was both directly related to prosocial behavior and indirectly related to prosocial behavior via sympathy or personal distress. Furthermore, this study proposed an emotion regulation framework for understanding the relation between empathy and prosocial behavior, suggesting that one's emotion regulation abilities would cause a differential presentation of empathic responses, leading to a potential increase or decrease in prosocial behavior. An adult sample was recruited. Analyses were completed using Structural Equation Modeling (SEM). Results indicate that hypothesized model adequately fit the data. All hypothesized associations between variables were significant. However, contrary to the hypothesis, emotion regulation ability did not alter the associations between study constructs. Strengths, limitations, and implications will be discussed. / Master of Science

The increase in bullying and its detrimental impacts threaten children's healthy development across the world; however, little research has examined multi-factors related to bullying. Guided by ecological theory, this study examined ecological factors that related to children's bystander and defender behavior when they witness bullying. Considering the role of culture and maternal emotion socialization in children's socio-emotional development, cultural differences in the relation of maternal emotion socialization on children's reactions to bullying through their empathy were investigated. Children (10-12 years old) and their mothers in the United States (n=165) and South Korea (n=158) participated in an online survey. Mothers completed the Coping with Children's Negative Emotions to assess maternal unsupportive and supportive reactions to their children's emotions. Children reported on their empathy (i.e., personal distress and empathic concern) using the Interpersonal Reactivity Index and on their bystander/defender behaviors using the Types of the Conformity Groups in Bullying. For bystander behavior, mothers' unsupportive reactions were significantly correlated with children's bystander behavior through empathic concern in both cultures. Personal distress mediated the relation of maternal unsupportive reactions to bystander behavior only in the American sample. For defender behavior, American mothers' supportive reactions directly predicted defender behavior whereas the effect of Korean mothers' supportive reactions on defender behavior was mediated by empathic concern. More personal distress was related to more defender behavior in the American sample while less personal distress was related to more defender behavior in the Korean sample. Results of this study supported cultural differences in the relation of maternal emotion socialization to children's reaction to bullying. American children were more likely to help the victim when their mothers supported their negative emotions. For Korean children, mothers' supportive reactions were related to their prosocial behavior through their empathic concern. However, in both cultures, children's empathic concern was a significant mediator in the relation between maternal unsupportive reactions and bystander behavior. This finding may provide educational guidance to bullying intervention programs across cultures. / Doctor of Philosophy / More than one out of five students in the United States and more than one out of ten students in South Korea experience bullying. The detrimental effects of bullying can affect not only victims and bullies but also classmates who witness the bullying. I examined factors that related to bystander behavior (ignoring or staying away from bullying) and defender behavior (helping the victim or actively endeavoring to stop bullying) in bullying to help in efforts to stop bullying. Because positive emotional experiences with mothers can help children develop empathy and empathy tends to elicit helping behavior, I examined how mothers' reactions to their children's negative emotions were related to children's bystander behavior and defender behavior through their empathic abilities. However, research and theories on bullying has been predominantly focused on Western populations. My study addressed this gap, examining cultural differences in the relations between the United States and South Korea to bring attention to the role of culture in parents' emotional socialization and children's development. Results from this study will help schools and communities to provide culturally sensitive bullying intervention programs with parents. Children (10-12 years old) and their mothers in the United States (n=165) and South Korea (n=158) participated in an online survey. Mothers were asked about ways that they react to their children's negative emotions. Mothers' unsupportive reactions refer to minimization, distress and punitive reactions when their children express negative emotions. Mothers' supportive reactions mean maternal comforting, acknowledgement, and encouragement of children's negative emotions. In the online survey, children reported on their empathy and reactions when they witness bullying. Cultural differences in the relations were confirmed. American children were more likely to help the victim when their mothers supported their negative emotions. For Korean children, mothers' supportive reactions were related to their defender behavior through their empathic concern. However, in both countries, the more mothers displayed supportive reactions, the more children reported empathic concern; children's empathic concern was an important bridge between maternal unsupportive reactions and bystander behavior.

Yes / According to the theory of predictive processing, understanding in the present involves non-consciously representing the immediate future, based on probabilistic inference shaped by learning from the past. This paper suggests links between this neuroscientific theory and the psychoanalytic concept of reverie–an empathic, containing attentional state–and considers implications for the ways therapists intuit implicit material in their clients. Using findings from a study about therapists’ experiences of this state, we propose that reverie can offer practitioners from diverse theoretical s a means to enter the predictive moment deeply, making use of its subtle contents to connect with clients.

This research explores the relationship between narrative, empathy and anxiety in art museum education. The study begins from my personal experience with anxiety and is methodologically rooted in narrative inquiry and friendship as method. In this study, I propose a creative method of narrative postcard writing called (fe)mail – rooted in a feminist ethic of care that seeks to understand and empathize with the experience of others through correspondence. This research asks relevant questions about the future of art museum programming for mental illness and the act of writing (fe)mail as a reflective practice for academics and educators in the field of social science. In my narrative analysis of the program and the data, I also problematizes my role as researcher, educator and friend throughout the study by considering my own biases, expectations and personal educator agenda. The study is divided into two parts. The first comprises correspondence and analysis of (fe)mail between myself and my best friend/co-participant, Atleigh. In Part I, I conduct a narrative analysis of the (fe)mail data produced between us in order to answer the following questions: What qualities of (fe)mail will appear in the exchange? Can (fe)mail be used as a tool for self-care during the research writing process? In Part II of the study, (fe)mail is brought into the museum by way of a virtual museum program for six women in order to answer the following questions: In what ways does the museum program create a sense of community among participants? In what ways might (fe)mail create empathy for works of art, the self, and others as part of a museum program?

Parent-child interactions tend to be problematic among families of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Although much attention has been paid in research and therapy to negative cycles of interaction between parent and child, it is equally important to consider how positive family interactions can be promoted, as these are likely to help prevent or reduce behavior problems and facilitate the best possible outcomes for children. Major contributors to the fields of psychology and child therapy have postulated that parental empathy is of primary importance in facilitating healthy child personality development. However, the effect of parental empathy has not been systematically studied with ADHD children. Thus, this study investigated the relationship between parental empathy and child adjustment factors in children with ADHD. It was hypothesized that among parent-child dyads with ADHD children, higher levels of parental empathy would predict higher levels of child self-esteem, social skills, and compliance, and lower levels of child aggression. Participants were 56 children who were previously diagnosed with ADHD and their parent/guardian. Thirty-seven parent-child dyads served as a control group. The study included parent-child participation in a videotaped analogue observation procedure and completion of parent-, child-, and teacher-report measures. Results indicated that higher levels of parental empathy predicted higher child self-esteem regarding their relationships with their parents. Before bonferroni adjustment, parental empathy also predicted lower levels of aggression among ADHD children. Parental empathy did not predict peer acceptance or compliance for these children. Children of high empathy parents scored higher on peer acceptance and lower on child aggression measures than children of low empathy parents. Scores on self-esteem and compliance, however, did not differ across groups. Although there were no differences between ADHD and non-ADHD children on self-esteem, peer acceptance, or compliance measures, children with ADHD were significantly more aggressive. These results suggest the importance of interventions for ADHD children that focus on increasing parental empathy in parent-child interactions.

The purpose of the present study was to further explore evidence for the construct-related validity of the Sulliman Scale of Social Interest (SSSI) through the implementation of both convergent and discriminant procedures. This was done through (a) replicating St. John's 1992 study, (b) extending the findings of that study by incorporating additional psychological measures, and (c) examining SSI itself by means of principal axis factor analytic procedures. First, all nine of the relationships demonstrated between the SSSI and other variables in the St. John (1992) study were replicated in the present study. Second, in extending the findings of that study, 22 of 26 hypothesized relationships between the SSSI and other psychological measures were in the predicted direction. Third, the results of the factor analysis produced three factors labeled "contextual harmony," "positive treatment/response," and "confidence and trust." Taken together, the outcomes of both studies appear to offer some support for the SSI's construct validity and to provide possible directions for future research.

The purpose of this study was to assess rape attitudes and empathy levels of students at a university in North Texas. The Attitudes Toward Rape questionnaire and the Rape Empathy Scale were administered to 387 undergraduate students. Dependent variables were attitudes and empathy and independent variables were prior knowledge or experience as a rape victim, having female siblings, gender, marital status, and age. Significance was found between rape-intolerant attitudes and both prior experience as a victim (p < .001), and gender (p < .001). Significance was also found between empathy and experience as a rape victim (p < .035) and gender (p < .032).