Why empathy has a beneficial impact on others in medicine: unifying theories

Abstract

The past decades have seen an explosion of studies on empathy in various academic domains including affective neuroscience, psychology, medicine, and economics. However, the volumes of research have almost exclusively focused on its evolutionary origins, development, and neurobiological bases, as well as how the experience of empathy is modulated by social context and interpersonal relationships. In the present paper, we examine a much less attended side of empathy: why it has a positive impact on others? After specifying what the construct of empathy encompasses, we briefly review the various effects of empathy on health outcomes in the domain of medicine. We then propose two non-mutually exclusive mechanistic explanations that contribute to explain the positive effects of physician empathy on patients. (1) The social baseline theory (SBT), building on social support research, proposes that the presence of other people helps individuals to conserve metabolically costly somatic and neural resources through the social regulation of emotion. (2) The free energy principle (FEP) postulates that the brain optimizes a (free energy) bound on surprise or its complement value to respond to environmental changes adaptively. These conceptualizations can be combined to provide a unifying integrative account of the benefits of physicians’ empathetic attitude on their patients and how it plays a role in healing beyond the mere effect of the therapeutic alliance.

An Evolutionary Perspective on Pain Communication

“…In such a situation, merely getting a diagnosis may alleviate suffering, because the pain is recognized as legitimate and the effort for making pain credible can be reduced (Steinkopf, 2015). All in all, research on affect, behavior, and cognition of pain observers (Bastian, Jetten, Hornsey, & Leknes, 2014;Goubert et al, 2005); research on the social modulation of pain (Decety & Fotopoulou, 2015;Krahé, Springer, Weinman, & Fotopoulou, 2013;Mogil, 2015); and research on pain malingering (Butcher, Arbisi, Atlis, & Mcnulty, 2003;Kucyi, Scheinman, & Defrin, 2015;Mendelson & Mendelson, 2004) could benefit from taking into account contextual factors that can enable or undermine pain's communicative function.…”

Mentalizing homeostasis: The social origins of interoceptive inference

“…Indeed, affective touch and cutaneous pain are two sub-modalities of interoception with contrasting affective qualities (pleasant/unpleasant) and social meanings (care/harm). In experimental studies, it is well established that social support can modulate psychological and neurophysiological response to pain, in adults and in children (see Decety & Fotopoulou, 2015;Krahé et al, 2013, for reviews). Moreover, in experimental and neuroimaging studies with adults, we (AF's lab) have shown that this pain modulation depends on particular 'embodied' social support variables (e.g., the presence of another individual, affective touch by another individual), as well as individual differences in the perception of social relationships themselves, namely attachment styles (Hurter et al, 2014;Krahé et al, 2015;Sambo et al, 2013;Krahé et al, 2016).…”

“…We have proposed elsewhere (Decety & Fotopoulou, 2015;Krahé et al, 2013) that from the perspective of the free energy model, this modulation may be conceptualised as a modulation of the precision (salience) of nociceptive signals in a social context. In other words, our perception of pain, and of bodily threat more generally, may vary not only according to how much tissue damage is communicated by nociceptive, peripheral pathways, but also according to how much social support we predict is available to us in a given situation, or more generally.…”

Empathic people have more friends: Empathic abilities predict social network size and position in social network predicts empathic efforts

“…The individual differences are partly due to genetic causes (Rodrigues et al, 2009) but empathic abilities can also be improved through learning (e.g. Decety and Fotopoulou, 2015).…”