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We determined the validity and reliability of the Clinical Interpersonal Reactivity Index in a sample of Japanese nurses. Participants were registered nurses at national university hospitals and nursing researchers in Japan. A postal questionnaire was conducted. Construct validity was analyzed by exploratory and confirmatory factor analysis, and convergent validity demonstrated using the Interpersonal Reactivity Index. The Clinical Interpersonal Reactivity Index has an 18-item, two-factor structure with Cronbach's alpha values of 0.87 and 0.73. Confirmatory factor analysis showed a goodness-of-fit index of 0.917, an adjusted goodness-of-fit of 0.894, a root mean square error of approximation of 0.60, and a comparative fit index of 0.911. Correlation analysis between the Clinical Interpersonal Reactivity Index and Interpersonal Reactivity Index indicated the factors were significantly correlated for empathic concern and perspective taking (r = 0.439-0.401). Test-retest assessment showed reliability coefficients for the first factor as r = 0.859 and the second factor as r = 0.709. The Clinical Interpersonal Reactivity Index demonstrated validity and reliability for Japanese nurses. The two factors evaluated perspective taking and unconditional positive regard.

BACKGROUND Offenders are more likely than the general population to have experienced relationship trauma. They are also more likely to have lower empathy. To date, relationships between historical trauma and later empathic states have not been examined among offenders. AIMS To explore the association between history of trauma in close personal relationships and empathy among offenders. Our research question is: Is such relational trauma associated with self-rated impairments in empathy? METHODS All men with a primary school education and above at a single all-male prison in Jiangsu Province in China were invited to participate. The self-reported Interpersonal Reactivity Index was used to evaluate empathy, and the Brief Betrayal Trauma Survey was to explore interpersonal trauma and classify such experiences. RESULTS Interpersonal trauma was associated with higher personal distress and lower empathic concern among men reporting relational trauma in adulthood, but only higher personal distress when the trauma reported was in childhood. Non-relational trauma was associated with higher empathic concern. Cognitive aspects of empathy varied little between groups. CONCLUSIONS Our findings add to the existing literature by making distinctions between the types of trauma and the age of key experience in its relationship to self-reported empathy. The differences found suggest that it may be helpful to consider planning any trauma-related interventions differently according to the type and age of trauma experiences.

OBJECTIVE To analyse factors associated with affective and cognitive empathy in informal and formal caregivers of older people. METHODS A cross-sectional study was conducted with 111 formal and informal caregivers divided into three groups (lower, intermediate and higher empathy) based on the Multidimensional Interpersonal Reactivity Index score (total, affective and cognitive empathy). A sociodemographic questionnaire, the Zarit Burden Inventory, Patient Health Questionnaire-9 and Functional Assessment Questionnaire were applied. RESULTS The participants were predominantly women (91%), and median [IQR] age was 46 [33-57] years. In the multinomial regression analysis being an informal caregiver, being older and having depressive symptoms were associated with higher levels of empathy (total score and the affective domain). No associations were found for the cognitive domain. CONCLUSION A high level of empathy, especially affective empathy, was associated with depressive symptoms, older age and being an informal caregiver. Family relationships and the lack of training among informal caregivers should be explored.

Korsakoff’s syndrome (KS) is a neuropsychiatric disorder, caused by a vitamin B1 deficiency. Although it is known that patients with KS display diminished theory of mind functioning and frequently exhibit marked antisocial interactions little attention has so far focused on the integrity of moral decision‐making abilities, moral reasoning, and empathy. In an experimental cross‐sectional design, 20 patients diagnosed with KS, and twenty age‐, education‐, and gender‐equivalent healthy participants performed tests assessing moral decision‐making, moral reasoning maturity, empathy, and executive functioning. Participants were administered the Moral Behaviour Inventory (MBI) for everyday moral dilemmas, and ten cartoons of abstract moral dilemmas. Responses were scored according to the Kohlberg stages of moral reasoning. Empathy and executive functioning were assessed with the Interpersonal Reactivity Index (IRI) and the Frontal Assessment Battery (FAB). In contrast to frontal traumatic brain injury patients, KS patients did not display a utilitarian bias, suggesting preserved moral decision‐making abilities. Of interest, KS patients had significantly lower levels of moral reasoning maturity on everyday moral dilemmas, and abstract moral dilemmas. In patients, empathy was moderately related to the level of moral maturity on both tasks, while executive functioning was not. In conclusion, KS patients have preserved moral decision‐making abilities, but their moral reasoning abilities are poorer in everyday and abstract situations. Lower moral reasoning abilities and lower levels of empathy together may be responsible for adverse social functioning in KS.

Objective Schizophrenia may reflect an interactive network of disturbances in cognition. In this study we have examined the relationship between two forms of cognition: metacognition and social cognition among a sample with schizophrenia (n = 41), early episode psychosis (n = 37), and major depression (n = 30) gathered in Moscow, Russia. Methods Metacognition was assessed with the Metacognition Assessment Scale-Abbreviated. Social cognition was assessed with the Ekman 60 Faces Test and the Interpersonal Reactivity Index. Verbal memory and global psychopathology were included as potential covariates. Results Partial correlations controlling for demographics, neurocognition, and psychopathology revealed greater metacognitive capacity was linked to better facial emotion recognition and perspective taking in the prolonged schizophrenia group. Greater metacognitive capacity in the early psychosis group was linked with greater facial emotion recognition. Metacognition and social cognition were not related to one another in the depression group. Conclusions Social cognition and metacognition may be uniquely related in psychosis.

Although empathy is widely recognized as an important trait for healthcare professionals, little research has examined empathy attributes in genetic counselors. Decreases in empathy levels have been recognized in other healthcare professionals over the span of their professional education program. This research sought to characterize empathy levels in first- and second-year genetic counseling students and recent (2017) graduates, and to determine whether there are differences in empathy levels displayed by genetic counseling students at different points in their training. Additionally, this research examined whether experiences prior to graduate school, including specific aspects of advocacy experience, correlated with differences in self-reported empathy levels among genetic counseling students and new genetic counselors. An online survey was administered to first- and second-year genetic counseling students and practicing genetic counselors to determine whether there were differences in empathy levels between these groups, and to analyze for associations between pre-graduate school advocacy work and levels of empathy as measured by the Interpersonal Reactivity Index (IRI). We identified significant differences in self-reported empathy levels in several of the subscales of the IRI between first-year students and second-year students, and between first-year students and recent graduates. Furthermore, we identified significantly lower scores on the personal distress subscale of the IRI in participants who engaged in advocacy work for longer than 12 months when compared to participants who engaged in advocacy work for between 6 and 12 months. Other advocacy and educational characteristics were also examined for correlations with IRI scores, and no significant associations were identified between these additional factors and self-reported empathy scores. Practice implications and recommendations for future research are discussed.

Despite its clear importance, there have been very few empirical investigations of boundary violation propensity among mental health professionals. The present study explored the relationships between self‐reported propensity for boundary violations and predictors theorized to increase their likelihood. Australian mental health professionals (N = 275) completed an online questionnaire battery including demographics, the Sexual Boundary Violation Index, Boundaries In Practice Scale, Boundary Violations Propensity Questionnaire, Marlow‐Crowne Social Desirability Scale, Circumplex of Interpersonal Problems, Brief Inventory of Pathological Narcissism, Barratt Impulsiveness Scale Brief Version, Satisfaction With Life Scale, Brief Experiential Avoidance Questionnaire, Adverse Childhood Experiences Questionnaire and the Interpersonal Reactivity Index. Regression analysis was used to identify unique predictors. Boundary violation propensity was associated with nurturant interpersonal styles in females and dominant interpersonal styles in males. In regression analysis, unique predictors for male boundary violation propensity were grandiose narcissism, vulnerable narcissism, self‐centred interpersonal traits and low levels of empathic concern. For females, unique predictors were impulsivity, childhood adversity, self‐sacrificing interpersonal traits and vulnerable narcissism. In addition to informing theory about those at risk of perpetrating boundary violations, the identified predictors can inform those involved in selection for training programs and staff appointments and serve as markers for providing closer supervision. Refereed/Peer-reviewed

Objective Oncologists are exposed to suffering, loss, and death, which can potentially lead to grief reactions. Although grief over patients may be a natural consequence of the close and longstanding oncologist-patient relationship, the empathy that oncologists feel toward their patients may put them at risk for compassion fatigue (CF). This study examined the mediating role of the two components of CF-secondary traumatic stress (STS) and burnout-in the relation between empathy and grief among oncologists. Method Participants included 71 Israeli oncologists. Measures consisted of a demographic questionnaire, the Texas Revised Inventory of Grief-Present, the Interpersonal Reactivity Index, and the Professional Quality of Life questionnaire. Results Oncologists reported moderate levels of grief and relatively high levels of both STS and burnout. In addition, they reported high levels of the three components of empathy: perspective taking, empathic concern, and personal distress. The PROCESS SPSS macro revealed support for the mediation model. The mediators (STS and burnout) fully accounted for the relationship between the following two components of empathy-perspective taking and personal distress-and grief. Conclusions Oncologists commonly experience grief over patients. We found that oncologists' grief was related to their empathy, and that this association was explained by their levels of CF. The current research may mark a step toward recognizing oncologists' grief as well as understanding the processes associated with it.

While most German anatomy institutes provide only limited information about body donors and their lives, students have expressed a desire to learn more about these individuals, especially about their motivations to donate their bodies for the sake of medical education. In order to gratify this wish, as well as to further humanize body donors, an educational film was compiled, and a study designed to capture the film's effects on medical students. This is the first study using standardized, validated psychological tools to evaluate the impact of an educational film about body donors on students' empathy and psychological stress levels. The study followed a longitudinal, controlled, and cluster randomized design, including 77 (48 females/29 males) participants who watched the video either before, midway, or after the dissection course. Questionnaires were completed at four points in time applying the Jefferson Scale for Empathy (JSPE-S) and the Interpersonal Reactivity Index (IRI) to measure empathy. Psychological stress levels were recorded by the Brief Symptom Inventory (BSI). Overall, students recommended the film to be shown to all students (median 6.0; maximum on the six-point Likert scale). Viewing the film revealed no significant changes between study groups or over time in JSPE-S sum scores. All groups demonstrated a significant reduction of BSI values before the dissection course actually started and increased values during the course, but both developments appeared not to be associated with the intervention. Overall, the educational film did not correlate with any negative effects on students' empathy and psychological stress levels, and it was strongly approved of by students, as it provided more humanizing personal information about body donors without violating their anonymity.

The Questionnaire of Cognitive and Affective Empathy (QCAE) is a commonly used instrument in empathy research. However, this scale has not been validated in the Chinese context. We examined the psychometric properties and structure of the QCAE in a Chinese sample consisting of 1224 college students. The whole sample was split into two halves for exploratory factor analysis (EFA; n = 617) and confirmatory factor analysis (CFA; n = 607). A subsample (n = 351) completed the Chinese versions of the Interpersonal Reactivity Index (IRI) to examine convergent validity and the Revised Social Anhedonia Scale (RSAS) to examine the discriminate validity. Finally, 79 participants of the above subsample were retested after a 4-week interval. Results from EFA and CFA suggested a five-factor model, namely Perspective Taking, Online Simulation, Emotional Contagion, Proximal Responsivity, and Peripheral Responsivity. The internal consistency was .86 and test-retest reliability was .76. Scores on the QCAE positively correlated with scores on the IRI and negatively correlated with scores on the RSAS. The Chinese version of the QCAE exhibited good factor structure, reliability, and validity. Specific relationships between empathy and social anhedonia were also demonstrated.

Empathy is essential for the survival of social species. In many studies, especially those with animal models, empathy for pain was evaluated by the modulation of pain sensitivity. However, the relationship between pain sensitivity and empathy for pain is not well established. Here, by performing two experiments, we aimed to investigate their relationship at both behavioral and electrophysiological levels. In Experiment 1, we characterized individual pain sensitivity using pain threshold and tolerance in a cold pressor test, self-report empathy using Interpersonal Reactivity Index, and pain-related psychological factors, including pain-related anxiety, depression, pain catastrophizing, and pain-related fear, using well-validated questionnaires. We observed that pain sensitivity was positively correlated with emotional empathy, and their relationship was mediated by pain-related anxiety, pain catastrophizing, and pain-related fear. In Experiment 2, we quantified empathy for pain using pain intensity and unpleasantness as well as event-related potentials (ERPs) in an empathy for pain task. Positive correlations were observed between pain sensitivity and psychophysiological empathic responses (i.e., the P3 component and the late positive potential in ERPs), and their relationship was mediated by pain-related fear. These results suggested that being influenced by some pain-related psychological factors, individuals with higher pain sensitivity tended to have stronger empathy for pain, manifested as stronger emotional reactions to others' pain. Our results indicated that the conventional strategy of using pain sensitivity to quantify empathy should be treated with caution, as their relationship could be disturbed by experimental manipulations or pathological modulations that could influence individual emotional states or cognitive processes.

Background Despite growing evidence for neurobehavioral deficits in social cognition in alcohol use disorder (AUD), the clinical relevance remains unclear, and little is known about its impact on treatment outcome. This study prospectively investigated the impact of neurocognitive social abilities at treatment onset and on treatment completion. Methods Fifty-nine alcohol-dependent patients were assessed with measures of social cognition including three core components of empathy via paradigms measuring: 1) emotion recognition (the ability to recognize emotions via facial expression), 2) emotional perspective taking, and 3) affective responsiveness at the beginning of inpatient treatment for alcohol dependence. Subjective measures were also obtained, including estimates of task performance, and a self-report measure of empathic abilities (Interpersonal Reactivity Index). According to treatment outcomes, patients were divided into a patient group with a regular treatment course (e.g., with planned discharge, and without relapse during treatment) or an irregular treatment course (e.g., relapse and/or premature and unplanned termination of treatment, “dropout”). Results Compared with patients completing treatment in a regular fashion, patients with relapse and/or dropout of treatment had significantly poorer facial emotion recognition ability at treatment onset. Additional logistic regression analyses confirmed these results, and identified poor emotion recognition performance as a significant predictor for relapse/dropout. Self-report (subjective) measures did not correspond with neurobehavioral social cognition measures, respectively objective task performance. Analyses of individual subtypes of facial emotions revealed poorer recognition particularly of disgust, anger and no (neutral faces) emotion in patients with relapse/dropout. Conclusions Social cognition in AUD is clinically relevant. Less successful treatment outcome was associated with poorer facial emotion recognition ability at the beginning of treatment. Impaired facial emotion recognition represents a neurocognitive risk factor that should be taken into account in alcohol dependence treatment. Treatments targeting the improvement of these social cognition deficits in AUD may offer a promising future approach. This article is protected by copyright. All rights reserved.

Social network games (SNGs) are popular online venues for young adolescents. The aim of this study is to examine how individual traits, need for cognition (NFC) and perspective taking (PT), are related to young-adolescents' conceptual (i.e. understanding selling and persuasive intentions) and attitudinal (i.e. critical attitude) advertising literacy in these SNGs. The current study also examines how a child's conceptual and attitudinal advertising literacy is related to purchase intentions after seeing advertising in an SNG. In total, 781 young adolescents (aged 10–14 years) took part in our study. First, participants were shown a 5-min video clip of an SNG including advertising. After watching the video clip, the participants completed a questionnaire about, among others, NFC, PT, conceptual advertising literacy, attitudinal advertising literacy and purchase intentions. NFC was found predictive of children's understanding of the selling and persuasive intent of SNG advertising. This means that children who score higher on the NFC scale are also more likely to have a higher conceptual knowledge of SNG advertising. PT was found to negatively influence children's critical attitude towards SNG advertising. As expected, critical attitude towards advertising was negatively related to purchase intentions. Finally, purchase intention was only partially related to conceptual advertising literacy. Copyright © 2016 John Wiley & Sons, Ltd.

Context Resilience is a beneficial trait for resident physicians who are exposed to adversity through their work with patients. Inpatient hematology–oncology produces vicarious trauma for physicians in training. Physician distress and empathy influence patient care and may be associated with respectively lower and greater levels of resilience. Methods We collected measures of resilience (Connor–Davidson Resilience Scale), distress (Impact of Events Scale – Revised), and rotation-specific information (e.g., number of death encounters, death stress, and meaning) at the end of a routine hematology–oncology ward rotation. Empathy (Interpersonal Reactivity Index) was measured both before and after the rotation. Results Fifty-six out of 96 residents completed the study with an overall response rate of 58%. Resilience was negatively correlated with distress (r = −0.306, p = 0.023) but not with empathy (r = 0.172, p = 0.204) and nor with change in empathy over the course of the rotation (r = −0.122, p = 0.374). When separated by sex, male resilience was negatively correlated with distress (r = −0.389, p = 0.04), but female resilience was not. Resident distress levels were in a clinically significant (76%) or posttraumatic stress disorder range (17%), and resident empathy decreased during the rotation (p = 0.018). Resilience levels were similar in those who reported that death events were the most stressful experiences of the rotation and those who derived a sense of meaning from working with dying patients. Conclusions Resident physicians experienced clinically relevant distress and a decrease in empathy. Resilient resident physicians were less likely to experience distress. This study provides evidence for the salutary effects of resilience on physician distress. Copyright © 2016 John Wiley & Sons, Ltd.

Objective A reason for empathy decline during medical training has not been fully elucidated. Empathy may decrease acutely during an inpatient hematology–oncology rotation because of the acuity of death exposures. This study aimed to explore physician trainee empathy, distress, death exposures, and their attributed meaning for the trainee. Methods Internal medicine interns and residents at a single academic center were evaluated before and after hematology–oncology ward rotations using Interpersonal Reactivity Index for empathy, previously cited reasons for empathy decline, Impact of Event Scale-Revised for distress, death exposures (no. of dying patients cared for) and attributed sense of meaning (yes/no) (post-rotation). Results Fifty-six trainees completed both pre-rotation and post-rotation questionnaires (58% response). Empathy averaged 58.9 (SD 12.0) before and 56.8 (SD 11.1) after the rotation (2.1 point decrease) (p = 0.018). Distress was elevated but did not change significantly during the rotation. Residents cared for 4.28 dying patients. Seventy-three percent reported that death was the most stressful event during the rotation, yet 68% reported that they derived a sense of meaning from caring for dying patients. Empathy and distress scales were positively correlated before the rotation (r = 0.277, p = 0.041) but not after (r = .059, p = 0.69). Conclusion This study suggests that an acute drop in empathy can occur over several weeks in residents rotating through inpatient hematology–oncology, similar to empathy decline associated with years of training in other studies. Empathy decline may be associated with elevated distress and death exposures on the hematology–oncology ward and should be explored further in other medical training environments. Copyright © 2016 John Wiley & Sons, Ltd.

An observer's brain is known to respond to another person's small nonverbal signals, such as gaze shifts and eye blinks. Here we aimed to find out how an observer's brain reacts to a speaker's eye blinks in the presence of other audiovisual information. Magnetoencephalographic brain responses along with eye gaze were recorded from 13 adults who watched a video of a person telling a story. The video was presented first without sound (visual), then with sound (audiovisual), and finally the audio story was presented with a still-frame picture on the screen (audio control). The viewers mainly gazed at the eye region of the speaker. Their saccades were suppressed at about 180 ms after the start of the speaker's blinks, a subsequent increase of saccade occurence to the base level, or higher, at around 340 ms. The suppression occurred in visual and audiovisual conditions but not during the control audio presentation. Prominent brain responses to blinks peaked in the viewer's occipital cortex at about 250 ms, with no differences in mean peak amplitudes or latencies between visual and audiovisual conditions. During the audiovisual, but not visual-only, presentation, the responses were the stronger the more empathetic the subject was according to the Empathic Concern score of the Interpersonal Reactivity Index questionnaire (Spearman's rank correlation, 0.73). The other person's eye blinks, nonverbal signs that often go unnoticed, thus elicited clear brain responses even in the presence of attention-attracting audiovisual information from the narrative, with stronger responses in people with higher empathy scores.

The vasopressin V1b receptor (AVPR1B) gene has been shown to be closely associated with bipolar disorder and depression. However, whether it relates to positive social outcomes, such as empathy and prosocial behavior, remains unknown. This study explored the possible role of the AVPR1B gene rs28373064 in empathy and prosociality. A total of 256 men, who were genetically unrelated, non-clinical ethnic Han Chinese college students, participated in the study. Prosociality was tested by measuring the prosocial tendencies of cognitive and emotional empathy using the Interpersonal Reactivity Index (IRI). The single nucleotide polymorphism (SNP), rs28373064, was genotyped using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. The results suggest that the AVPR1B gene rs28373064 is linked to emotional empathy and prosociality. The mediation analysis indicated that the effect of the AVPR1B gene on prosociality might be mediated by emotional empathy. This study demonstrated the link between the AVPR1B gene and prosociality and provided evidence that emotional empathy might mediate the relation between the AVPR1B gene and prosociality.

Background and purpose Converging research in patients with multiple sclerosis (MS) has shown increased rates of alexithymia and disturbances in social cognition, including empathy and theory of mind. Moral judgment is one of the most complex spheres of human cognition, relying on intricate neural circuits related to many other affective, social, cognitive and behavioral processes. Methods Relapsing−remitting MS patients (n = 38) and age-, gender- and education-matched controls (n = 38) completed a measure of alexithymia (Toronto Alexithymia Scale), a measure of empathy (Interpersonal Reactivity Index) and a series of moral dilemmas, for which measures of moral permissibility, emotional reactivity and moral relativity (the perception of how one's moral attitudes compare to the attitudes of the rest of the people) were derived. Results Relative to controls, patients exhibited decreased levels of other-oriented empathy [empathic concern (P

Background: Through two studies, we introduce and validate the Empathy for Pain Scale (EPS), which characterizes the phenomenology of empathy for pain, including the vicarious experience of pain when seeing others in pain. Methods: In study 1, 406 individuals completed the EPS and Interpersonal Reactivity Index (IRI). In the EPS, four painful scenarios (witnessing surgery, patient recovering from surgery, assault and accidental injury) were rated for 12 emotional, empathic and sensory responses. In study 2, 59 participants completed the same questionnaires and then watched and rated videos of sporting injuries. Results: In study 1, we identified three factors of the EPS with principal component analysis, which were validated with confirmatory factor analysis: affective distress; vicarious pain; and empathic concern. The EPS demonstrated good psychometric properties, re-test reliability (n = 105) and concurrent validity. In study 2, we validated the EPS against empathic reactions to the pain of others as displayed in video clips depicting sporting injuries and showed that the scale has unique utility to characterize empathic reactions to pain above general trait empathy measures. Both studies showed that the affective distress and empathic concern subscales of the EPS correlated with measures of cognitive and affective empathy from the IRI, whereas the vicarious pain subscale was only correlated with the personal distress IRI subscale. Conclusions: The EPS is a psychometrically sound new scale that characterizes empathy for pain and vicarious pain. The EPS offers valuable insight to the phenomenological profile of the affective, empathic and sensory dimensions of empathy for pain.

Background Schizophrenia patients display impaired recognition of their own emotions and those of others and deficits in several domains of empathy. The first-person experience of pain and observing others in pain normally trigger strong emotional mechanisms. We therefore hypothesized that schizophrenia patients would display impaired recognition and categorization of both their own pain and the pain of others. Methods We studied 29 patients (18 men/11 women; 36 ± 13 years old) with paranoid schizophrenia-spectrum disorder and 27 healthy volunteers (20 men/7 women; 31 ± 9 years old) matched for age, gender, IQ and socio-cultural level. We assessed symptom severity and theory of mind. The participants' ability to detect and categorize pain in others was assessed with the sensitivity to expressions of pain (STEP) test, which is based on facial expressions, and another dynamic test involving a series of video sequences showing various pain-inducing events. The ability of patients to evaluate their own pain was assessed with the situational pain questionnaire (SPQ), which includes a series of questions assessing how one would expect to feel in different imaginary situations. Empathic tendencies were assessed with the interpersonal reactivity index. Results Patients and controls differed significantly in STEP, pain video and SPQ scores. By contrast with control subjects, the patients' pain judgements were not correlated with their affective or cognitive empathic capacities. Conclusions Schizophrenic patients have a deficit of the identification and categorization of pain both in themselves and in others.

This study investigates values and affective empathy as predictors for care-based moral development. Fifty-three students from a university of applied sciences were interviewed with Skoe's Ethic of Care Interview at the beginning of their studies and two years later. Value priorities were measured by Schwartz et al.'s Portrait Value Questionnaire, empathy variables by Davis' Interpersonal Reactivity Index, and feelings of sympathy were rated using a real-life moral conflict. The results showed that students in care-oriented fields progressed in care reasoning. Real-life sympathy and the value of self-direction positively predicted development in care reasoning, whereas personal distress was a negative predictor. The results indicate that care-based moral development is more closely connected with affective empathy than personal values. Individuals who feel empathy for others, and who prefer independent thinking and action, achieve the greatest gains in care development. In conclusion, educators should encourage students' empathy and moral reasoning in authentic moral conflicts.

OBJECTIVES Resident doctors' (residents) well-being impacts on the medical care they provide. Despite the high prevalence of resident doctors' distress, the relationship between their well-being and the specific competencies defined by the Accreditation Council for Graduate Medical Education is poorly understood. We evaluated the association of resident well-being with medical knowledge as assessed on both a standardised test of general medical knowledge and at the end of web-based courses on a series of focused topics. METHODS We conducted a repeated cross-sectional study of associations between well-being and medical knowledge scores over time for internal medicine residents from July 2004 to June 2007. Well-being measures included linear analogue self-assessment (LASA) scales measuring quality of life (including overall quality of life, mental, physical and emotional well-being, and fatigue), the Medical Outcome Study Eight-Item Short Form Health Survey (SF-8) assessment of mental and physical well-being, the Maslach Burnout Inventory and the PRIME-MD two-item depression screen. We also measured empathy using the perspective taking and empathic concern subscales of the Interpersonal Reactivity Index. Medical knowledge measures included scores on web-based learning module post-tests and scores on the national Internal Medicine In-Training Examination (IM-ITE). As data for each association were available for at least 126 residents, this study was powered to detect a small-to-moderate effect size of 0.3 standard deviations. RESULTS No statistically significant associations were observed between well-being and either web-based learning module post-test score or IM-ITE score. Parameter estimates of the association of well-being variables with knowledge scores were uniformly small. For all well-being metrics, meaningful differences were associated with knowledge score difference estimates of < 1 percentage point. CONCLUSIONS Resident well-being appears to have limited association with competence in medical knowledge as assessed following web-based courses on specific topics or using standardised general medical examinations.

Recent research suggests a relationship between empathy and error processing. Error processing is an evaluative control function that can be measured using post-error response time slowing and the error-related negativity (ERN) and post-error positivity (Pe) components of the event-related potential (ERP). Thirty healthy participants completed two measures of empathy, the Interpersonal Reactivity Index (IRI) and the Empathy Quotient (EQ), and a modified Stroop task. Post-error slowing was associated with increased empathic personal distress on the IRI. ERN amplitude was related to overall empathy score on the EQ and the fantasy subscale of the IRI. The Pe and measures of empathy were not related. Results remained consistent when negative affect was controlled via partial correlation, with an additional relationship between ERN amplitude and empathic concern on the IRI. Findings support a connection between empathy and error processing mechanisms.

The mirror neuron system (MNS) is considered crucial for human imitation and language learning and provides the basis for the development of empathy and mentalizing. Alexithymia (ALEX), which refers to deficiencies in the self‐awareness of emotional states, has been reported to be associated with poor ability in various aspects of social cognition such as mentalizing, cognitive empathy, and perspective‐taking. Using functional magnetic resonance imaging (fMRI), we measured the hemodynamic signal to examine whether there are functional differences in the MNS activity between participants with ALEX (n = 16) and without ALEX (n = 13), in response to a classic MNS task (i.e., the observation of video clips depicting goal‐directed hand movements). Both groups showed increased neural activity in the premotor and the parietal cortices during observation of hand actions. However, activation was greater for the ALEX group than the non‐ALEX group. Furthermore, activation in the left premotor area was negatively correlated with perspective‐taking ability as assessed with the interpersonal reactivity index. The signal in parietal cortices was negatively correlated with cognitive facets assessed by the stress coping inventory and positively correlated with the neuroticism scale from the NEO five factor personality scale. In addition, in the ALEX group, activation in the right superior parietal region showed a positive correlation with the severity of ALEX as measured by a structured interview. These results suggest that the stronger MNS‐related neural response in individuals scoring high on ALEX is associated with their insufficient self‐other differentiation. Hum Brain Mapp, 2009. © 2008 Wiley‐Liss, Inc.

Work stress, burnout, and diminished empathy are prevalent issues for health-care professionals. Mindfulness meditation (MM) is one commonly used strategy to manage stress. Measuring salivary cortisol allows for the assessment of serum cortisol level, a known stress level indicator. This study evaluated the association of subject-reported stress symptoms and salivary cortisol in health-care professionals, in an 8-week MM program, with data collected prospectively at baseline and 8 weeks after program completion. Questionnaires [Profile of Mood States—Short Form (POMS-SF), Maslach Burnout Inventory (MBI), and Interpersonal Reactivity Index (IRI)] measured mood, burnout and empathy. A paired t-test between groups for pre/post-salivary cortisol yielded no significant change. The POMS-SF was most sensitive to change (mean increase 12.4; p = 0.020). Emotional exhaustion, measured in the MBI, was also affected by MM (mean decrease 4.54; p = 0.001). Changes in empathy may not have been captured due to either absence of effect of MM on empathy, subject number or scale sensitivity. Baseline and 8-week correlations between salivary cortisol and survey results, and correlations between changes in these measures, were weak and not statistically significant. Nevertheless, psychometric results present a strong case for additional clinical trials of MM to reduce stress for health-care professionals. Copyright © 2005 John Wiley & Sons, Ltd.

BACKGROUND: Assessment of and interventions for promoting eating in persons with late-stage dementia have primarily focused on facilitation of safe feeding and methods to promote ingestion of nutrients via several routes. Using Social Exchange Theory, this study examined how the quality of the interaction between care giver and care receiver influenced the proportion of food consumed by persons with late-stage dementia. METHODS: Fifty-three dyads composed of nursing home residents with late-stage dementia and Certified Nursing Assistants (CNAs) were observed during the breakfast meal. The proportion of food consumed by the residents was measured by weight. The study included measures of the quality of interaction between the resident and the CNA (Interaction Behavior Measure-Modified (IBM-M) and the IBM), CNA empathy (Interpersonal Reactivity Index), and CNA power (Control subscale of the FIRO-B). RESULTS: Specific resident behaviors and the CNA's ability to allow another person to control a relationship were most predictive of the variance in the proportion of food consumed (R2 =. 41; F3,49 = 12.54; P

Purpose. The main aims of the study were to investigate attitudes towards the victims of bullying, and to explore the role of empathy in bullying others. It was predicted that those who reported ‘bullying others’ would report less positive attitudes towards victims and lower levels of empathy than those who did not engage in bullying behaviour. It was predicted that differences would be found in attitudes and empathy between sex. No predictions were made with regard to adults vs. young offenders. Method. The sample was selected from five separate prison establishments and consisted of 98 young offenders (21 women and 77 men) and 211 adult offenders (53 women and 158 men). Prisoners were categorized as ‘bullies’, ‘bully/victims’, ‘pure victims’ or ‘not involved’ on the basis of a self-report behaviour checklist (Direct and Indirect Prisoner Behaviour Checklist (DIPC)). A modified version of the Rigby & Slee (1991) Provictim Scale and the Davis (1980) Interpersonal Reactivity Index were used to measure attitudes and empathy respectively. Results. The attitudes of the ‘bully’ and the ‘bully/victim’ group were found to reflect their behaviour in that both were less ‘provictim’ than those not involved in bullying. Women were significantly more provictim than men, and adults were significantly more provictim than young offenders. Women scored significantly higher on some components of empathy than men. The implications of these findings for bullying intervention programmes are discussed.

At Chavez Community School in Phoenix, disposilional empathy and cognitive perspective taking of elementary school students were examined. The study compared social-cognition of peer mediators with nonmediators over the course of an academic year. Pre-to-post increases in cognitive and affective perspective taking, as measured by the Interpersonal Reactivity Index, indicate that social cognition may be enhanced by mediation training and practice. Effects for disputants were also observed.

Purpose. Post-conviction DNA exonerations demonstrate a failure of alibis to protect innocent suspects. We contend one reason alibis are not believed is because evaluators underestimate how difficult it is for an innocent person to generate a convincing alibi. We hypothesized that asking evaluators to first generate an alibi of their own would lead evaluators to consider a suspect's alibi as more believable. Methods. Participants (N= 147) were randomly assigned to either evaluate a suspect's alibi before generating their own alibi (evaluate-first) or generate their own alibi before evaluating the suspect's alibi (generate-first). Participants provided alibis from either 3 days previous or 30 days previous. In Experiment 2, participants (N= 255) were randomly assigned to either generate-first, evaluate-first, or read-experience (in which they read about alibi-generation difficulty) conditions. Half the participants were primed to think empathetically with Interpersonal Reactivity Index (IRI) subscales, and half were not. All participants evaluated the believability of the suspect's alibi as well as their own alibis. Results. Across both experiments, participants who generated their own alibi first rated the suspect's alibi as more believable. This alibi-generation effect overshadowed alibi latency in Experiment 1 and the empathy manipulation in Experiment 2. Conclusions. Alibi-generation experience seems to change the expectations evaluators have of alibis from criminal suspects. This effect likely emanates from increased awareness that alibis are difficult for innocent people to generate and from the emotional experience of having difficulty generating alibis.