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Empathy and Emotion Regulation: Training complementary skills for well-being

Compassion in Action Webinar Series

April 23, 2019

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Stephanie Adler Yuan

Director, Education & TrainingThe Schwartz Center for Compassionate Healthcare

Moderator

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Audience Reminders

• This webinar is funded in part by a donation in memory of Julian and Eunice Cohen.

• You may submit a question by typing it into the Question and Answer pane at the right of your screen at any time.

• Please respond to audience polls by clicking on the answer of your choice.

• We value your feedback! Please complete our electronic survey following the webinar.

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Beth Lown, MD

Medical DirectorThe Schwartz Center for Compassionate Healthcare

Host

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Today’s Speaker

Tammi Kral, MSDoctoral Candidate, Psychology

Center for Healthy Minds, University of Wisconsin–Madison

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Overview

• What is empathy?

• Measuring empathy

• Learning empathy

• Mindfulness meditation for emotion regulation

• Complementary approach to empathic well-being

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What is empathy?Underlying processes & neural bases

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Empathy

• The ability to understand others’ emotions

• May be first step in altruistic behavior

• Associated with less bullying and internalizing symptoms in teens

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Empathy & Patient Care

• Empathic care associated with improvements in:• Outcomes

• Satisfaction

• Adherence to treatment

• Professional satisfaction (physician)

• Can also relate to provider burnout

• For summary see: Decety & Fotopoulou, Front Behav Neurosci, 2015

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Psychological Processes

• Perspective Taking• “cognitive empathy”

• thinking

• Experience Sharing• “affective empathy”

• feeling

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Neural bases of perspective taking & experience sharing

Temporal pole

Precuneus Medial

prefrontal

cortex

Anterior

cingulate

cortex

Premotor cortex Inferior parietal

lobule

Temporoparietal

junction

(TPJ)

Anterior insula

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Polling Question 1:

In general, what do you feel when empathizing with others?

A. warmth, compassionB. stress

C. sadnessD. a combination

E. none of the above

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Empathic Response

• Empathic Concern• Other-focused

• Associated with altruism

• Empathic Distress• Self-focused

• Necessitates emotion regulation

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BEmotion Regulation

PFC

Amygdala

• The ability to alter one’s emotions

• Explicit strategies• Cognitive reappraisal / reframing

• Suppression of response

• Implicit (e.g. automatic) forms• Extinction learning

• Supported by amygdala and prefrontal cortex (PFC)

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Polling Question 2:

Have you learned any strategies to regulate your emotions?

A. cognitive reframing / reappraisalB. mindfulness-based stress reduction

C. compassion meditationD. acceptance

E. other strategy

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Measuring empathyThe importance of accuracy

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Empathic Accuracy

• Naturalistic, behavioral measure

• Opportunities for perspective taking (narratives) & experience sharing (emotionally expressive faces)

(Kral et al., 2017)

TARGET PROCEDURE

STEP 1: Record videos of target

describing emotional events

from adolescence.

STEP 2: Target watches and rates

emotion intensity in their own videos

from “Very Negative” to “Very Positive”.

FINAL STEP: Compute empathic accuracy

for the video from correlation between

target (pink) and perceiver ratings (green).

TIME (s)

RA

TIN

G

A. HIGH EMPATHIC ACCURACYC1.

0 10 20 30 40 50 60 70 80−3

−2

−1

0

1

2

3

4

+

LOW EMPATHIC ACCURACYC2.

0 10 20 30 40 50 60 70 80−3

−2

−1

0

1

2

3

4

TIME (s)

RA

TIN

G

TARGET

PERCEIVER

5 6 7 8 94321

How did you feel while talking?

Very

Negative

Very

Positive

PERCEIVER PROCEDURE

STEP 1: Perceiver rates target’s emotions in videos during an fMRI scan using the identical

scale as the targets used in Step 2 of Part A (above).

B.

28 - 144s3s 2s

CUE5 6 7 8 94321

How did this person feel while talking?

Very

Negative

Very

Positive

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Neural bases of empathic accuracy

Zaki, J., Weber, J., Bolger, N., Ochsner, K., 2009. The neural bases of empathic accuracy. Proc.

Natl. Acad. Sci. U. S. A. 106, 11382–11387. doi:10.1073/pnas.0902666106

Supported by brain

regions underlying

perspective taking &

experience sharing

in adults.

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Example Video: Empathic Accuracy Task

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PERSPECTIVE

TAKING

NETWORK

EXPERIENCE

SHARING

NETWORK

Kral et al., SCAN,

2017

Neural bases of empathic accuracy in teens

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Experience sharing in teens

• Activation of experience sharing brain networks associated with lower empathic accuracy

• Experience sharing can easily lead to empathic distress, especially when regulation is lacking

• Teens have difficulty with emotion regulation

• Empathic distress without regulation may hinder ability to empathize (accurately)

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Learning empathyVideo game training

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a

b

c

d

e

f

a

b

c

d

e

f

a

b

c

d

e

fa

b

c

d

e

f

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Empathic Accuracy-Related Changes

TARGET PROCEDURE

STEP 1: Record videos of target

describing emotional events

from adolescence.

STEP 2: Target watches and rates

emotion intensity in their own videos

from “Very Negative” to “Very Positive”.

FINAL STEP: Compute empathic accuracy

for the video from correlation between

target (pink) and perceiver ratings (green).

TIME (s)

RA

TIN

G

A. HIGH EMPATHIC ACCURACYC1.

0 10 20 30 40 50 60 70 80−3

−2

−1

0

1

2

3

4

+

LOW EMPATHIC ACCURACYC2.

0 10 20 30 40 50 60 70 80−3

−2

−1

0

1

2

3

4

TIME (s)

RA

TIN

G

TARGET

PERCEIVER

5 6 7 8 94321

How did you feel while talking?

Very

Negative

Very

Positive

PERCEIVER PROCEDURE

STEP 1: Perceiver rates target’s emotions in videos during an fMRI scan using the identical

scale as the targets used in Step 2 of Part A (above).

B.

28 - 144s3s 2s

CUE5 6 7 8 94321

How did this person feel while talking?

Very

Negative

Very

Positive

a

b

c

d

e

f

a

b

c

d

e

f

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Empathic Accuracy-related Changes in Connectivity of Emotion Regulation Brain Network

B

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Mindfulness MeditationTraining to improve emotion regulation

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Mindfulness meditation to improve emotion regulation

• Attention focused on present-moment experience without avoiding negative or clinging to positive feelings

• Practice seeing thoughts as temporary, impersonal

• Improves anxiety, depression, mood and emotion regulation

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Mindfulness Training Increased Amygdala – PFC Connectivity

B

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Empathic well-beingA complementary approach

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Combined training in empathy & emotion regulation

• Improved emotion regulation through mindfulness meditation could mitigate empathic distress

• Regulating emotions increases empathic concern (Decety & Fotopoulou, Front Behav Neurosci, 2015)

• Initial evidence a mindfulness-based intervention for physicians may improve empathy while lowering burnout (Krasner, et al, JAMA, 2009)

• May be particularly useful in helping professions to avoid burnout, improve well-being & outcomes

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Thank YOU!

Richard Davidson Jeanette MumfordBrianna SchuylerRick SolisMelissa RosenkranzConstance SteinkuehlerSteven LoriaNate VackMike BeallDiane BussanRasmus BirnAntoine Lutz

Lisa FlookElena PatsenkoCraig Anderson Michael AnderleRobin GoldmanDan GrupeRon FisherJeanne HarrisChris HartyLisa AngelosAbigail FreemanAndy SchoenCory Burghy

Reza FarajianNagesh AdluruSteve KecskemetiSasha Sommerfeldt David PerlmanDaniel LevinsonShannon HarrisGreg VaughnJohn BinzakKurt SquireAllison Salmon

*And a big thanks to all of our participants & their families!

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Questions & Answers

Beth Lown, MDMedical Director

The Schwartz Center for Compassionate Healthcare

Tammi Kral, MSDoctoral Candidate, Psychology

Center for Healthy Minds, University of Wisconsin–Madison

Type your questions in the Questions Pane on your screen at any time.

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