Understanding the Links between Inferring Mental States, Empathy, and Burnout in Medical Contexts

  1. Delgado, Naira
  2. Bonache, Helena
  3. Morera, Yurena
  4. Betancort, Moisés
  5. Harris, Lasana T.
  1. 1 Universidad de La Laguna
    info

    Universidad de La Laguna

    San Cristobal de La Laguna, España

    ROR https://ror.org/01r9z8p25

  2. 2 University College London
    info

    University College London

    Londres, Reino Unido

    ROR https://ror.org/02jx3x895

Revista:
Healthcare

ISSN: 2227-9032

Año de publicación: 2021

Volumen: 9

Número: 2

Páginas: 158

Tipo: Artículo

DOI: 10.3390/HEALTHCARE9020158 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Healthcare

Resumen

It is generally accepted that empathy should be the basis of patient care. However, this ideal may be unrealistic if healthcare professionals suffer adverse effects when engaging in empathy. The aim of this study is to explore the effect of inferring mental states and different components of empathy (perspective-taking; empathic concern; personal distress) in burnout dimensions (emotional exhaustion; depersonalization; personal accomplishment). A total of 184 healthcare professionals participated in the study (23% male, Mage = 44.60; SD = 10.46). We measured participants’ empathy, the inference of mental states of patients, and burnout. Correlation analyses showed that inferring mental states was positively associated with perspective-taking and with empathic concern, but uncorrelated with personal distress. Furthermore, emotional exhaustion was related to greater levels of personal distress and greater levels of inferences of mental states. Depersonalization was associated with greater levels of personal distress and lower levels of empathic concern. Personal accomplishment was associated with the inference of mental states in patients, lower levels of personal distress, and perspective-taking. These results provide a better understanding of how different components of empathy and mental state inferences may preserve or promote healthcare professionals’ burnout.

Referencias bibliográficas

  • Shapiro, J.; McDonald, T.B. Supporting clinicians during Covid-19 and beyond—Learning from past failures and envisioning new strategies. N. Engl. J. Med. 2020, 383, e142. [CrossRef] [PubMed]
  • Gleichgerrcht, E.; Decety, J. The costs of empathy among health professionals. In Empathy: From Bench to Bedside; Decety, J., Ed.; MIT Press: Cambridge, MA, USA, 2012; pp. 245–261.
  • Gleichgerrcht, E.; Decety, J. Empathy in clinical practice: How individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS ONE 2013, 8, e61526. [CrossRef] [PubMed]
  • Halpern, J. Clinical empathy in medical care. In Empathy: From Bench to Bedside; Decety, J., Ed.; MIT Press: Cambridge, MA, USA, 2012; pp. 229–244.
  • Rothschild, B. Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma; WW Norton & Company: New York, NY, USA, 2006.
  • Aström, S.; Norberg, A.; Nilsson, M.; Winblad, B. Tedium among personnel working with geriatric patients. Scand. J. Caring Sci. 1987, 1, 125–132. [CrossRef] [PubMed]
  • Ferri, P.; Guerra, E.; Marcheselli, L.; Cunico, L.; Di Lorenzo, R. Empathy and burnout: An analytic cross-sectional study among nurses and nursing students. Acta Bio-Med. Atenei Parm. 2015, 86, 104–115.
  • Hoffman, M.I. Empathy and Moral Development: Implications for Caring and Justice; Cambridge University Press: New York, NY, USA, 2000.
  • Mercer, S.W.; Reynolds, W.J. Empathy and quality of care. Br. J. Gen. Pract. 2002, 52, S9–S12. [PubMed]
  • Picard, J.; Catu-Pinault, A.; Boujut, E.; Botella, M.; Jaury, P.; Zenasni, F. Burnout, empathy and their relationships: A qualitative study with residents in General Medicine. Psychol. Health Med. 2015, 21, 354–361. [CrossRef]
  • Davis, M.H. A multidimensional approach to individual differences in empathy. JSAS 1980, 10, 85.
  • Batson, C.D. These things called empathy. In The Social Neuroscience of Empathy; Decety, J., Ickes, W., Eds.; MIT Press: Cambridge, MA, USA, 2009; pp. 3–15.
  • Decety, J. The neuroevolution of empathy. Ann. N. Y. Acad. Sci. 2011, 1231, 35–45. [CrossRef]
  • Decety, J.; Cowell, J.M. The complex relation between morality and empathy. Trends Cogn. Sci. 2014, 18, 337–339. [CrossRef]
  • Decety, J.; Smith, K.E.; Norman, G.J.; Halpern, J. A social neuroscience perspective on clinical empathy. World Psychiatry 2014, 13, 233–237. [CrossRef]
  • Singer, T.; Lamm, C. The social neuroscience of empathy. Ann. N. Y. Acad. Sci. 2009, 1156, 81–96. [CrossRef] [PubMed]
  • Völlm, B.A.; Taylor, A.N.; Richardson, P.; Corcoran, R.; Stirling, J.; McKie, S.; Deakin, J.F.; Elliott, R. Neuronal correlates of theory of mind and empathy: A functional magnetic resonance imaging study in a nonverbal task. NeuroImage 2006, 29, 90–98. [CrossRef] [PubMed]
  • Epley, N.; Waytz, A. Mind perception. In Handbook of Social Psychology; Wiley: New York, NY, USA, 2010; pp. 498–541.
  • Harris, L.T.; Fiske, S.T. Social neuroscience evidence for dehumanised perception. Eur. Rev. Soc. Psychol. 2009, 20, 192–231. [CrossRef]
  • Gray, H.M.; Gray, K.; Wegner, D.M. Dimensions of mind perception. Science 2007, 315, 619. [CrossRef] [PubMed]
  • Fiske, S.T.; Taylor, S.E. Social Cognition, 2nd ed.; Mcgraw-Hill: New York, NY, USA, 1991.
  • Fiske, S.T.; Taylor, S.E. (Eds.) Attention and encoding. In Social Cognition: From Brains to Culture; McGraw-Hill: New York, NY, USA, 2008; pp. 51–74.
  • Herrmann, E.; Call, J.; Hernàndez-Lloreda, M.V.; Hare, B.; Tomasello, M. Humans have evolved specialized skills of social cognition: The cultural intelligence hypothesis. Science 2007, 317, 1360–1366. [CrossRef]
  • Saxe, R. Uniquely human social cognition. Curr. Opin. Neurobiol. 2006, 16, 235–239. [CrossRef]
  • Waytz, A.; Schroeder, J.; Epley, N. The lesser minds problem. In Humanness and Dehumanization; Bain, P.G., Vaes, J., Leyens, J.-P., Eds.; Psychology Press: New York, NY, USA, 2014; pp. 49–67.
  • Fiske, S.T. Varieties of (de) humanization: Divided by competition and status. In Objectification and (De) Humanization; Gervais, S.J., Ed.; Springer: New York, NY, USA, 2013; pp. 53–71.
  • Harris, L.T.; Fiske, S.T. Dehumanizing the lowest of the low: Neuroimaging responses to extreme out-groups. Psychol. Sci. 2006, 17, 847–853. [CrossRef]
  • Harris, L.T.; Fiske, S.T. Perceiving humanity or not: A social neuroscience approach to dehumanized perception. In Social Neuroscience: Toward Understanding the Underpinnings of the Social Mind; Todorov, A., Fiske, S., Eds.; Oxford University Press: Oxford, UK, 2011; pp. 123–134.
  • Haslam, N. Dehumanization: An integrative review. Pers. Soc. Psychol. Rev. 2006, 10, 252–264. [CrossRef]
  • Haslam, N.; Loughnan, S. Dehumanization and infrahumanization. Annu. Rev. Psychol. 2014, 65, 399–423. [CrossRef]
  • Leyens, J.-P.; Rodríguez-Pérez, A.; Rodríguez-Torres, R.; Gaunt, R.; Paladino, M.P.; Vaes, J. Psychological essentialism and the differential attribution of uniquely human emotions to ingroups and outgroups. Eur. J. Soc. Psychol. 2001, 31, 395–411. [CrossRef]
  • Buffone, A.E.; Poulin, M.; Delury, S.; Ministero, L.; Morrisson, C.; Scalco, M. Don’t walk in her shoes! Different forms of perspective taking affect stress physiology. J. Exp. Soc. Psychol. 2017, 72, 161–168. [CrossRef]
  • Dvash, J.; Shamay-Tsoory, S.G. Theory of Mind and empathy as multidimensional constructs: Neurological foundations. Top. Lang. Disord. 2014, 34, 282–295. [CrossRef]
  • Christoff, K. Dehumanization in organizational settings: Some scientific and ethical considerations. Front. Hum. Neurosci. 2014, 8, 748. [CrossRef]
  • Halpern, J. What is clinical empathy? J. Gen. Intern. Med. 2003, 18, 670–674. [CrossRef] [PubMed]
  • Lamothe, M.; Boujut, E.; Zenasni, F.; Sultan, S. To be or not to be empathic: The combined role of empathic concern and perspective taking in understanding burnout in general practice. BMC Fam. Pract. 2014, 15, 15. [CrossRef]
  • Capozza, D.; Falvo, R.; Boin, J.; Colledani, D. Dehumanization in medical contexts: An expanding research field. Test. Psychom. Methodol. Appl. Psychol. 2016, 23, 545–559.
  • Decety, J.; Yang, C.-Y.; Cheng, Y. Physicians down-regulate their pain empathy response: An event-related brain potential study. NeuroImage 2010, 50, 1676–1682. [CrossRef]
  • Vaes, J.; Muratore, M. Defensive dehumanization in the medical practice: A cross-sectional study from a health care worker’s perspective. Br. J. Soc. Psychol. 2013, 52, 180–190. [CrossRef]
  • Fitzgerald-Yau, N.; Egan, J. Defense styles mediate the association between empathy and burnout among nurses. J. Nerv. Ment. Dis. 2018, 206, 555–561. [CrossRef]
  • Duarte, J.; Pinto-Gouveia, J. The role of psychological factors in oncology nurses’ burnout and compassion fatigue symptoms. Eur. J. Oncol. Nurs. 2017, 28, 114–121. [CrossRef]
  • Thomas, J. Association of personal distress with burnout, compassion fatigue, and compassion satisfaction among clinical social workers. J. Soc. Serv. Res. 2013, 39, 365–379. [CrossRef]
  • Von Harscher, H.; Desmarais, N.; Dollinger, R.; Grossman, S.; Aldana, S. The impact of empathy on burnout in medical students: New findings. Psychol. Health Med. 2018, 23, 295–303. [CrossRef] [PubMed]
  • Pérez-Albéniz, A.; De Paúl, J.; Etxeberría, J.; Montes, M.P.; Torres, E. Adaptación de interpersonal reactivity index (IRI) al español. Psicothema 2003, 15, 267–272.
  • Egleichgerrcht, E.; Edecety, J. The relationship between different facets of empathy, pain perception and compassion fatigue among physicians. Front. Behav. Neurosci. 2014, 8, 243. [CrossRef]
  • Maslach, C.; Jackson, S.E. Inventario Burnout de Maslach (MBI): Síndrome del Quemado por Estrés Laboral Asistencial; TEA Ediciones: Madrid, Spain, 1997.
  • Hernández, J.; Betancort, M. ULLRToolbox. 2016. Available online: https://sites.google.com/site/ullrtoolbox/ (accessed on 21 September 2020).
  • Rosseel, Y. Lavaan: An R package for structural equation modeling. Version 0.5-12 (BETA). J. Stat. Softw. 2012, 48, 1–36. [CrossRef]
  • Hayes, A.F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach; The Guilford Press: New York, NY, USA, 2013.
  • Haque, O.S.; Waytz, A. Dehumanization in medicine: Causes, solutions, and functions. Perspect. Psychol. Sci. 2012, 7, 176–186. [CrossRef]
  • Davis, M.H. The effects of dispositional empathy on emotional reactions and helping: A multidimensional approach. J. Pers. 1983, 51, 167–184. [CrossRef]
  • Decety, J. Empathy in medicine: What it is, and how much we really need it. Am. J. Med. 2020, 133, 561–566. [CrossRef]
  • Hojat, M. Empathy in Health Professions Education and Patient Care; Springer Nature: New York, NY, USA, 2016.
  • Hojat, M.; DeSantis, J.; Shannon, S.C.; Mortensen, L.H.; Speicher, M.R.; Bragan, L.; LaNoue, M.; Calabrese, L.H. The Jefferson scale of empathy: A nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students. Adv. Health Sci. Educ. 2018, 23, 899–920. [CrossRef]
  • Moudatsou, M.; Stavropoulou, A.; Philalithis, A.; Koukouli, S. The role of empathy in health and social care professionals. Healthcare 2020, 8, 26. [CrossRef]
  • Preusche, I.; Lamm, C. Reflections on empathy in medical education: What can we learn from social neurosciences? Adv. Health Sci. Educ. 2016, 21, 235–249. [CrossRef] [PubMed]
  • Shapiro, J. The paradox of teaching empathy in medical education. In Empathy: From Bench to Bedside; Decety, J., Ed.; MIT Press: Cambridge, MA, USA, 2012; pp. 275–300.
  • Lamothe, M.; Rondeau, É.; Malboeuf-Hurtubise, C.; Duval, M.; Sultan, S. Outcomes of MBSR or MBSR-based interventions in health care providers: A systematic review with a focus on empathy and emotional competencies. Complement. Ther. Med. 2016, 24, 19–28. [CrossRef] [PubMed]
  • Levett-Jones, T.; Cant, R.; Lapkin, S. A systematic review of the effectiveness of empathy education for undergraduate nursing students. Nurse Educ. Today 2019, 75, 80–94. [CrossRef] [PubMed]
  • Ford, R.; Bammer, G. A research routine to assess bias introduced by low response rates in postal surveys. Nurse Res. 2009, 17, 44–53. [CrossRef] [PubMed]