Relationship between affective state and empathy in medical and psychology students

Abstract

Objective Stress, affective distress (e.g., anxiety & depression symptoms) and burnout, which are commonly experienced by health sciences students and clinicians, are reported to impair empathy. However, few prior studies have examined them in regards to empathy despite its importance to clinical practice. Thus, we examined the relationship between stress, affective distress (i.e., anxiety, depression), components of burnout (i.e., emotional exhaustion, cynicism, low professional efficacy), and empathy in medical and psychology students and compared empathy and its predictors in the two student groups. Further, the putative mechanism underpinning empathy – interoceptive sensibility (IS; i.e., extent of awareness of bodily sensations) – was also examined in regards to empathy.

Methods Medical (N = 80) and psychology (N = 213) students, including 206 females (70.3%) and 85 males, completed an online questionnaire that asked about empathy, stress, affective distress, burnout and IS. Multiple regression analyses identified which factors were related to global empathy (GE, i.e., total score), emotional empathy (EE), and cognitive empathy (CE).

Results As a whole, the students reported average empathy levels as follows: EE (M = 13.49, SD = 3.92), CE (M = 16.32, SD = 5.11), and GE total score (M = 44.95, SD = 11.5). In the full sample, after controlling for gender, degree type and Autism Spectrum Quotient score, low GE and CE were associated with low professional efficacy, and low EE was related to high cynicism and low emotional exhaustion. A similar profile of results was obtained in psychology students except that low GE was also associated with low anxiety and high autonomic nervous system (ANS)-reactivity, low EE was related to low professional efficacy (but unrelated to emotional-exhaustion and low CE was related to low anxiety. No difference in GE, EE and CE were detected between psychology and medical students.

Conclusion Results suggest that the qualities which reduce the potential for good quality communication (i.e., cynicism, autistic traits) may compromise empathy. However, hyper-arousal states (e.g., anxiety, emotional-exhaustion) may not necessarily impair empathy unless a person excessively focuses on their autonomic arousal sensations.

KEY POINTS What is already known about this topic: (1) Psychological distress is reported to impair empathy in clinicians and medical students, but few studies have examined the premise despite the importance of empathy in clinical practice. (2) Prior studies have shown that empathy is inconsistently related to emotional state measures including the components of affective distress (e.g., anxiety) and burnout (e.g., emotional-exhaustion), and no studies have examined interoceptive awareness in this regard. (3) Most prior studies have shown that low empathy was related to greater affective distress and burnout, but several reported that it was related to low affective distress and burnout. What this topic adds: (1) Our results showed that low empathy was related to low anxiety, emotional-exhaustion and professional efficacy, but greater cynicism, autistic traits and awareness of ANS sensations. (2) No differences in global, emotional or cognitive empathy was detected between medical students and psychology students. (3) Results suggest that empathy may be impaired by experiences that can hamper communication (e.g., cynicism, autistic traits) whereas hyper-arousal states (i.e., anxiety, emotional-exhaustion) may not necessarily impair empathy, except when there is heightened awareness of ANS sensations.