- Goubert a,b,*,1, K.D. Craigc, T. Vervoort a,b,2, S. Morleyd, M.J.L. Sullivane, A.C. de C. Williams f, A. Canog, G. Crombeza,b
aDepartment of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium bResearch Institute for Psychology & Health, Utrecht, The Netherlands
A wealth of research addresses intra-individual determinants of pain, distress and disability. In contrast, limited attention has been devoted to the interpersonal domain. It is well established that significant others have an impact upon the experience of pain and associated suffering (Romano et al., 2000). Largely unexplored are the effects of pain upon the experience of observers themselves. Facing others in pain elicits a varied range of responses from ignoring to distress, compassion, and inclinations to comfort or help. In this review we will argue that understanding the effects of facing others in pain requires an understanding of empathy. After defining the construct and exploring relevant theories, we apply empathy to pain. We discuss how and when empathy may foster distress and inclinations to help, and provide suggestions for future research.
Definition of empathy
Most definitions of empathy have a core tenet that empathy is about a sense of knowing the personal experience of another person, a capacity which Ickes (2003) dubbed ‘mind-reading’. Most definitions also include the position that this sense of knowing is accompanied by affective and behavioural responses (Davis, 1996). Although simple and operational, this definition requires further qualification. First, we contend that empathy is not exclusively human (Preston and de Waal, 2002). Second, the inferred experience of the other may comprise thoughts, feelings or motives. Third, empathy may manifest itself in various ways. Some of these may be automatic and implicit. Others might be explicit and depend upon the intentional and effortful use of cognitive processes. Fourth, affective responses to facing another personmay often, but not always, entail sharing that person’s emotional state. In sum, empathy is best construed as a sense of knowing the experience of another person with cognitive, affective and behavioural components.
Models of empathy
An influential account of empathy in clinical models of therapy was proposed by Carl Rogers (1957). He concluded that accurate empathy is a necessary condition for therapists attempting to help others. He was convinced that therapists had to sense the patient’s private world as if it were his/her own, but without ever losing the ‘as if’ quality. The latter was needed to avoid becoming overinvolved and overwhelmed by the patient’s experience.
Empathy in the context of pain
Few studies have directly examined empathy for pain. Notable exceptions are fMRI studies providing evidence that observing somebody in pain activates similar neurons as if the observer were feeling pain himself (Botvinick et al., 2005; Jackson et al., 2005). Lack of absolute concordance is reflected in the findings of Singer et al. (2004) who observed that only the affective and not the sensory components of the pain network were activated. It seems then that facing others in pain most often elicits affective distress in the observer.