+ Published Research Papers

Andreychik, M. R., & Lewis, E. (2017). Will you help me to suffer less? How about to feel more joy? Positive and negative empathy are associated with different other-oriented motivations. Personality and Individual Differences, 105, 139-149.

• This paper does an excellent job of reviewing the research and its differing focuses on positive and negative empathy. The paper highlights two studies performed by the authors, one of which measured each type of empathy as well as the strength of ‘other-oriented’ approach and avoidance motivations. The second study examined both positive and negative empathy, and how each would predict acts of helping in different situations.

• Positive empathy in the literature is empathy associated with desiring positive outcomes and positive emotions for others. Whereas, negative empathy puts its focus on an association with a desire to help others to avoid negative outcomes and accompanying negative emotions. While these two may seem similar, each appear to approach a helping, empathic act from differing directions and are important in developing a more finely tuned approach to motivations of others when helping people around them.

• Each type of empathy was associated with accompanying motivations: positive empathy with approach motivation; negative empathy with avoidance motivations. I found this passage particularly illuminating to the concepts laid out in this paper:

• “...sensitivity to others’ positive emotions characteristics of high levels of positive empathy should be associated with the adoption of other-oriented approach goals aimed at helping others to approach or maintain positive emotional states. In contrast, the sensitivity to others’ negative emotions characteristic of high levels of negative empathy should be associated with the adoption of other-oriented avoidance goals aimed at helping others to reduce or avoid negative emotional states.”

• By understanding each approach, this project can begin to focus on cultivating the appropriate type of empathy, which I see as positive empathy. Doorway Project focuses on maintaining positive emotional states, as a ‘second-tier’ service focusing on medium to long-term goals and cultivation of skills and prosocial habits in a community cafe.

Bloom, P. (2017). Empathy and its discontents. Trends in cognitive sciences, 21(1), 24-31.

• The general perception of empathy (in this paper, feeling what others feel) is as a beneficial attribute for everything. Bloom argues that empathy can interfere with moral decision-making, since we tend to empathize with individuals instead of numbers.

• Additionally, empathy has some evidence to be influenced by an ingroup bias (we are more likely to empathize by someone we identify with), and it can be used to promote retaliation toward those who harm people we do empathize with. Bloom points to compassion (“feeling positive and warm thoughts toward others without vicariously experiencing their suffering”) as a more desirable trait, since it promotes pro-social behavior but also fosters better coping skills, since compassion does not necessitate taking on the emotional traits of another. Ultimately, Bloom recommends a more utilitarian approach to decision-making, with logic coming first and empathy as a follow-up emotion.

Buch, K., & Harden, S. (2011). The impact of a service-learning project on student awareness of homelessness, civic attitudes, and stereotypes toward the homeless. Journal of Higher Education Outreach and Engagement, 15(3), 45-61.

• The goals of the student service learning organization (Niner Neighbors) and ensuing program were threefold: 1) increase awareness of homelessness; 2) changing stereotypes and attitudes about homeless individuals, and 3) promoting positive civic attitudes. The authors lay out the published research behind why these are the goals, as well as end-of-course surveys that were employed to measure the pre-post changes in attitudes and perspectives by the engaged students.

• Over the 3-year course of the program, an estimated 400 students were involved, many of whom did not actually need the service-learning hours for their course. 114 of these students were surveyed at the end of their semester, with qualitative feedback including themes that aligned with the goals of the program, as well as increased empathy towards those experiencing homelessness in their community.

• This paper does an excellent job of describing the campus-community partnership that existed from 2007 to 2010 between UNC-Charlotte and Room at the Inn, the service provider in the community. The authors also provide the context and background for the service-learning organization as it pertains to the UNC system’s pivot toward increasing service learning for students and staff as a means of connection with communities throughout North Carolina.

Cuff, B. M., Brown, S. J., Taylor, L., & Howat, D. J. (2016). Empathy: a review of the concept. Emotion Review, 8(2), 144-153.

• The lack of a consistent definition of empathy poses challenges for research, education, and therapy. This literature review synthesizes key concepts across definitions and came across eight emergent themes (summarized below) from which they formed a common definition.

(1). Distinguishing empathy from other concepts. The authors explained the distinction between sympathy and empathy as “feeling as versus “feeling for” the other. Compassion was distinguished as concern toward another’s plight, rather than sharing emotions. Other emotions that they explored in comparison to empathy included:

• Compathy - Shared feelings due to shared circumstances

• Mimpathy - Mimicking another’s emotions without experiencing them oneself

• Transpathy - Emotional contagion

• Unipathy - Intense form of transpathy

• Tenderness - An expansive, “warm-and-fuzzy” feeling, often elicited to the delicate and defenseless.

(2). Cognitive vs affective “Cognitive” and “affective” empathy are often separated as concepts; however, the authors argue that they need not be, but that scenarios during which a person has a cognitive understanding without experiencing emotions, it should be considered “empathic understanding” rather than true empathy.

(3). Congruent vs incongruent: There is ambiguity surrounding whether the emotions experienced by the perceiver needs to be the same emotions experienced by the perceived. Neuroscientific evidence has not been able to prove this either way. Authors conclude that true congruency is impossible since everyone’s perception is based on their own experience.

(4). Subject to other stimuli? Empathy is not limited to people who are directly present, or even who are necessarily real (eg. Fictional characters).

(5). Self/other distinction or merging? During an empathetic experience, the observer is aware that the emotions they are experiencing belong to the other. Nevertheless, emotions occur on a neurological level. Thus, some merging is evident.

(6). Trait or state influences Some generalizations can be made about traits, but situations potentially affect empathetic capacity more.

(7). Has a behavioral outcome? Empathy can be a behavioral motivation, but it is not guaranteed to have an outcome. Generally the response/outcome is pro social, but it can be used for manipulation.

(8). Automatic or controlled? Research indicates that both automatic and controlled processes influence empathy.

Thus, the authors reached the following definition of empathy:

• “Empathy is an emotional response (affective), dependent upon the interaction between trait capacities and state influences. Empathetic processes are automatically elicited but are also shaped by top-down control processes. The resulting emotion is similar to one’s perception (directly experienced or imagined) and understanding (cognitive empathy) of the stimulus emotion, with recognition that the source of the emotion is not one’s own.”

• This definition sheds light on many of the ambiguities and also distinguishes it from other emotions. Concepts that remained ambiguous through the literature review were not included, and the only articles reviewed were written in English, which means that this is a Western interpretation of empathy. Nevertheless, this is a good starting point for guiding and interpreting future research on this topic. I hope to see this definition evolve as we learn more, particularly about whether empathy influences future behavior.

Fiske, S. T. (2009). From dehumanization and objectification to rehumanization: Neuroimaging studies on the building blocks of empathy. Annals of the New York Academy of Sciences, 1167(1), 31-34.

• This paper is an excellent introduction to the basics of the neuroscience level of what is happening during the presence and absence of empathy. The author breaks down the first two building blocks of what constitutes empathy from one person to another: First, an individual must recognize another as human. And second, a person reflexively determines the other person’s valuation based upon two characteristics: trait warmth and competence.

• The author highlights the high/low stereotyped valuation of these two characteristics in people, such as elderly people, being high in warmth, but low in competence. Conversely, rich people are stereotyped as low in warmth, but high in competence. “Out groups” such as racial minorities, those addicted to drugs, or those experiencing homeless are stereotyped as low warmth/low competence, with extended levels of positive empathy following accordingly.

• Important areas of the brain highlighted were the mPFC and the amygdala, which both are heavily involved in the process of empathy towards another. An interesting last piece to this article was a reference to another research study which found the following:

  “...an individuating goal that requires mind perception (inferring vegetable preferences) also eliminates the amygdala activation to racial out-groups. The same task rehumanizes the lowest of the low-social outcasts, such as homeless people and drug addicts. That is, inferring vegetable preferences re-activates the mPFC for images that previously de-activated it.” (The referenced study in this passage is “Harris & Fiske 2007. Social groups that elicit disgust are differentially processed in mPFC.”)

Frans De Waal. (2005). The Evolution of Empathy. Greater Good Science Center at UC Berkeley

• This short article highlights the prevalence of empathy beyond humans, and focuses on its existence as a biological force, rather than a human moral one. By understanding our biological underpinnings of empathy, we can subvert the typical ties of morality to the concept and begin to understand it as a drive for connection that has existed throughout our evolution.

• De Waal terms this as our ’biological leash’ and it is an important concept to keep in mind as we venture into sociological and health sciences territories. At the end of the day, we are a species defined by group connection. Leveragining that tendency toward greater social justice is the key to cultivating empathy in others and creating positive outcomes for a broader community.

Goldstein, T. R., & Winner, E. (2012). Enhancing empathy and theory of mind. Journal of cognition and development, 13(1), 19-37.

• This quasi-experimental study investigated whether experience in acting, an activity in which one must put oneself into another’s shoes, leads to growth in empathy and/or theory of mind (matching others’ mental states). Elementary and high school children were given the choice of one year of either acting or another arts training. Participants in both elementary and high school showed significant gains in empathy scores; high schoolers, who received more training throughout the week, also showed gains in theory of mind.

• The authors conclude that findings demonstrate plasticity in empathy and theory of mind past the previously-understood watershed age of 3 to 4 years and suggests that “both capacities are enhanced by role-playing.”

• These findings are intriguing, and it would be interesting to see a study in which students were randomly assigned to a group, or replicated with adults. Findings also beg the question: if people were instructed to act like someone in a subgroup that they might stigmatize (eg. People experiencing homelessness), would they become more empathetic toward that group? How could we apply this knowledge to foster empathy in our communities and do so without perpetuating stereotypes?

Lifewise. (2015). An Insight Into the Experience of Rough Sleeping in Central Auckland (Rep.). Auckland, New Zealand: Lifewise.

• This report uses interviews with people in Auckland to gain further insight into the best practices needed to address the issue of homelessness (“rough sleeping”) there. Through interviews with people who directly or indirectly experienced the effects of homelessness (i.e. family members), the researchers were able to gain insight into influencing factors, coping mechanisms, challenges faced and pathways into and out of homelessness.

• Also interviewed were non-homeless people who interact in and around the areas of the city in which people “rough sleep”. This provided information into how the general public may perceive this issue, and what approaches may prove successful to gain proactive support to provide services and opportunities.

• This report can be used as a model for the non-academic and easy-to-access way in which information is presented. Illustrations, word clouds and digestible graphics each provide increased access to readers from all backgrounds.

Morelli, S. A., Lieberman, M. D., & Zaki, J. (2015). The emerging study of positive empathy. Social and Personality Psychology Compass, 9(2), 57-68.

• The authors of this paper do an excellent job of asking critical questions of the emerging study of ‘positive empathy,’ or “the ability to share, celebrate, and enjoy others' positive emotions.” Their main questions, which frame the paper, are: 1) Is positive empathy a unique construct from concepts like general positivity or negative empathy? And, 2) Does positive empathy actually, verifiably enhance relationships or increase happiness?

• The answers to both of these questions are still unclear, but the authors do find a correlative relationship between positive empathy and prosociality, though it is unclear which comes first. The key part of this paper that I would like to highlight is Table 1, which lays out the similarities and differences between positive empathy and concepts like: negative empathy, general positive affect, ‘warm glow’ (which I think is the most important distinction to make), and perceived positive empathy. By understanding where these concepts overlap and distinguish themselves from positive empathy, we can key in on the unique characteristics of positive empathy that facilitate positive social change, rather than self-serving or short-lived bursts of good feelings.

Morgan, M. M., Goddard, W., & Newton Givens, S. (1997). Factors that influence willingness to help the homeless. Journal of Social Distress and the Homeless, 6(1), 45-56..

• (We were not initially sure of including this article in this bibliography. It was written in 1997 and uses a sample that is unrepresentative of the general population-- it’s only undergrads, almost all single and white. We’ve decided to keep it to show the ways in which research on empathy has positively evolved to better represent a broader adult population by race and gender.)

• Participants were given an empathy questionnaire, a survey to measure religion, and self-reported political orientation. Participants were then given a questionnaire “addressing attitudes toward the homeless” through hypothetical situations. The majority indicated some willingness to help the homeless, 36% reported willingness to help the homeless consistently; 12% consistently reported that they would not. Empathy was correlated with religiosity and the female sex. Higher empathy scores, liberal political attitudes, non-whiteness and higher levels of religiosity were correlated with a willingness to help the homelessness.

• This study was not representative of the national adult population and was purely hypothetical. Additionally, the study was published over 20 years ago, and attitudes toward homelessness may have shifted over that time. While this may serve as an interesting baseline model for a future study, the results cannot be taken to be nationally representative or contemporarily relevant.

Oudshoorn, A., Ward-Griffin, C., Poland, B., Berman, H., & Forchuk, C. (2013). Community health promotion with people who are experiencing homelessness. Journal of community health nursing, 30(1), 28-41.

• This cross-sectional interview study used participant observation and qualitative interviews to explore how place is experienced within a community health clinic for people experiencing homelessness in Ontario. Results indicated that the respective parties contested the clinic space, with clients desiring emphasizing privacy and autonomy and providers focusing on safety and health promotion.

• The concept of “space vs place” was explored, with space considered to be a physical structure and place considered to be “a location that has meaning.” Day centers were experiencienced by services “as a means both of accessing material resources, and of finding refuge, respite, and even empowerment.” Day centers also “provided a space where certain behaviors were more tolerated than in other agencies, though this was balanced by a degree of policing and control.” In these spaces, clients are “forced to live out their private identities within a public space.”

• Interview analysis led to three key questions:
  1. Whose space is it: the clients’, or the providers’? Providers must find the balance of meeting their funding and safety requirements including the needs and desires of their clients. However, with a heterogenous population of clients, this can be easier said than done.
  2. What constitutes a health promoting place? Receiving services does not make a person feel healthier if they are treated with disrespect. The place and attached meanings are an essential part of what makes it health promoting.
  3. Is safer always healthier? “Critical reflection is required to explore what level of risk is deemed appropriate in order to facilitate a health promoting place.”

• Researchers concluded that agencies need to strongly consider how to make their place a space in which clients can play a role in developing and managing their services, and that “a shift to thinking of health promoting places must be supported at a system level if it is to be attractive to individual agencies.”

Patterson, N., & Hulton, L. J. (2012). Enhancing nursing students’ understanding of poverty through simulation. Public Health Nursing, 29(2), 143-151.

• Senior-level Bachelors of Science Nursing students in a two-credit course titled “Community as Partner: Care of Vulnerable Groups” were required to participate in a poverty simulation activity. The simulation was called “Life in the State of Poverty” and is a copyrighted program designed and created by the Missouri’s Community Action Partnership to help participants begin to understand what it might be like to live in poverty.

• The evaluation design of the education program was from an action research perspective. After this interactive activity that simulated four weeks, nursing students had stronger feelings that society has the responsibility to help poor people, more likely to support programs that raise taxes to support poor people, to disagree with the statements “welfare makes people lazy” and “some ‘poor’ people live better than I do, considering all their benefits.” The researchers concluded that “if executed appropriately, nursing students significantly changed their attitudes about people who live in poverty and evaluated the simulation as an effective learning tool.”

• While this seems promising, poverty tools are colloquially stigmatizing and the participants in this study were 92% White females. This was only a pilot study and should not be taken at face value. Exploring other poverty simulation tools with more diverse audiences would be valuable for future research.

Pierangeli, L. T., & Lenhart, C. M. (2018). Service-Learning: Promoting Empathy Through the Point-in-Time Count of Homeless Populations. Journal of Nursing Education, 57(7), 436-439.

• This reflective research paper discusses the educational innovation of students becoming involved in annual point-in-time (PIT) one-night count of homeless individuals, which has become an urban metric for cities across the country to measure the extent of unhoused individuals in the area. Far from perfect, the PIT count provides a snapshot from which public health programs and social services can base their broader service goals on.

• The authors describe the effect that volunteer participation has upon her students, who are undergraduate nursing and public health students. Much as expected, the author highlights the pre-post differences in stereotypes and assumptions that were held by students about people experiencing homelessness, and highlights the importance of direct interactions to diffuse those beliefs.

• “Students gained a more positive assessment and appreciation for the range of individuals experiencing homelessness, as was found in other service-learning projects.’’ A brief exposure such as this can serve as a stepping stone for building empathy in otherwise ‘green’ undergraduate students who may not have direct experience with people who are struggling. I appreciated the highlighting of this service-learning exercise and the applicability of it towards greater involvement of students in research and direct participation in the future.

Segal, E. A. (2007). Social empathy: A new paradigm to address poverty. Journal of Poverty, 11(3), 65-81.

• This excellent macro-level paper does a thorough job of laying out the main factors for wealth inequality in the US, as well as the necessity and applicative steps of instituting social empathy into society as a means of developing a more economically and socially just society. The first half of the paper highlights the main factors that have precipitated the rise of structural wealth inequality in the US since the New Deal. More importantly for the purposes of this review, the second half breaks down the ways in which social empathy can be cultivated. The sequential framework the authors lay out is the following: exposure, explanation and experience. With these three levels laid out for a social empathy model, there is an easy to understand sequence in which social leaders can build this in others.

• I did see this paper as a bit elemental, especially as it doesn’t go beyond the surface level of ‘exposure, explanation, and experience’ in its development of social empathy. I also found it disheartening that the primary aim of the model and the paper overall was to increase social change via ‘helping policy makers’ understand why social inequities and poverty exist. I would argue that policy makers who perpetuate social injustices and wealth inequality are not poorly informed or in need of a ‘tag-along’ day with someone in poverty.

• Rather than focusing on policy makers, I believe this model may be more effective for sparking change on a community level by activating inert individuals who may want to help in their community but do not know how. Also, there is very little critique or examination in this paper of structural oppression beyond economic inequality. Critiques and tactics for the dismantling of white supremacy, patriarchy, ableism and heteronormativity must be included in the development of social empathy, lest it only perpetuate systems of oppression that underlie economic injustices.

Singer, T., & Lamm, C. (2009). The social neuroscience of empathy. Annals of the New York Academy of Sciences, 1156(1), 81-96.

• This meta-analysis of results from social neuroscience explains that most neuroscience studies around empathy measure the neural representations of pain in people observing pain in others. Observing pain in another activates the same parts of the neural network that are activated during actual experiences of pain. Emotional states affect our bodies and this may serve as the visceral correlate of how something may feel for others. More research is needed to understand the precise neural correlates and mechanisms.

• Singer & Lamm apply findings to distinguish between top-down (regulation, contextual appraisal, and control) versus bottom-up (direct matching between perception and control) and ultimately support the top-down approach, meaning that empathizers have a certain amount of determination over their own experience of empathy.

• This last point may partially explain the tendency of many people to emotionally distance themselves from people experiencing homelessness. They have the choice to not engage, which is inherently less painful-- but might also diminish part of their own neural tendency to connect with and care for others.

Slesnick, N., Glassman, M., Garren, R., Toviessi, P., Bantchevska, D., & Dashora, P. (2008). How to open and sustain a drop-in center for homeless youth. Children and Youth Services Review, 30(7), 727-734.

• Research suggests that in the short-term, case management is helpful for youth to have access to drop-in centers, as well as add-on services such as integrated treatment for substance abuse, mental health and HIV prevention.

• Mixed results were found when add-on services of motivational interventions to address substance abuse. “Motivational interventions” were individual sessions with service providers that included raising the issue of substance abuse, supporting harm reduction and encouraging greater service utilization.

• The principles of “unconditional positive regard” and interagency collaboration must be the foundation of the program philosophy of any successful drop-in center.

• Noted to be successful for homeless youth were “strength-based, single plan of care”, typically referred to as “wraparound services”.

• Accessibility, both physical and emotional, was identified as an important aspect of success. Youth must be able to identify with the center as being integrated into the community, inviting to them as individuals, while also being easily accessible by foot.

• A successful drop-in also needs to be accessible during more desperate or needy times for youth, such as late nights or early mornings, if possible. This support helps youth make positive and safe decisions during the most vulnerable times of their lives.

• Create space that meets basic needs; i.e. showering, food, relaxation, clothing

• Structuring physical spaces to allow semi-privacy and varied activity

• Create system of consequences that foster success, while also incentivizing and encouraging pro-social activities (e.g. helping clean, cook, do peer outreach etc.)

• Cultural competence for staff is recommended, though I would rather focus on cultural humility concepts. A “cultural humility” approach addresses the need for each person to prioritize emotional self-reflection and continual examination of one’s personal and cultural privileges in order to provide better care or service. This is a preferred approach in comparison to “cultural competence”, which too-often regards understanding another culture as a static, technical skill.

Thieda, K. (2014). Brené Brown on empathy vs. sympathy. Psychology Today.

• Possibly the cutest explanation of empathy vs sympathy out there, this video imagines forest creatures interacting in empathetic vs sympathetic ways. The fox character’s despair is portrayed as a hole that she cannot see her way out of. The sympathetic character, a deer, stays above and tells the fox how hard her position looks from his vantage point. This is unhelpful. The empathetic character, a bear, climbs down the ladder and connects in an empathetic manner, validating the fox’s emotions. The fox’s pain is lightened, and after a hug, the bear shows her the ladder and the fox chooses to climb up.

• This video is a highly useful tool for communicating what empathy looks like in practice and difference between it and sympathy.

Vandemark, L. M. (2007). Promoting the sense of self, place, and belonging in displaced persons: The example of homelessness. Archives of psychiatric nursing, 21(5), 241-248.

• Vandemark explores the concept of displacement during homelessness as extending beyond the loss of a physical place to call one’s own, and into displacement from a sense of one’s own self. This is a loss of both sense of purpose in a societal context and sense of self-familiarity. The lack of a space to rest or organize to fit the inner-workings of one’s own mind contributes to some of the anxiety associated with homelessness.

• Therapeutic attention to place-related dimensions of human experience could, Vandemark suggests, reduce anxiety, promote feelings of being understood, and open access to previously unexplored areas of a person’s psyche. “Language allows humans to bridge time and space,” thus narrative could be a way to both help a person access parts of themselves that matter and also help the service provider understand their client more deeply. Treatment should also instill self-efficacy to help a person regain their sense of self-identity.

Zhang, P., & Kteily-Hawa, R. (2018). Poetry, Prose and Personhood: The Art of Storytelling with the Homeless. Canadian Journal for the Study of Adult Education, 30(2).

• The authors piloted a five-session program for storytelling in an all-male shelter. This was conceived based on the intersection of mental health, homelessness, and a loss of sense of personhood from both circumstances. Mental health challenges were not an explicit requirement in the advertising, but they were implicitly addressed in the subject matter. Freedom of choice for level of participation and validation/affirmation in feedback were tenants of the program. Although no quantitative data was collected, participants had positive feedback, and some reported continuing to meet with each other to practice and share writing after the sessions were over. Participants also expressed the desire to have their work published as a way to have their voices heard.

• Storytelling is a powerful tool both for coping with one’s situation and for building community. Through telling their stories, participants were able to process their situation and recognize their own resiliency. One of the main limitations in the continuation of this program was difficulty in scheduling from the staff. Perhaps a center that was not exclusively designed for shelter and survival needs would have a more successful time with consistency.

+ COMPLETE ANNOTATED BIBLIOGRAPHY

• Authors, A-Z (links to Google Doc)