Does Empathy Come with Reciprocity?

It’s already well-documented that perpetual unforgiveness and anger wreak havoc on the body. One study in the Journal of the American College of Cardiology credits chronic anger with a 19 percent increase in developing heart disease—even among healthy populations.

But how does being empathetic influence one’s health?

A new study from Emory, funded by the National Institute on Aging, will test whether caregivers of those living with dementia who receive cognitive empathy training will have improved health outcomes.  This study builds on the results of a previous pilot study, funded by Emory’s Roybal Center, the Center for Health and Aging, and Georgia’s Aging and Disability Resource Connection, that measured before-and-after emotional well-being and brain activation (fMRI) of the caregivers as well as their blood for proinflammatory biomarkers.

These proinflammatory biomarkers, called cytokines or CRP, are not only associated with chronic stress but also with traumatic events such as major car accidents or being hospitalized with severe COVID-19. Having too many cytokines contributes to inflammation, a well-known contributor to many age-related diseases.

As caregivers experience elevated levels of stress, this study examines how they would be affected by a 10-day training period, in which the caregivers photographed their loved ones with dementia every day, writing captions describing how they may be feeling to accompany each photo.

Following the study, the brain imaging (fMRI) of caregivers who received cognitive empathy training showed that the parts of the brain associated with cognitive empathy and emotion regulation became more active. One area of consistent activation, for example, was the ventrolateral prefrontal cortex, critical to emotional regulation. These changes were associated with reduced stress in caregivers. Following this pilot study, caregivers reported decreased levels of depression, anxiety, perceived stress, and burden.

Regarding the cytokines, or proinflammatory biomarkers, the study states that were was some preliminary indication that empathy training may decrease inflammation in some individuals, but the findings warrant a larger study.

“Our working model is that cognitive empathy improves relationships among the caregivers and care recipients when the caregiver becomes more empathetic and starts to adopt their mental perspective more easily,” said James Rilling, lead author on the study and a professor of psychology at Emory College of Arts and Sciences. “If the relationship improves, you would expect there to be less stress for both parties, and it’s known that psychological stress can increase levels of inflammation,” he adds.

Rilling says there will be more than 20 million family caregivers in the US by 2060, citing a growing crisis and the need for interventions that improve caregiver health and emotional well-being.

The new study is also led by Ken Hepburn, a professor at Emory’s Nell Hodgson Woodruff School of Nursing. “The photo-captioning process challenges caregivers to inhabit the thoughts, feelings, and experiences of persons living with these illnesses,” says Hepburn. “Such acts of cognitive empathy may enhance caregivers’ daily care effectiveness and may also enable them to maintain an emotional connection with persons whose illness is gradually eroding their capacity to connect with themselves, others, and the world around them,” he adds.

The interdisciplinary project also involved the School of Medicine’s Molly Perkins, professor and co-director with Hepburn of the Emory Roybal Center for Dementia Caregiving Mastery, and researchers from the Rollins School of Public Health, including professor John Hanfelt and senior biostatistician Liping Zhao, both from the Department of Biostatistics and Bioinformatics and Emory’s Goizueta Alzheimer’s Disease Research Center.