Search Results (287)

Background/Objectives: Culturally responsive care requires both intercultural communication competence (ICC) and empathy; however, these constructs are often examined separately in nursing research. This study aimed to (i) describe nurses’ ICC and empathy levels, (ii) test the association between ICC and empathy, and (iii) examine group differences by selected demographic and professional variables. Methods: A quantitative, cross-sectional correlational design was conducted with 300 nurses recruited from state and private hospitals. ICC was measured using the Arasaratnam Intercultural Communication Competence Scale (cognitive, affective, and total), and empathy was assessed using the 18-item Jefferson Scale of Empathy (compassionate care, perspective taking, standing in the patient’s shoes, and total). Data were analyzed with descriptive statistics, Pearson correlations, independent-samples t-tests, and one-way ANOVAs with Scheffé post hoc tests (α = 0.05). Results: Both ICC and empathy were above the scale midpoint. Cognitive ICC (M = 4.71, SD = 1.42) exceeded affective ICC (M = 4.35, SD = 1.34), and total empathy was high (M = 4.50, SD = 0.90), with compassionate care as the highest subscale (M = 4.60, SD = 1.10). ICC total was moderately correlated with total empathy (r = 0.607, p < 0.05); affective ICC correlated with compassionate care (r = 0.455) and perspective taking (r = 0.493). Male nurses reported higher ICC than female nurses (p < 0.05), while empathy did not differ by gender. Younger nurses (20–29) scored higher in ICC and empathy than older groups, and nurses with ≥28 years of experience also showed elevated levels. Nurses who willingly chose nursing had higher ICC and empathy across dimensions (all p < 0.001). Hospital type showed minimal differences except for “standing in the patient’s shoes” (private > state, p = 0.04). Conclusions: ICC and empathy were generally high and interrelated among nurses, with meaningful variation across workforce characteristics. Training should emphasize experiential and reflective approaches to strengthen affective ICC and perspective taking, while organizational strategies should foster intrinsic motivation and support professional development across career stages. Full article

Background: Autobiographical memory undergoes qualitative changes across the lifespan, influencing self-understanding, emotional regulation, and psychological adaptation. Research shows memory is a dynamic process, reconstructed through retrieval, narration, and social interaction. How narrative construction and empathic engagement shape memory reconsolidation and self-continuity remains insufficiently integrated. Objectives: This narrative review synthesizes theoretical, empirical, and applied findings on autobiographical memory, narrative processes, and empathy, proposing an integrative model linking memory reconsolidation, identity reconstruction, and adaptive functioning. Methods: A theory-oriented narrative review was conducted across psychology, neuroscience, gerontology, and narrative research, drawing on literature from PubMed, PsycINFO, Web of Science, Scopus, J-STAGE, and CiNii. Peer-reviewed empirical studies, systematic reviews, and theoretical papers were organized around three interrelated conceptual domains: (1) autobiographical memory and self-related processes, (2) neurobiological and emotional mechanisms relevant to memory updating and reconsolidation, and (3) narrative construction within empathically mediated social interaction contexts, with additional consideration of evidence from narrative-based and creative interventions. Results: The reviewed literature suggests that autobiographical memory functions as a plastic, socially embedded system supporting self-continuity, although the strength and consistency of evidence vary across studies and contexts. Narrativization within empathically responsive and psychologically safe contexts enhances narrative coherence, emotional integration, and perspective-taking, promoting psychological stability, although these effects are not uniformly observed across all populations and study designs. Creative narrative activities further facilitate retrieval and meaning reconstruction, extending memory updating beyond recall, while the underlying mechanisms and causal pathways remain to be fully established. Conclusions: We propose an empathy-mediated narrative reconstruction model in which creative activity, narration, empathic response, and retelling interact cyclically to support memory reconsolidation and self-narrative updating. By integrating cognitive, social, and creative dimensions, this model provides a theoretically grounded framework with implications for clinical, educational, gerontological, and creative applications. Full article

White lie-telling reflects children’s integration of moral cognition and situational adaptation, yet its mechanisms in prosocial dilemmas remain understudied in Chinese cultural contexts that prioritize “face-saving”—a core construct that shapes interpersonal behavior in Eastern societies. This study investigates how situational cues and developmental differences shape children’s white lie decisions by disentangling the interactive effects of external expectations and recipient presence. A total of 629 children aged 4–11 years (Study 1) and 6–11 years (Study 2) participated in two studies using a modified “painting evaluation task” Study 1 manipulated emotional expectation and recipient presence to establish baseline situational effects, while Study 2 introduced target expectation to create a prosocial value conflict between providing immediate emotional comfort and supporting long-term developmental goals. The Study 1 showed the highest white lie rate under the “emotional expectation + recipient presence” condition, with white lie rates exhibiting a significant developmental increase with age. Binary logistic regression identified these two factors as critical predictors of children’s white lie behavior. In Study 2, amid such prosocial value conflicts, older children showed lower white lie rates than younger peers, who prioritized others’ long-term goals via cost benefit analysis. Notably, recipient presence still moderated face-saving decisions, even for older children. This research makes three key contributions to the field. Firstly, it integrates Chinese “face culture” into situational manipulation, highlighting recipient presence as a culture-specific moderator and mitigating the Western-centric bias in prior research. Secondly, it constructs a prosocial moral dilemma to uncover children’s developmental transition from emotion-driven to value-based rational decision-making, extending existing developmental theories on moral cognition. Thirdly, it advances understanding of prosocial lying motivation beyond blind empathy by quantifying the interactive effects of dual expectations and revealing that children engage in deliberate cost benefit analysis that aligns with others’ overall long-term interests. Full article

Background/Objectives: Time-constrained consultations in high-volume settings can crowd out patient-centered communication, while AI-generated advice may face algorithm aversion when it lacks a humanistic dimension. This study examined whether a brief narrative-based prompt could improve coded patient-facing communication features in an LLM relative to both clinicians and an unprompted model on authentic patient queries. Methods: We conducted a three-condition comparative evaluation using a stratified sample of 1000 de-identified MedDialog-CN consultations (2016–2020). For each consultation, the same patient query was used to generate (i) a zero-shot GPT-o3-mini response and (ii) a narrative-prompted GPT-o3-mini response; the original physician reply served as the human baseline. Responses were annotated with a pre-specified schema operationalizing four communication dimensions—Storytelling, Empathy, Personalization, and Clarity—with expert adjudication. Frequency-based indicators were summarized as mean events per consultation, and binary indicators as proportions; secondary checks captured unwarranted certainty and risk-relevant language. Results: Narrative prompting shifted coded patient-facing communication from sparse and selectively deployed (clinicians and zero-shot AI) to more routine and standardized. Across the reported communication measures, the prompted model showed the most favorable overall pattern, with higher narrative-device use, empathic support, contextual tailoring, and terminology explanation, alongside more frequent consideration of patient preferences and markedly higher rates of emotion–symptom linkage and the presence of a patient-centered narrative framework. Conclusions: Narrative prompting may offer a lightweight and potentially scalable strategy for improving patient-facing communication in Chinese asynchronous, text-based online consultations. An important next step is calibration: humanistic cues should be delivered selectively and safely so that responses remain credible, locally feasible, and cognitively manageable. Full article

Psychopathy is a complex personality trait involving emotional and behavioral deficits that often overlap with alexithymia and reduced empathy. While it is reasonable to assume that the cognitive and behavioral traits associated with this construct may be influenced by specific sociocultural factors, research examining these cross-cultural variations remains scarce. In this cross-sectional study, we examined the relationship between psychopathy traits, empathy, and alexithymia in Brazilian (n = 171) and British (n = 167) adults. Participants completed the Levenson Self-Report Psychopathy Scale, the Basic Empathy Scale, and the Toronto Alexithymia Scale. British participants scored significantly higher on primary, secondary, and total psychopathy, as well as on difficulties describing feelings, compared to Brazilians. Regression analyses indicated that affective empathy and alexithymia dimensions were statistically associated with psychopathy scores in both groups. The regression models accounted for substantially more variance in primary psychopathy, marked by narcissism, grandiosity, and emotional detachment, in the British group than in the Brazilian one (36.4% vs. 13.4%, p < 0.05). Our findings are consistent with sociocultural differences in psychopathy traits and highlight the importance of investigating these constructs from a cross-cultural perspective to better characterize contextual differences and refine assessment and intervention. Full article

Background/Objectives: Patients with liver cirrhosis experience a high symptom burden and low Health-Related Quality of Life (HR-QoL). Hepatic encephalopathy (HE) occurs in 75% of patients with cirrhosis but is sparsely described from the patient’s perspective. Due to recurrent cognitive impairment, a marginalized diagnosis, and a healthcare discourse emphasizing involvement and self-responsibility, these patients appear vulnerable when navigating a complex healthcare system. This study aims to explore how patients with chronic liver disease experience living with HE as a recurring condition, and how these patients are met by healthcare professionals (HCPs). Methods: Eight semi-structured interviews were conducted with four patients and four HCPs. Data were analyzed thematically following Braun and Clarke’s six-step analysis within the framework of Interpretive Description. The study was reported according to COREQ Guidelines. Results: The overarching theme “Becoming a different person” captured the profound identity changes experienced by patients. Three main themes emerged: 1. change and loss—in identity and self-understanding, in relationships, in relation to losing control, and in relation to experiencing isolation; 2. new paths—mental and practical alternative strategies; 3. HE in clinical encounters—requiring empathy, flexibility, and continuity. Stigma related to cirrhosis and its association with alcohol further intensified patients’ vulnerability. Conclusions: HE is experienced as a transformative and isolating condition, deeply affecting patients’ autonomy and social roles through vulnerability. The clinical encounter is shaped by the cognitive impairment due to HE, requiring tailored and sensitive care. Full article

Education for Sustainable Development (ESD) can support and strengthen responses to the environmental challenges faced today. However, the sustainability knowledge–action gap remains mostly unbridged. This article examines communication as a lever for learning and behavior change in sustainability education and compares the use of communication in conventional delivery and a narrative, dialogic and affective communication mode in secondary, university and community-based learning settings in a mixed-methods experimental study. Quantitative measures (pre-, post-, follow-up) included knowledge, systems thinking, emotional engagement, motivation and self-reported sustainable behaviors. Qualitative data, including interviews, observations and action research projects, were also collected to gain deeper insights into learner engagement with knowledge, systems thinking, emotional engagement and motivation. Results suggest that participants in the catalytic communication condition felt more cognitively and emotionally engaged than the control condition, and displayed more long-term pro-environmental behavior. Mediation analysis suggests that the increase in pro-environmental behavior may be driven by an increase in feelings of empathy and hope associated with the learning experience. This supports the understanding that tailored communication can help to reduce the knowledge–action gap in ESD and provides additional insights into the usefulness of cognitive, affective and behavioral dimensions of sustainability-oriented pedagogical approaches. Full article

AI-enabled technology (AI) has a transformational role in our modern society because it is increasingly used as an interaction partner, making anthropomorphism (tendency to ascribe human features to non-human agents) a central mechanism shaping how people evaluate, accept or resist AI systems. Existing technology acceptance models and anthropomorphism frameworks, however, offer limited guidance on how human-like attributes of AI translate into perceptions of usefulness, perceived control, perceived opportunity or threats, particularly across different levels of AI autonomy. Building on the theory of planned behavior, the technology acceptance model and threat rigidity model, this paper develops a mid-range conceptual framework of AI anthropomorphism grounded in universal social perception dimensions of warmth and competence. We integrate fragmented research to derive three core propositions and four corollaries that specify how warmth and competence attributions shape evaluative cognitions in relation to AI. The framework further identifies AI autonomy as a boundary condition under which anthropomorphic cues may either facilitate acceptance or trigger perceptions of pseudo-empathy, cognitive superiority and identity threat. By offering a parsimonious, theoretically informed model, this paper clarifies when anthropomorphism fosters acceptance versus resistance in human–AI interaction and provides a structured agenda for future empirical research and AI design aimed at fostering synergies and resilience in human–AI ecosystems. Full article

The purpose of this study is to explore how adolescents in self-contained classrooms or schools for students with autism or ADHD, with no prior involvement in criminality, perceive and interpret different forms of early offending behavior through fictional case stories. The study specifically aims to examine their ability to discern what constitutes offending behavior, based on the double empathy problem. In total, 13 participants currently receiving secondary-level education (grades 10–12, aged 16–20 years) in self-contained classes at schools for adolescents with autism or ADHD participated. No student had cognitive disabilities or had been involved in any criminal act or criminal justice issues. The students were individually given three fictional written cases of offending behavior (theft, physical assault, and sexual assault). Audio-recorded stimulated recall interviews were obtained while the students solved tasks in relation to the cases, and these were analyzed to capture whether and what aspects of early offending were discerned. Overall, the results indicated limited awareness and enhanced social vulnerability, risking unwitting engagement in early offending behavior. Adapting social science education to students’ special educational needs to understand social interactions might be used to prevent and enhance their awareness of early offending behavior. Full article

Background/Objectives: Empathy is a core component of professional competence in dentistry, influencing patient-centered care and treatment outcomes. Evidence suggests that empathy may decline during clinical training, but data from Lithuanian dental students are lacking. This study aimed to assess empathy levels and subscale patterns among Lithuanian dental students and examine their association with academic year. Methods: A cross-sectional study was conducted among third- to fifth-year dental students at the two universities in Lithuania. The Lithuanian version of the Jefferson Scale of Empathy–Health Professions Students (JSE-HPS) was used to measure total empathy and three subscales: Perspective Taking (PT), Compassionate Care (CC), and Standing in the Patient’s Shoes (SPS). Internal consistency was assessed using Cronbach’s alpha. Factor validity was examined via principal component analysis with Varimax rotation and Kaiser normalization. Differences across academic years were analyzed using Kruskal–Wallis tests. Results: A total of 252 students completed the questionnaire (response rate: 93%). The Lithuanian JSE-HPS demonstrated good internal consistency (α = 0.808) and confirmed a three-factor structure. The mean total empathy score was 106.07 ± 12.55. JSE-HPS scores differed significantly between dental classes (p < 0.001). Fifth-year students had significantly lower JSE-HPS scores than third- and fourth-year students (101.65 vs. 107.05 and 109.36; p = 0.035 and p = 0.007). PT and CC scores significantly declined in fifth-year students compared with earlier years, whereas SPS scores remained stable. Conclusions: The Lithuanian version of the JSE-HPS is a reliable and psychometrically sound tool for assessing empathy. Clinical training was significantly associated with a decline in total empathy scores among Lithuanian dental students, highlighting the impact of academic progression on both cognitive and affective components of empathy. Given the cross-sectional design, causal inferences cannot be drawn. Full article

Religiosity and empathy have been identified as two key variables that may significantly influence an individual’s social justice attitude and behavior. Despite their significance, studies addressing the relationships between these variables are rare. Thus, the present study aims to explore the associations between interpersonal empathy, instrumental religiosity, and social justice values using the conceptual framework of motivated information processing theory. Structural equation modeling (SEM) was employed to assess the hypothetical relationships between these variables. The findings indicate that personal instrumental religiosity, social interaction, and cognitive behavior are positively associated with the level of adherence to both instrumental and social terminal values of social justice. In contrast, social instrumental religiosity exerts only a direct influence on the instrumental values of social justice. This study also revealed the role of social interaction and cognitive behavior as mediators between personal instrumental religiosity and the instrumental and social terminal values of social justice. The findings underscore the imperative for researchers to devise educational programs that acknowledge and promote the significance of religion and empathy in fostering a more equitable and compassionate society. Full article

As Education for environmental resilience increasingly adopts Game-based learning (GBL) to address climate challenges, a critical ambiguity remains regarding how learning outcomes are structured. While games effectively enhance learner engagement, it is unclear whether this affective participation translates into the higher-order competency of sustainable climate resilience. To address this, this study followed PRISMA guidelines to conduct a systematic literature review (SLR) of 175 studies published between 2015 and 2025. We adopted a hierarchical taxonomy to code outcomes, distinguishing between affective precursors (empathy), cognitive foundations (systems thinking), and the ultimate goal of resilience (adaptive action competence). The macro-analysis indicated that although the complexity of game simulations has risen, evaluations often remain arrested at the motivational level due to a disjunction between game affordances and instructional support. Multi-level coding further reveals that specific mechanisms, such as dynamic perturbation, spatio-temporal feedback, and resource trade-offs, provide the structural scaffolding necessary to elevate learning from shallow empathy to cognitive resilience. Based on these findings, we propose the Game–Teacher–Resilience (GTR) Framework, arguing that transformative education requires coupling specific mechanics with pedagogical intervention to bridge the gap between engagement and resilience. Full article

Pain empathy plays an important role in both social bonding and defensive mechanisms, yet previous studies have mostly used non-predictive paradigms and rarely examined the effects of expectation. Using event-related potentials (ERPs), this study explored how pain expectation temporally modulates empathic responses and proposed an avoidance–approach dual-drive model. Behaviorally, participants responded faster and more accurately under pain-expectation conditions. At the neural level, greater N2 amplitudes were elicited by pain expectation, reflecting avoidance reactions driven by self-protection. In the P3 stage, two concurrent effects emerged: (1) overall P3 amplitudes decreased under pain expectation, suggesting reduced cognitive resource allocation due to avoidance; and (2) painful stimuli still evoked larger P3 amplitudes than neutral stimuli, indicating empathic engagement associated with approach motivation. These results suggest that pain empathy is not governed by a single mechanism but by a dynamic interplay between avoidance and approach motivations at different temporal stages, providing a neurophysiological framework that integrates defensive and affiliative needs in pain empathy. Full article

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social communication, reciprocity, and adaptive behavior. Converging neurobiological evidence suggests that these clinical features arise from aberrant connectivity and dysregulated neuronal oscillations across distributed brain networks. In particular, dysfunction within the mirror neuron regions, concentrated in the inferior frontal gyrus (IFG) and inferior parietal lobule (IPL), has been implicated in deficits of imitation, empathy, and social cognition in ASD. Non-invasive neuromodulation using repetitive transcranial magnetic stimulation (rTMS) has shown modest behavioral benefits in ASD. However, most studies apply the conventional protocols targeting the dorsolateral prefrontal cortex. The effects of intermittent theta-burst stimulation (iTBS), a potent excitatory rTMS protocol targeting the mirror neuron regions, on the oscillatory dynamics in ASD remain largely unexplored. Objective: To investigate whether iTBS targeting the bilateral IFG and IPL modulates EEG-derived oscillatory activity in adolescents with ASD and to explore the relationship between oscillatory changes and social reciprocity. Methods: Six adolescents with Level I or II ASD (ages 13–18) underwent bilateral iTBS targeting the IFG and IPL using a figure-of-eight coil and standardized theta-burst parameters. Participants were randomized to receive either 18 active iTBS sessions or a waitlist-controlled crossover design (9 sham followed by 9 active sessions). Standard 21-channel EEG recordings were obtained during the first (EEG-1) and final (EEG-2) active stimulation sessions, including pre- and post-stimulation epochs. Power spectral analyses were conducted across frequency bands (delta through gamma). Behavioral outcomes were assessed using the Childhood Autism Rating Scale, Second Edition (CARS2), administered pre- and post-intervention. Results: All participants tolerated the intervention without adverse effects. Behavioral analysis demonstrated a significant reduction in CARS2 scores following iTBS and is reported in detail in our prior clinical outcomes manuscript, consistent with improved social reciprocity (p < 0.001). EEG analysis revealed an immediate post-stimulation increase in gamma-band power during EEG-1 in five of six participants, whereas lower-frequency bands exhibited variable responses. In contrast, EEG-2 showed no consistent post-stimulation gamma enhancement. Net comparisons between EEG-1 and EEG-2 demonstrated attenuation of the initial gamma response in the same five participants. At the group level, gamma percent change did not reach statistical significance at EEG-1 (p = 0.12) or EEG-2 (p = 0.66), and exploratory comparisons between the 9-active versus 18-active arms did not reach statistical significance. While ipsi-directional changes in gamma power and CARS2 scores were observed in four participants, correlation was not identified in this pilot sample. Conclusions: Bilateral iTBS targeting the IFG and IPL induces a transient enhancement of gamma oscillations in adolescents with ASD that attenuates with repeated stimulation. This pattern is consistent with adaptive homeostatic plasticity (metaplasticity) within excitatory–inhibitory circuits, potentially mediated by GABAergic interneurons. These findings support the feasibility of EEG as an objective biomarker of neuromodulatory engagement in ASD and highlight the importance of network-level and oscillatory mechanisms in interpreting therapeutic responses. Larger, sham-controlled studies incorporating multimodal biomarkers are warranted to clarify clinical relevance and optimize personalized neuromodulation strategies. Full article

Personality traits are essential to understanding individual differences in values, attitudes, behaviours, and cognitive-emotional reactions to climate change (CC). Prosocial traits (empathy and altruism) and nature relatedness (NR), that is, the subjective sense of connection with the natural world, have been linked both to pro-environmental behaviours (PEB) and to CC-related psychological distress. As these reactions are increasingly common in the context of CC, it is crucial to distinguish their adaptive components from their maladaptive ones, namely, by identifying which psychological predictors most strongly promote PEB, in order to design targeted interventions and communication strategies that effectively foster sustainable action. This study examined whether CC-worry, CC-distress, and CC-impairment mediate the relationships between prosocial traits, NR, and PEB. A community sample of 577 adults (mean age = 32.62 ± 14.71 years; 64.6% women) completed self-report measures of the abovementioned study variables, and a multiple mediation model using structural equation modelling was tested. Prosocial traits and NR were positively associated with CC-related psychological distress and PEB, and CC-worry and CC-distress showed significant mediating roles, whereas CC-impairment did not. The model explained 40% of PEB’s variance. Overall, CC-worry and CC-distress appear to function as adaptive, motivational processes that link positive traits and nature connection to environmental action, while CC-impairment reflects a maladaptive, unconstructive response that may index the more pathological end of climate change-related psychological distress. Full article