title: Why empathy has a beneficial impact on others in medicine: unifying theories.
abstract: The past decades have seen an explosion of studies on empathy in various academic domains including affective neuroscience, psychology, medicine, and economics. However, the volumes of research have almost exclusively focused on its evolutionary origins, development, and neurobiological bases, as well as how the experience of empathy is modulated by social context and interpersonal relationships. In the present paper, we examine a much less attended side of empathy: why it has a positive impact on others? After specifying what the construct of empathy encompasses, we brieﬂy review the various effects of empathy on health outcomes in the domain of medicine. We then propose two non-mutually exclusive mechanistic explanations that contribute to explain the positive effects of physician empathy on patients. (1) The social baseline theory (SBT), building on social support research, proposes that the presence of other people helps individuals to conserve metabolically costly somatic and neural resources through the social regulation of emotion. (2) The free energy principle (FEP) postulates that the brain optimizes a (free energy) bound on surprise or its complement value to respond to environmental changes adaptively. These conceptualizations can be combined to provide a unifying integrative account of the benefits of physicians' empathetic attitude on their patients and how it plays a role in healing beyond the mere effect of the therapeutic alliance.
authors: Department of Psychology, University of Chicago Chicago, IL, USA ; Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine Chicago, IL, USA.
authors: Jean
authors: J
authors: Decety
authors: Research Department of Clinical, Educational and Health Psychology, University College London London, UK.
authors: Aikaterini
authors: A
authors: Fotopoulou
keywords: empathy; free energy principle; health; medicine; neuroscience; predictability; social baseline theory; social support
references: Psychiatry (Edgmont). 2007 May;4(5):35-40
references: 20806028
references: J Pain. 2014 Sep;15(9):934-44
references: 24953886
references: Psychoneuroendocrinology. 2013 Dec;38(12):3139-44
references: 24099859
references: Psychol Sci. 2006 Dec;17(12):1032-9
references: 17201784
references: Curr Opin Psychiatry. 2008 Mar;21(2):201-5
references: 18332671
references: Mol Psychiatry. 2014 Mar;19(3):392-8
references: 23358155
references: J Clin Epidemiol. 2006 Apr;59(4):331-5
references: 16549251
references: Nature. 1971 Apr 30;230(5296):598-9
references: 4928671
references: J Pers Soc Psychol. 2004 Sep;87(3):363-83
references: 15382986
references: Lancet. 2001 Mar 10;357(9258):757-62
references: 11253970
references: Horm Behav. 2012 Mar;61(3):410-8
references: 22265852
references: Front Hum Neurosci. 2013 Nov 19;7:772
references: 24312039
references: Ann N Y Acad Sci. 2011 Aug;1231:17-22
references: 21651565
references: JAMA. 2009 Sep 23;302(12):1284-93
references: 19773563
references: Med Teach. 2010;32(7):593-600
references: 20653383
references: Front Hum Neurosci. 2013 Jul 23;7:386
references: 23888136
references: Nat Rev Neurosci. 2010 Feb;11(2):127-38
references: 20068583
references: J Couns Psychol. 2014 Oct;61(4):541-8
references: 25285714
references: Dev Psychopathol. 2008 Fall;20(4):1053-80
references: 18838031
references: Eur J Pain. 2009 Apr;13(4):431-8
references: 18602319
references: Prog Neurobiol. 2012 Jul;98(1):38-48
references: 22580447
references: J Pers Soc Psychol. 2001 Dec;81(6):1205-24
references: 11761318
references: Behav Cogn Neurosci Rev. 2004 Jun;3(2):71-100
references: 15537986
references: Curr Biol. 2007 Oct 9;17(19):1708-13
references: 17900903
references: J Gen Intern Med. 2012 Oct;27(10):1280-6
references: 22549298
references: BMC Fam Pract. 2012 Feb 08;13:6
references: 22316293
references: Acad Med. 2011 Mar;86(3):359-64
references: 21248604
references: Neuron. 2014 Mar 19;81(6):1223-39
references: 24656247
references: BMJ. 2008 Oct 23;337:a1938
references: 18948346
references: Br J Gen Pract. 2002 Oct;52 Suppl:S9-12
references: 12389763
references: Psychol Med. 2013 Aug;43(8):1747-53
references: 23146328
references: Arthritis Rheum. 2004 Dec;50(12):4035-44
references: 15593181
references: Psychoneuroendocrinology. 2013 Nov;38(11):2800-4
references: 23768973
references: New Dir Child Dev. 1989 Summer;(44):51-64
references: 2771129
references: Psychoneuroendocrinology. 2010 Jan;35(1):67-82
references: 19914001
references: Curr Opin Neurobiol. 2013 Feb;23(1):11-6
references: 23040540
references: Pain. 2010 Dec;151(3):687-93
references: 20869808
references: Trends Cogn Sci. 2012 Oct;16(10):504-10
references: 22959875
references: Proc Natl Acad Sci U S A. 2012 Oct 16;109 Suppl 2:17208-12
references: 23047689
references: Psychol Bull. 2014 Jan;140(1):256-82
references: 23607429
references: Biol Psychiatry. 2016 Apr 15;79(8):693-705
references: 25499958
references: Acad Med. 2010 Sep;85(9):1445-52
references: 20736672
references: Soc Neurosci. 2010;5(2):163-70
references: 19844845
references: Proc Natl Acad Sci U S A. 2009 Dec 15;106(50):21437-41
references: 19934046
references: J Pain. 2005 Apr;6(4):228-36
references: 15820910
references: Philos Trans R Soc Lond B Biol Sci. 2005 Apr 29;360(1456):815-36
references: 15937014
references: Biol Psychol. 2011 Mar;86(3):174-80
references: 21126557
references: Behav Neural Biol. 1993 Jul;60(1):79-83
references: 8216163
references: Neurosci Biobehav Rev. 2014 Nov;47:410-30
references: 25277283
references: Annu Rev Psychol. 2007;58:145-73
references: 16903808
references: Neuroimage. 2007 May 1;35(4):1601-12
references: 17395493
references: PLoS One. 2014 Apr 09;9(4):e94207
references: 24718585
references: Front Behav Neurosci. 2013 Dec 11;7:185
references: 24376404
references: Clin Psychol Rev. 2008 Mar;28(3):407-29
references: 17719157
references: PLoS One. 2010 Oct 13;5(10):e13309
references: 20967200
references: Psychol Sci. 2009 Nov;20(11):1316-8
references: 19788531
references: J Psychosom Res. 2008 May;64(5):479-86
references: 18440400
references: Trends Cogn Sci. 2009 Oct;13(10):447-54
references: 19726219
references: Neural Comput. 1995 Sep;7(5):889-904
references: 7584891
references: Proc (Bayl Univ Med Cent). 2003 Apr;16(2):157-61; discussion 161
references: 16278732
references: Fam Med. 2009 Jul-Aug;41(7):494-501
references: 19582635
references: Front Hum Neurosci. 2014 May 14;8:302
references: 24860482
references: Ann N Y Acad Sci. 2009 Mar;1156:81-96
references: 19338504
references: BMC Med. 2010 Feb 23;8:15
references: 20178561
references: Nat Rev Neurosci. 2002 Aug;3(8):655-66
references: 12154366
references: Neuroscientist. 2007 Dec;13(6):580-93
references: 17911216
references: J Nerv Ment Dis. 2009 May;197(5):362-7
references: 19440110
references: Perspect Psychol Sci. 2014 Sep;9(5):525-37
references: 25429304
references: Neuron. 2009 Aug 27;63(4):533-43
references: 19709634
references: Attach Hum Dev. 2013;15(3):303-15
references: 23547803
references: Neuron. 2013 Sep 4;79(5):836-48
references: 24012000
references: Front Hum Neurosci. 2012 May 24;6:147
references: 22654749
references: Dev Cogn Neurosci. 2012 Jan;2(1):1-24
references: 22682726
references: PLoS One. 2013 Apr 19;8(4):e61526
references: 23620760
references: J Neurosci. 2013 Sep 25;33(39):15466-76
references: 24068815
references: Front Behav Neurosci. 2014 Jul 11;8:243
references: 25071495
references: J Neurosci. 2010 Dec 1;30(48):16324-31
references: 21123578
references: Pain. 2009 Oct;145(3):365-6
references: 19716658
references: Psychosom Med. 2003 Mar-Apr;65(2):276-83
references: 12651995
references: Neuroimage. 2010 May 1;50(4):1676-82
references: 20080194
references: Virtual Mentor. 2007 Jun 01;9(6):423-7
references: 23218048
references: Front Neurosci. 2014 Jun 12;8:152
references: 24971049
references: J Med Ethics. 2011 Jun;37(6):380-3
references: 21292696
references: Neuron. 2007 Jul 19;55(2):325-36
references: 17640532
references: Front Neuroendocrinol. 2009 Oct;30(4):470-82
references: 19545584
references: Front Psychol. 2014 May 12;5:425
references: 24860537
references: Soc Neurosci. 2014 Feb;9(1):1-9
references: 24295535
references: Psychol Bull. 1996 May;119(3):488-531
references: 8668748