Nonverbal expression of empathy in healthy human populations : a scoping review protocol

The present scoping review aims to understand the extent and type of evidence related to the nonverbal expression of empathy (and empathic concern) in healthy human (or human-like) empathizers across contexts

Validation Experiments of Digital Characters from the EEVEE Platform

This project briefly describes validation experiments of new digital human characters from the Empathy-Enhancing Virtual Evolving Environment (EEVEE; Jackson et al., 2015) for future studies (e.g., on pain, emotions, and empathy). All Rights Reserved

Perspectives fondamentale, clinique et sociétale de l’utilisation des personnages virtuels en santé mentale

Avec l’attrait engendré par les avancées en informatique et en intelligence artificielle, les personnages virtuels (c.-à-d. personnages représentés numériquement d’apparence humaine ou non) sont pressentis comme de futurs prestataires de soins en santé mentale. À ce jour, l’utilisation principale de tels personnages est toutefois marginale et se limite à une aide complémentaire à la pratique des cliniciens. Des préoccupations liées à la sécurité et l’efficacité, ainsi qu’un manque de connaissances et de compétences peuvent expliquer cette discordance entre ce que certains s’imaginent être l’utilisation future (voire futuriste) des personnages virtuels et leur utilisation actuelle. Un aperçu des récentes données probantes contribuerait à réduire cette divergence et à mieux saisir les enjeux associés à leur utilisation plus répandue en santé mentale.Objectif Cet article vise à informer tous les acteurs impliqués, dont les cliniciens, quant au potentiel des personnages virtuels en santé mentale, et de les sensibiliser aux enjeux associés à leur usage.Méthode Une recension narrative de la littérature a été réalisée afin de synthétiser les informations obtenues de la recherche fondamentale et clinique, et de discuter des considérations sociétales.Résultats Plusieurs caractéristiques des personnages virtuels provenant de la recherche fondamentale ont le potentiel d’influencer les interactions entre un patient et un clinicien. Elles peuvent être regroupées en deux grandes catégories : les caractéristiques liées à la perception (p. ex. réalisme) et celles liées à l’attribution spontanée d’une catégorie sociale au personnage virtuel par un observateur (p. ex. genre). Selon la recherche clinique, plusieurs interventions ou évaluations utilisant des personnages virtuels ont montré divers degrés d’efficacité en santé mentale, et certains éléments de la relation thérapeutique (p. ex. alliance et empathie) peuvent d’ailleurs être présents lors d’une relation avec un personnage virtuel. De multiples enjeux socioéconomiques et éthiques doivent aussi être discutés en vue d’un développement et d’une utilisation plus accrue qui soient responsables et éthiques. Bien que l’accessibilité et la disponibilité des personnages virtuels constituent un avantage indéniable pour l’offre de services en santé mentale, certaines iniquités demeurent. L’accumulation de données biométriques (p. ex. rythme cardiaque) a également le potentiel d’enrichir le travail des cliniciens, mais aussi de mener au développement de personnages virtuels autonomes à l’aide de l’intelligence artificielle, ce qui pourrait conduire à certains dérapages (p. ex. erreurs de décision clinique). Quelques pistes de recommandations visant à éviter ces effets indésirables sont présentées.Conclusion L’emploi des personnages virtuels sera de plus en plus répandu en santé mentale en raison de leurs avantages prometteurs. Ainsi, il est souhaitable que tous les acteurs impliqués s’informent sur leur usage dans ce contexte, se sensibilisent aux enjeux spécifiques, participent activement aux discussions quant à leur développement et adoptent des recommandations uniformes en vue d’un usage sécuritaire et éthique en santé mentale.Along other breakthroughs in computer sciences, such as artificial intelligence, virtual characters (i.e. digitally represented characters featuring a human appearance or not) are foreseen as potential providers of mental healthcare services. However, their current use in clinical practice is marginal and limited to an assistive role to help clinicians in their practices. Safety and efficiency concerns, as well as a general lack of knowledge and experience, may explain this discrepancy between the expected (sometimes futuristic) and current use of virtual characters. An overview of recent evidence would help pinpoint the main concerns and challenges pertaining to their use in mental healthcare. Objective This paper aims to inform relevant actors, including clinicians, on the potential of virtual characters in mental healthcare practices and to raise awareness on societal challenges regarding their use.Method A narrative literature review was conducted to summarize basic and clinical research findings, and to outline an in-depth discussion on various societal caveats related to the inclusion of virtual characters.Results Basic studies highlight several characteristics of the virtual characters that seem to influence patient-clinician interactions. These characteristics can be classified into two categories: perceptual (e.g. realism) and social features (i.e. attribution of social categories such as gender). To this day, many interventions and/or assessments using virtual characters have shown various levels of efficiency in mental health, and certain elements of a therapeutic relationship (e.g. alliance and empathy) may even be triggered during an interaction with a virtual character. To develop and increase the use of virtual characters, numerous socioeconomic and ethical issues must be examined. Although the accessibility and the availability of virtual characters are an undeniable advantage for their use in mental healthcare, some inequities about their application remain. In addition, the accumulation of biometric data (e.g. heart rate) could provide valuable information to clinicians and could help develop autonomous virtual characters, which raises concerns over issues of security and privacy. This paper proposes some recommendations to avoid such undesirable outcomes.Conclusion Due to their promising features, the inclusion of virtual characters will no doubt be increasingly prevalent in mental healthcare services. All involved actors should thus be informed about specific challenges raised by such breakthroughs. They should also actively participate in discussions regarding the development of virtual characters in order to adopt unified recommendations for their safe and ethical use in mental healthcare

Is Prolonged and Repeated Exercise-Induced Myocardial Ischemic Training Deleterious?

Background: In patients with ischemic heart disease (IHD), the current guidelines on exercise prescription recommend that exercise training intensity be 10 beats/min below the heart rate at which there is >1 mm ST-segment depression (ischemic threshold). However, it is not well established that exercise training above the ischemic threshold is harmful. Methods: Twenty-two patients with angiographically documented IHD (>70% stenosis) were randomized to exercise training either at a target intensity that induced myocardial ischemia (ischemic group) or that adhered to current guidelines (control group). Training was progressively increased to 60 min under continuous ECG monitoring. Cardiac troponin T (cTnT) was measured at regular intervals. Ambulatory ECG monitoring was performed before and after 6 wkof training and left ventricular function was evaluated by echocardiography in the ischemic group after at least 6 wk of training. Results: The ischemic training sessions were very well tolerated. The ischemic group had myocardial ischemia during the first 20, 40, and 60 min exercise sessions for 12.3 ± 6.8 min, 29.0 ± 12.9 min and 49.8 ± 2.2 min, respectively, with ST-segment depression ranging from 1.0 to 2.1 mm. The estimated myocardial work (as expressed by RPP) during the training session was also higher in the ischemic than in the control group for the first 20 min (17 354 ± 6 528 vs 13 355 ± 2 936 beats/min • mmHg, respectively; P=0.08), 40 min (16 329 ± 5 407 vs 12 452 ± 2 330 beats/min • mmHg, respectively; P=0.04), and 60 min training sessions (18 750 ± 5 698 vs 13 352 ± 2 947 beats/min • mmHg, respectively; P=0.02) No patient in either group demonstrated significant arrhythmias nor increased cTnT. The measured cTnT stayed below the detectable values of the essay (>0.01μg/l) for all patients at all times. Left ventricular function remained unchanged in the ischemic group. Conclusion: In patients with IHD, prolonged and repeated ischemic training sessions up to 60 min can be well tolerated without evidence of myocardial injury, significant arrhythmias or left ventricular dysfunction. Thus exercising at or above the ischemic threshold does not appear deleterious under this kind of supervision

Attenuation of the Threshold for Myocardial Ischemia in Ramp vs Standard Bruce Protocol in Patients with Positive Exercise Stress Test and Angiographically Demonstrated Coronary Artery Narrowing?

Background: Gradual instead of abrupt increases in workload favour a more physiological response in terms of hemodynamic and gas exchange parameters. Therefore, we sought to determine whether myocardial ischemia is attenuated with a ramp compared to a standard Bruce exercise protocol in patients with coronary artery disease (CAD). Methods: We compared ischemic parameters on the Bruce protocol with an individualized ergocycle ramp protocol in 18 men with documented CAD (≥ 70% stenosis) and a reproducible ischemic ECG exercise test. These 2 symptom-limited tests were performed in random order 2 weeks apart. Oxygen consumption (VO2), ischemic threshold [systolic blood pressure x heart rate (RPP) at 1 mm ST-segment depression], and maximum ST-segment depression corresponding to the highest RPP common to the 2 tests (AdjSTmax) were determined. Results: While all subjects showed ischemia on the treadmill, 6/18 did not on the ergocycle. However, ischemic threshold was higher on the ramp than the Bruce protocol (23 420 ± 5 732 vs 20 018 ± 3 542 bpm•min-1•mmHg; P=0.007). Peak RPP was higher during the ramp than with the Bruce protocol (28 492 ± 6 450 vs 25 519 ± 6 067 bpm•min-1•mmHg, respectively; P=0.02), despite similar peak VO2 (25.59 ± 5.05 vs 26.39 ± 4.65 mlO2•kg-1•min-1, respectively; P=0.6). AdjSTmax was less on the ramp than the Bruce protocol (-1.2 ± 0.9 vs -1.9 ± 0.7 mm; P=0.003). Conclusion: Exercise-induced myocardial ischemia is markedly attenuated on the more gradually increasing workload of the individualized ramp ergocycle compared with the standard Bruce treadmill protocol. This effect is unexplained by energy expenditure (VO2) or myocardial work (RPP) and is consistent with a “warm-up” ischemic mechanism. The more gradually increasing workload of the ramp ergocycle protocol may have favoured a “warm-up” ischemic effect despite achieving higher RPP than the Bruce protocol treadmill suggesting it may be physiologically preferable for exercise prescription in patients with CAD

I can but I shall not always be empathic

Empathy, a core process for social interactions, is the capacity to understand and share others’ mental states and emotions. Each individual is thought to have a maximum level of empathy (empathic ability) and a spontaneous tendency to express it (empathic propensity), which can be affected by multiple factors. Two within-subject studies were conducted to assess the malleability of empathy by modulating contextual factors and measuring their interaction with psychological characteristics. In Study 1, 59 healthy adults evaluated their empathy for people showing facial expressions of pain following different instructions: Passive Observation and Instruction to Actively Empathize. In Study 2, 56 healthy adults performed a similar task under two conditions: Passive Observation and Observation under a Cognitive Load. The results revealed that empathy was significantly increased in the actively empathizing condition (Study 1) and under a cognitive load, but more importantly for men (Study 2). The level of change between the two conditions was associated with self-reported empathy, autistic, alexithymia and psychopathic traits (Study 1), as well as with working memory capacities and the level of empathy reported in the passive observation condition (Study 2). These findings suggest that an instruction to actively empathize and, surprisingly, a cognitive load can both increase empathy, but not for the same individuals. An instruction to actively empathize seems to increase empathy for individuals with good empathic dispositions, while a cognitive load enhances empathy in people for which empathic propensity is sub-optimal

Therapeutic education in atopic dermatitis: A position paper from the International Eczema Council

International audienceBackgroundAtopic dermatitis (AD) is a chronic, inflammatory skin disease that affects as many as 12.5% of children aged 0-17 years and 3% of the adult population. In the United States, 31.6 million children and adults are estimated to be living with AD.ObjectiveTherapeutic patient education (TPE) has proven its value in the management of chronic diseases for which adherence to therapy is suboptimal. This article explores experts' opinions and treatment practices to determine if TPE is a recommended and effective method for treating AD.MethodsForty-two (51%) of 82 Councilors and Associates of the International Eczema Council (IEC), an international group with expertise in AD, responded to an electronic survey on TPE and AD.ResultsMost respondents (97.5%) agreed that TPE should play an important role in the management of AD. Many respondents (82.9%) believed that all patients with AD, regardless of disease severity, could benefit from TPE.LimitationsThe International Eczema Council survey lacks specific information on AD severity.ConclusionsPublications have shown the positive effect of TPE on the course of the disease, the prevention of complications, and the autonomy and quality of patient life. Survey respondents agreed that TPE can improve the quality of patient care and patient satisfaction with care

Therapeutic education in atopic dermatitis: A position paper from the International Eczema Council

BackgroundAtopic dermatitis (AD) is a chronic, inflammatory skin disease that affects as many as 12.5% of children aged 0-17 years and 3% of the adult population. In the United States, 31.6 million children and adults are estimated to be living with AD.ObjectiveTherapeutic patient education (TPE) has proven its value in the management of chronic diseases for which adherence to therapy is suboptimal. This article explores experts' opinions and treatment practices to determine if TPE is a recommended and effective method for treating AD.MethodsForty-two (51%) of 82 Councilors and Associates of the International Eczema Council (IEC), an international group with expertise in AD, responded to an electronic survey on TPE and AD.ResultsMost respondents (97.5%) agreed that TPE should play an important role in the management of AD. Many respondents (82.9%) believed that all patients with AD, regardless of disease severity, could benefit from TPE.LimitationsThe International Eczema Council survey lacks specific information on AD severity.ConclusionsPublications have shown the positive effect of TPE on the course of the disease, the prevention of complications, and the autonomy and quality of patient life. Survey respondents agreed that TPE can improve the quality of patient care and patient satisfaction with care