Training: Papers‎ > ‎

(Teding van Berkhout 2016)*

 Title:  The Efficacy of Empathy Training: A Meta-Analysis of Randomized Controlled Trials

DOI or Website Link:

Publication:  Journal of Counseling Psychology

Authors:   Emily Teding van Berkhout and John M. Malouff

Date:   2016

Affiliation(s):  University of New England, Australia

Citation: Teding van Berkhout, E., & Malouff, J. M. (2016).  The efficacy of empathy training: A meta-analysis of randomized controlled trials. Journal of Counseling Psychology, 63(1), 32–41.

Abstract:   Cut and pasted:

High levels of empathy are associated with healthy relationships and prosocial behavior; in health professionals, high levels of empathy are associated with better therapeutic outcomes. To determine whether empathy can be taught, researchers have evaluated empathy training programs. After excluding 1 outlier study that showed a very large effect with few participants, the meta-analysis included 18 randomized controlled trials of empathy training with a total of 1,018 participants. The findings suggest that empathy training programs are effective overall, with a medium effect (g 0.63), adjusted to 0.51 after trim-and-fill evaluation for estimated publication bias.

 Moderator analyses indicated that 4 factors were statistically significantly associated with higher effect sizes: 

  • (a) training health professionals and university students rather than other types of individuals, 
  • (b) compensating trainees for their participation, 
  • (c) using empathy measures that focus exclusively on assessing understanding the emotions of others, feeling those emotions, or commenting accurately on the emotions, and 
  • (d) using objective measures rather than self-report measures.
 Number of hours of training and time between preintervention assessment and postintervention assessment were not statistically significantly associated with effect size, with 6 months the longest time period for assessment. The findings indicate that
  •  (a) empathy training tends to be effective and
  •  (b) experimental research is warranted on the impact of different types of trainees, training conditions, and types of assessment.

Topic Area:
 (In which field / sector / perspective was this study conducted?)

(How was empathy defined?)

For this meta-analysis, we defined empathy as 

  • understanding the emotions another person is feeling,
  •  feeling the same emotions another person is feeling,
  • or commenting accurately on the emotions another person is feeling.

(Were any benefits of empathy mentioned?)

Studies have demonstrated that psychotherapist empathy is  an important feature of successful treatment by 

  • psychologists (Watson, Steckley, & McMullen, 2014), 
  • social workers (Gerdes & Segal, 2009), and 
  • substance abuse counselors (Moyers & Miller, 2013).

 Studies have also found that empathy is associated with 

  • better patient outcomes for physicians (Hojat et al., 2011) and
  •  increased patient adherence to treatments (Vermeire, Hearnshaw, Van Royen, & Denekens, 2001).
 In nonprofessionals, research results have indicated that high levels of empathy are associated with 
  • enhanced personal relationships (Long, Angera, Carter, Nakamoto, & Kalso, 1999) and
  •  prosocial behavior (Telle & Pfister, 2012).

 (What were the methods used to train empathy?)
  •  Not applicable -   a meta-analysis
  • From lit review:   Empathy training programs employ a number of methods. In a review, Lam et al. (2011) found that the most common methods included experiential training (instructors provide “experiences” such as games and role-play), didactic (lecture based), skills training (lectures, demonstrations and practice), and mixed methods. Many of these correspond to methods found in behavioral skills training, which includes modeling, instructions, rehearsal, and feedback (Mittenberger, 2015). For the present meta-analysis, we divided training methods into those that included all four components of behavioral skills training and those that did not include all four components.
  • From lit review: There is currently no consensus regarding the optimum length of time for an empathy training course or whether differences in duration or intervals impact training outcomes. Some reviews of interpersonal skills training, including empathy training, have suggested a training length of 1–3 days (Berkhof, van Rijssen, Schellart, Anema, & van der Beek, 2011), and others, such as Butters (2010), failed to find an association between training time and effect size, concluding that as little as 1 hr may be effective.

Target Group:  
(Who participated in this study / training?)


About the assessment: How was the change in empathy measured before/after the intervention/method?) 

Meta-analysis of 18 studies

(What was the result?)  Among results, these seem relevant to project: 
  • Use of behavioral skills training principles. Empathy training studies involving all four components of behavioral skills training (instruction, modeling, practice, and feedback) had higher, but not significantly higher, effect sizes than other studies. The trend found is consistent with the meta-analytic conclusion of Hill and Lent (2006) that helping-skills training programs using multiple behavioral skills training methods produce significantly higher effect sizes than programs that do not.
  • Type of empathy trained. Studies that targeted cognitive and behavioral, or cognitive, affective, and behavioral, empathy showed higher, but not significantly higher, effect sizes than studies targeting cognitive and affective empathy. It could be that behavioral training provides a valuable aspect to training. Interestingly, all included studies targeted at least cognitive empathy. This may be because cognitive empathy is considered to involve processes that can be consciously acquired, whereas affective empathy is considered to be more autonomic, and behavioral empathy is considered to occur in response to the affective or cognitive empathy process (Batt-Rawden et al., 2013; Elliott, Bohart, Watson, & Greenberg, 2011; Jolliffe & Farrington, 2004).
  • Training length. The metaregression found no significant evidence that number of training hours was associated with effect size. It is possible that these results are a consequence of population differences rather than the unimportance of training dose. This analysis involved populations ranging from children with disabilities to physicians, and it is possible that the time needed to produce empathy changes in each group varies. For example, Berkhof et al. (2011) have suggested that between 1 and 3 days of training is effective for physicians, while Gresham, Sugai, and Horner (2001) have suggested that over 30 hr of training is insufficient for children with disabilities. Thus, although the current results suggest that the amount of training has no effect on outcome, the nonsignificant result should be interpreted with caution.
Posted By:  
 Dorothy Della Noce


(Any other relevant information)

References marked with an asterisk were included in the meta-analysis.

Ali, F., Amorim, I. S., & Chamorro-Premuzic, T. (2009). Empathy deficits 
and trait emotional intelligence in psychopathy and Machiavellianism. Personality and Individual Differences, 47, 758–762. 

Ang, R. P., & Goh, D. H. (2010). Cyberbullying among adolescents: The 
role of affective and cognitive empathy, and gender. Child Psychiatry and Human Development, 41, 387–397. 

(ARCHER + 1973)Archer, J., & Kagan, N. (1973). Teaching interpersonal relationship skills on campus: A pyramid approach. Journal of Counseling Psychology, 20, 535–540.

Baron-Cohen, S., & Wheelwright, S. (2004). The empathy quotient: An 
investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders, 34, 163–175. 

Batt-Rawden, S. A., Chisolm, M. S., Anton, B., & Flickinger, T. E. (2013). 
Teaching empathy to medical students: An updated, systematic review. Academic Medicine, 88, 1171–1177. 

Beelmann, A., & Heinemann, K. S. (2014). Preventing prejudice and 
improving intergroup attitudes: A meta-analysis of child and adolescent training programs. Journal of Applied Developmental Psychology, 35, 10–24. Begeer, S., Gevers, C., Clifford, P., Verhoeve, M., Kat, K., Hoddenbach, 

(BEGEER + 2011)Begeer, S., Gevers, C., Clifford, P., Verhoeve, M., Kat, K., Hoddenbach, E., & Boer, F. (2011). (2011). Theory of mind training in children with autism: A randomized controlled trial. Journal of Autism and Developmental Disorders, 41, 997–1006. 

Berkhof, M., van Rijssen, H. J., Schellart, A. J. M., Anema, J. R., & van 
der Beek, A. J. (2011). Effective training strategies for teaching communication skills to physicians: An overview of systematic reviews. Patient Education and Counseling, 84, 152–162.

Blair, R. J. R. (2008). Fine cuts of empathy and the amygdala: Dissociable 
deficits in psychopathy and autism. The Quarterly Journal of Experimental Psychology, 61, 157–170.

Boot, W. R., Simons, D. J., Stothart, C., & Stutts, C. (2013). The pervasive 
problem with placebos in psychology why active control groups are not sufficient to rule out placebo effects. Perspectives on Psychological Science, 8, 445–454.

Brunero, S., Lamont, S., & Coates, M. (2010). A review of empathy 
education in nursing. Nursing Inquiry, 17, 65–74. 

(BUNN + 2009)*Bunn, W., & Terpstra, J. (2009). Cultivating empathy for the mentally ill using simulated auditory hallucinations. Academic Psychiatry, 33, 457– 460. 

Butters, R. P. (2010). A meta-analysis of empathy training programs for 
client populations (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3398227). 

Carkhuff, R. R. (1969). Human and helping relations (Vols. 1 & 2). New 
York, NY: Holt, Rinehart and Winston. 

Choudhury, S., Blakemore, S. J., & Charman, T. (2006). Social cognitive 
development during adolescence. Social Cognitive and Affective Neuroscience, 1, 165–174. 

Clark, M. A. (2007). Cognitive and affective empathy: Exploring the 
differential effects of empathy components on work-family conflict and emotional labor (Master’s thesis). Available from ProQuest Dissertations and Theses database. (UMI No. 1446883). 

(CRABB + 1983)*Crabb, W. T., Moracco, J. C., & Bender, R. C. (1983). A comparative study of empathy training with programmed instruction for lay helpers. Journal of Counseling Psychology, 30, 221–226.

(CSÁSZÁR 2012)*Császár, I. (2012). The effect of loving kindness meditation and student teachers stress and empathy (Doctoral dissertation, Louisiana State University). Retrieved from

(DADDS + 2012)*Dadds, M. R., Cauchi, A. J., Wimalaweera, S., Hawes, D. J., & Brennan, J. (2012). Outcomes, moderators, and mediators of empathic-emotion recognition training for complex conduct problems in childhood. Psychiatry Research, 199, 201–207.

(DANIELS + 1988)*Daniels, T. G., Denny, A., & Andrews, D. (1988). Using microcounseling to teach RN nursing students skills of therapeutic communication. The Journal of Nursing Education, 27, 246–252. 

Davis, M. H. (1983). Measuring individual differences in empathy: Evidence 
for a multidimensional approach. Journal of Personality and Social Psychology, 44, 113–126.

Decety, J., & Lamm, C. (2006). Human empathy through the lens of social 
neuroscience. The Scientific World Journal, 6, 1146–1163.

Dexter, V. J. (2012). Research synthesis with meta-analysis of empathy 
training studies in helping professions (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3510491). 

Duan, C., & Hill, C. E. (1996). The current state of empathy research. 
Journal of Counseling Psychology, 43, 261–274.

Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). 
Empathy. Psychotherapy, 48, 43– 49.

Gerdes, K. E., Lietz, C. A., & Segal, E. A. (2011). Measuring empathy in 
the 21st century: Development of an empathy index rooted in social cognitive neuroscience and social justice. Social Work Research, 35, 83–94.

Gerdes, K. E., & Segal, E. A. (2009). A social work model of empathy. 
Advances in Social Work, 10, 114–127. Retrieved from

Gladstein, G. A. (1983). Understanding empathy: Integrating counseling,
developmental, and social psychology perspectives. Journal of Counseling Psychology, 30, 467–482.

Gresham, F. M., Sugai, G., & Horner, R. H. (2001). Interpreting outcomes 
of social skills training for students with high-incidence disabilities. Exceptional Children, 67, 331–344.

(HANDMAKER +1999)*Handmaker, N. S., Hester, R. K., & Delaney, H. D. (1999). Videotaped training in alcohol counseling for obstetric care practitioners: A randomized controlled trial. Obstetrics and Gynecology, 93, 213–218.

Head, E. (2009). The ethics and implications of paying participants in 
qualitative research. International Journal of Social Research Methodology:Theory & Practice, 12, 335–344. ttp://

Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis.
New York, NY: Academic.

Higgins, H. M. (1990). Empathy training and stress: Their role in medical 
students’ responses to emotional patients (Doctoral dissertation). Retrieved from

Hill, C. E., & Lent, R. W. (2006). A narrative and meta-analytic review of 
helping skills training: Time to revive a dormant area of inquiry. Psychotherapy: Theory, Research, Practice, Training, 43, 154–172.

(HODGE 1978)Hodge, E. A., Payne, P. A., & Wheeler, D. D. (1978). Approaches to empathy training: Programmed methods versus individual supervision and professional versus peer supervisors. Journal of Counseling Psychology, 25, 449–453.

Hoffman, M. L. (2000). Empathy and moral development: Implications for 
caring and justice. New York, NY: Cambridge University Press.

Hogan, R. (1969). Development of an empathy scale. Journal of Consulting 
and Clinical Psychology, 33, 307–316.

Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C., & 
Gonnella, J. S. (2011). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine, 86, 359–364.

(JACOBS 1977)Jacobs, D. (1977). Role playing role reversal as a method for trainingadolescents in empathy (Master’s thesis). Retrieved from

Jolliffe, D., & Farrington, D. P. (2004). Empathy and offending: A systematic 
review and meta-analysis. Aggression and Violent Behavior, 9,441–476. ttp://

Jolliffe, D., & Farrington, D. P. (2006). Examining the relationship between
low empathy and bullying. Aggressive Behavior, 32, 540–550.

Kerem, E., Fishman, N., & Josselson, R. (2001). The experience of 
empathy in everyday relationships: Cognitive and affective elements.Journal of Social and Personal Relationships, 18, 709–729.

Kohut, H. (1959). Introspection, empathy, and psychoanalysis: An examination
of the relationship between mode of observation and theory.Journal of the American Psychoanalytic Association, 7, 459–483.

La Monica, E. L. (1981). Construct validity of an empathy instrument. 
Research in Nursing & Health, 4, 389–400.

Lam, T. C. M., Kolomitro, K., & Alamparambil, F. C. (2011). Empathy 
training: Methods, evaluation practices, and validity. Journal of MultidisciplinaryEvaluation, 7, 162–200. Retrieved from

Lambert, J. E., & Alhassoon, O. M. (2015). Trauma-focused therapy for 
refugees: Meta-analytic findings. Journal of Counseling Psychology, 62,28–37.

Lipsey, M. W. (2003). Those confounded moderators in meta-analysis: 
Good, bad and ugly. Annals of the American Academy of Political and Social Science, 587, 69 – 81.

Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis (Vol. 49). Thousand Oaks, CA: Sage.

(LOMIS + 1985)Lomis, M. J., & Baker, L. L. (1985). Microtraining of forensic psychiatric patients for empathic counseling skills. Journal of Counseling Psychology, 32, 84–93.

Long, E. C. J., Angera, J. J., Carter, S. J. C., Nakamoto, M., & Kalso, M. (1999). Understanding the one you love: A longitudinal assessment of an empathy training program for couples in romantic relationships. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 48, 235–242.

Mehrabian, A., & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality, 40, 525–543.

Mittenberger, R. G. (2015). Behavior modification: Principles and procedures (6th ed.). Boston, MA: Cengage Learning.

Moyers, T. B., & Miller, W. R. (2013). Is low therapist empathy toxic? Psychology of Addictive Behaviors, 27, 878–884.

Newman, J. A. (1993). Affective empathy training with senior citizensusing Zazen (Zen) meditation (Doctoral dissertation). Retrieved from

(ONEILL + 2012)*O’Neill, M., & McMillan, T. M. (2012). Can deficits in empathy after head injury be improved by compassionate imagery? Neuropsychological Rehabilitation, 22, 836–851.

(PECUKONIS 1990)*Pecukonis, E. V. (1990). A cognitive/affective empathy training program as a function of ego development in aggressive adolescent females. Adolescence, 25, 59–76.

(PERRY 1975)*Perry, M. A. (1975). Modeling and instructions in training for counselor empathy. Journal of Counseling Psychology, 22, 173–179. http://dx.doi .org/10.1037/h0076713

Pichon, I., Boccato, G., & Saroglou, V. (2007). Nonconscious influences of 
religion on prosociality: A priming study. European Journal of Social Psychology, 37, 1032–1045.

(REED 1996)*Reed, D. L. (1996). Effects of a combined didactic and experiential death education/empathy training program on death anxiety and empathic ability of medical students (Doctoral dissertation). Retrieved from

(RIESS 2012)*Riess, H., Kelley, J. M., Bailey, R. W., Dunn, E. J., & Phillips, M. (2012). Empathy training for resident physicians: A randomized controlled trial of a neuroscience-informed curriculum. Journal of General Internal Medicine, 27, 1280–1286.

Ripley, E. B. (2006). A review of paying research participants: It’s time to 
move beyond the ethical debate. Journal of Empirical Research on Human Research Ethics, 1, 9–20.

Rogers, C. R. (1992). The necessary and sufficient conditions of therapeutic 
personality change. 1957. Journal of Consulting and Clinical sychology, 60, 827–832.

Rogge, R. D., Cobb, R. J., Lawrence, E., Johnson, M. D., & Bradbury, 
T. N. (2013). Is skills training necessary for the primary prevention of marital distress and dissolution? A 3-year experimental study of three  interventions. Journal of Consulting and Clinical Psychology, 81, 949–  961. 

Salmon, S. (2003). Teaching empathy: The PEACE curriculum. Reclaiming  
Children and Youth, 12, 167–173. Retrieved from 

Shamay-Tsoory, S. G. (2011). The neural bases for empathy. The Neuroscientist,  
17, 18–24. 

Telle, N., & Pfister, H. (2012). Not only the miserable receive help:  
Empathy promotes prosocial behavior toward the happy. Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues, 31, 393–413. 

Tudor, K. (2011). Understanding empathy. Transactional Analysis Journal, 
41, 39–57. 

(UHLEMANN + 1976)Uhlemann, M. R., Lea, G. W., & Stone, G. L. (1976). Effect of instructions and modeling on trainees low interpersonal-communication skills. Journal of Counseling Psychology, 23, 509–513. 10.1037/0022-0167.23.6.509 

Vermeire, E., Hearnshaw, H., Van Royen, P., & Denekens, J. (2001). 
Patient adherence to treatment: Three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics, 26, 331–342. 

Watson, J. C., Steckley, P. L., & McMullen, E. J. (2014). The role of 
empathy in promoting change. Psychotherapy Research, 24, 286–298.