Finding Empathy and Connection through Gratitude

Scientists have used our perception of literal hills to explore how we respond to the figurative hills in our lives. A series of investigations demonstrated that when we are tired, stressed, down, or carrying a bookbag, we are more likely to perceive a hill as steeper than when we have more energy or are in a better mood.^1,2 Interestingly, participants with friends standing beside them judged the hill to be less steep.³

In another study, women were threatened with a shock while sitting alone, holding the hand of a romantic partner, or holding the hand of a stranger. Women in lower quality relationships had more of a stress response than the women in high-quality relationships, but still less than those with a stranger. Women who were alone when presented with the threat had the greatest stress response. In other words, our bodies use more resources when we are alone and less when we are with another person.

Scientists theorize that being close to your social network decreases the personal “cost” of responding to stressors.  Our brains evaluate relationships as a resource, much like oxygen and glucose,⁴ so our bodies are most efficient when we are near those with whom we have strong relationships.⁵

The evidence describing the power of strong relationships makes the statistics of loneliness all the more critical. One-fifth of adults in the United States report loneliness, with 50% of those describing an impact on personal relationships or physical health.⁶ Loneliness is compounded for people impacted by chronic disease. Forty years ago, Harold Benjamin described unwanted aloneness as one of the universal experiences of living with the effects of a life-threatening diagnosis, such as end-stage kidney disease.⁷

Home dialysis might further exacerbate unwanted aloneness and loneliness for the person on dialysis and care partner (if there is one), making the hill seem steeper. For instance, consider the impact of the logistical demands of home dialysis on participation in community activities or work. New dietary habits may change the experience at family meals. Friends might be uncertain about how to welcome home dialysis into the relationship. The accessories of home dialysis (like the boxes) might change the comfort level for inviting people into the home. Pressure from clinics on "adherence" and "compliance" may further alienate the person on dialysis and care partner from the treatment team.

Ironically, the reflex of sympathy to challenges from our social networks can further drive loneliness. Initially, the sympathetic response is a comfort. Phrases such as "I'm so sorry this is happening to you" are often meant with love and generosity. As both of these videos demonstrate, though, the unintended messages of sympathy are pity, victim status, and agreement:

• I’m sorry (pity)

• This is happening to you (victim status and agreement)

Sympathy continues to drive disconnects between people. When we respond to the distress of others with sympathy, we get lost in despair and end up trying to save a person who does not need saving—but needs connection. Dialysis providers often lament their feeling of powerlessness in helping patients achieve their goals, perhaps because they respond with sympathy to the person's experience and offer solutions to a problem that are not meaningful to the person on dialysis or their family.

Empathy, on the other hand, drives the connection between people. When we demonstrate our understanding with statements like, "I can see that you are really struggling and feel like there are no other options," we communicate we are connected with the other person. Empathic responses promote the autonomy and competence of the other person by avoiding the pitfalls of victim status.

The difference between sympathy and empathy begs the question, why do we use sympathy if empathy is so powerful? Sympathy is a muscle that is toned early in development when primary caregivers play games with infants and toddlers to encourage sharing and responding to the need of others. Empathy, often described as "feeling as if," is a more complicated psychological process. Empathy is dependent on the quality of the relationship between two people, familiarity with the situation, similar past experiences, and the capacity of the other for emotional regulation.⁸ Generally speaking, if we have not experienced loss, it is difficult to empathize with the grief of others. While curiosity is one tool to develop empathy, self-care is essential to help you climb your own hill—and necessary to empathize with the hill of your companion.

In the United States, it is Thanksgiving, a holiday that ritualizes the experience of reflecting on and experiencing gratitude. A practice of gratitude uses the same brain muscles as empathy and is an effective stress management exercise. Recent research has shown that empathy, gratitude, and life satisfaction share similar patterns of brain activity.⁹ Through activities such as journaling, letter writing, and saying "thank you," gratitude shifts our focus from toxic rumination to positive emotions, particularly when sharing it with someone else. In addition to training our brain to notice the positive, a regular gratitude practice becomes more potent, with benefits noticed for weeks and months.^10,11 The stress management benefits of gratitude—including increased happiness, less burnout, better sleep, less inflammation, and increased resilience—will help people on dialysis, their partners, and providers maintain the curiosity and self-relation necessary to lean into empathy.

The various hills the home dialysis team navigates can strengthen relationships when the team values self-care and practices curiosity to respond to challenges with empathy. Happy Thanksgiving!

References:

1. Schnall S, Zadra JR, Proffitt DR. Direct evidence for the economy of action: Glucose and the perception of geographical slant. Perception. 2010;39(4):464-482. doi:10.1068/P6445

2. Proffitt DR, Stefanucci J, Banton T, Epstein W. The role of effort in perceiving distance. Psychol Sci. 2003;14(2):106-112. doi:10.1111/1467-9280.T01-1-01427

3. Schnall S, Harber KD, Stefanucci JK, Proffitt DR. Social Support and the Perception of Geographical Slant. J Exp Soc Psychol. 2008;44(5):1246. doi:10.1016/J.JESP.2008.04.011

4. Coan JA, Sbarra DA. Social Baseline Theory: The Social Regulation of Risk and Effort. Curr Opin Psychol. 2015;1:87. doi:10.1016/J.COPSYC.2014.12.021

5. Coan JA, Schaefer HS, Davidson RJ. Lending a hand: social regulation of the neural response to threat. Psychol Sci. 2006;17(12):1032-1039. doi:10.1111/J.1467-9280.2006.01832.X

6. DiJulio B, Hamel L, Muñana C, Brodie M. Loneliness and Social Isolation in the United States, the United Kingdom, and Japan: An International Survey. Kaiser Fam Found. 2018;(August):1-29. https://www.kff.org/report-section/loneliness-and-social-isolation-in-the-united-states-the-united-kingdom-and-japan-an-international-survey-introduction/

7. Golant, M., Zaleta, A. K., Ash-Lee, S., Buzaglo, J. S., Stein, K., Saxton, M. C., Donziger, M., Thiboldeaux, K., & Bohannon L. The engaged patient: The Cancer Support Community’s comprehensive model of psychosocial programs, services, and research. In: W. S. Breitbart, P. N. Butow, P. B. Jacobsen, W. W. T. Lam, M. Lazenby & MJL, ed. Psychosocial Oncology. 4th ed. Oxford University Press; 2021:393-399.

8. Preston SD, Hofelich AJ. The Many Faces of Empathy: Parsing Empathic Phenomena through a Proximate, Dynamic-Systems View of Representing the Other in the Self: https://doi.org/10.1177/1754073911421378. 2012;4(1):24-33. doi:10.1177/1754073911421378

9. Kong F, Zhao J, You X, Xiang Y. Gratitude and the brain: Trait gratitude mediates the association between structural variations in the medial prefrontal cortex and life satisfaction. Emotion. 2020;20(6):917-926. doi:10.1037/EMO0000617

10. Kini P, Wong J, McInnis S, Gabana N, Brown JW. The effects of gratitude expression on neural activity. Neuroimage. 2016;128:1-10. doi:10.1016/J.NEUROIMAGE.2015.12.040

11. Wong YJ, Owen J, Gabana NT, et al. Does gratitude writing improve the mental health of psychotherapy clients? Evidence from a randomized controlled trial. Psychother Res. 2018;28(2):192-202. doi:10.1080/10503307.2016.1169332