The roles of emotion regulation and metacognition in performance based-empathy

Abstract

Background: People with schizophrenia experience significant deficits in empathic skills, which are important for effective interpersonal relationships. Researchers have speculated about the roles of personal distress, emotion regulation, and metacognition in empathic interaction, but the impact of these constructs on empathy has yet to be empirically investigated. This study examines the relationships among these constructs in a sample of people with schizophrenia receiving community-based treatment (N = 58). It was hypothesized that better emotion regulation and metacognition, as well as reduced personal distress, would predict empathy. Further, emotion regulation was expected to mediate the relationship between personal distress and empathy, and metacognition was expected to moderate the relationship between personal distress and empathy. Method: Participants with schizophrenia or schizoaffective disorder completed self-report questionnaires of emotion regulation and personal distress, a performance-based measure of empathy, and an observer-rated interview to assess metacognition. Results: Metacognition, but not emotion regulation or personal distress, significantly predicted cognitive empathy performance, with a trend-level association for affective empathy performance. Mediation analyses revealed that emotion regulation mediates the relationship between personal distress and affective empathy performance, and moderation analyses revealed that metacognition moderates the same relationship. Moderation results suggest the relationship between personal distress and affective empathy performance is significant for those with low metacognition, but that the relationship is the opposite of hypotheses – increased personal distress is associated with better performance. Conclusions: This study is the first of its kind to examine performance-based empathy with personal distress, emotion regulation, and metacognition. Results suggest interventions targeted to improve metacognition may be useful in enhancing empathic skills. Future work is needed to improve existing measures of empathy and personal distress, and to parse apart the intricacies of the relationships among personal distress, emotion regulation, and empathy.