Journal of the Society for Social Work and Research Volume 2, Issue 2, 104-124

July 2011 ISSN 1948-822X DOI:10.5243/jsswr.2011.6

The Empathy Assessment Index (EAI): A Confirmatory Factor Analysis of a Multidimensional Model of Empathy
Cynthia A. Lietz Karen E. Gerdes Fei Sun Jennifer Mullins Geiger M. Alex Wagaman Elizabeth A. Segal Arizona State University
Both historically and currently, social work and related fields have expressed considerable interest in the construct of empathy. However, the ability to define and ultimately measure empathy is limited. This project validates a revised version of the Empathy Assessment Index (EAI), which is a measure rooted in a social cognitive neuroscience conceptualization of empathy. To evaluate the instruments psychometric properties, we administered the 50-item EAI with a five-component model of empathy to a sample of 773 undergraduate students and community members. We evaluate the EAI psychometrics conducting internal consistency, testretest, and confirmatory factor analyses. Findings indicate that a 17-item five-factor model of the EAI offers the best fit [CFI = .98; RMSEA = .04 (90% CI (.03; .05); WRMR = .80]. The data do not support using empathic attitudes as a proxy for actions; however, the findings suggest the EAI functions better when measuring a fourfactor model, offering an important implication for future research. Keywords: empathy, measurement, psychometrics, confirmatory factor analysis

The concept of empathy has a long history within social work literature. For years, social work scholars have suggested practitioners need to develop empathy to understand and to respond appropriately when working with diverse populations facing a variety of social problems. Equally important, increased empathy in populations served by social workers has a number of positive outcomes, including increased satisfaction with relationships, improved parenting, and increased social well-being (Curtner-Smith et al., 2006; Hoffman, 2000; Hunter, Figueredo, Becker, & Malamuth, 2007). Although these assumptions regarding empathy remain ubiquitous across policy and practice texts, the term empathy lacks clarity, suggesting a need for further conceptualization (Duan & Hill, 1996; Gerdes, Segal, & Lietz, 2010; Pithers, 1999). Recent advances in social cognitive neuroscience have indicated empathy is an induction process that can be described and, therefore, can be measured, offering important implications regarding a conceptualization of empathy (Decety & Meyer, 2008; Decety & Moriguchi, 2007). Social workers would benefit from having an empathy measure that can be applied across social work settings. For example, social work educators seek to foster empathic responses from students whereas practitioners might attempt to cultivate empathy within

client populations. Having a robust measure of empathy would enable educators and practitioners working in these varied contexts to assess levels of empathy whatever the population of interest. In addition, because levels of empathy can inform interpersonal interactions across settings and purposes, a measure of empathy may offer important applications beyond social work. This project used confirmatory factor analysis to test revisions of the Empathy Assessment Index (EAI), which is an instrument designed to measure a multidimensional model of empathy grounded in social cognitive neuroscience (see Gerdes, Lietz, & Segal, 2011). Social cognitive neuroscience is a relatively new, interdisciplinary field, which examines topics that have traditionally been of interest to social science (e.g., information processing, emotional regulation) using approaches that are more typical of neuroscience such as brain imaging (e.g., functional magnetic resonance imaging). Literature Review The term empathy can be traced from early literature informing social work (Richmond, 1917; Rogers, 1975; Towle, 1945) to current discussions describing social work practice (Boyle, Hull, Mather, Smith, & Farley, 2006; Hepworth, Rooney, Rooney, Strom-Gottfried, & Larsen, 2006; Saleebey, 2009; Shulman, 2009). The

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historical development of the empathy concept within social work suggests that although influential, the construct lacks clarity and consensus (Gerdes et al., 2010). Some theorists have perceived empathy as a capacity to feel the experiences of another (Kohut, 1959), suggesting an introspective, cognitive component to empathy. On the other hand, Rogers (1957) discussed empathy as a skill that was demonstrated by a therapists ability to relate with a client without losing his or her sense of self. Rogers work represented some of the earliest consideration that differentiation between self and others may be an important part of empathy. Social developmental psychology contributed to the conceptualization of empathy by highlighting the possibility that empathy encompasses multiple dimensions (Cliffordson, 2002; Davis, 1996), including components such as awareness of self and others (Batson et al., 1997) and emotional regulation (Eisenberg at al., 1994). Hoffman (2000) added to this discussion and suggested empathy was not simply multidimensional, but may also represent a developmental process, progressing from automatic mimicry (Iacoboni, 2009) to cognitive processing that involves the ability to imagine the experiences of another. More recently, Decety and Jackson (2004) demonstrated that observable brain activity was linked to four subjectively experienced components of empathy. The first component is affective sharing, which comprises automatic reactions based on a persons observation of another. The second, self-awareness, is a persons ability to differentiate the experiences of another from his or her own. The third component is perspective taking, which is the cognitive process of imagining the experiences of another. The fourth component is emotion regulation that is described as a persons ability to sense anothers feelings without becoming overwhelmed by the intensity of this experience. Decety and Moriguchis (2007) descriptions of these four components increased the clarity of the overall conceptualization of empathy. Recent thinking within social work has suggested a fifth potentially important component to empathy. Gerdes and Segal (2009) have contended that empathy goes beyond automatic responses, suggesting the induction process culminates in a conscious course of action. Eisenberg (2006, p. 71) referred to this idea as empathyrelated responding, asserting the existence of a relationship between empathy and prosocial behavior. To measure this fifth component, the EAI includes a proxy for empathic action defined as empathic attitudes. The empathic attitudes component is of particular interest to social work because the component suggests that

empathic attitudes may increase the likelihood for taking empathic action. Considering the many variations in how empathy is conceptualized across disciplines, social work often serves as a bridging discipline. For example, many psychologists have described empathy as an automatic emotional response to others behavior or emotions (Freedberg, 2007). However, social work incorporates an interdisciplinary approach to understanding empathy as a biological, emotional, and cognitive response. In addition, social work is interested in how empathy can be developed and cultivated among professionals and client populations. In this way, as with other concepts within social work, empathy can be conceptualized by drawing from the strengths of other disciplines to create a holistic approach. Measuring Empathy Efforts to conceptualize and ultimately measure empathy have been informed by theoretical developments and advances in neuroscience. However, no instrument designed to measure empathy has used a four-factor model grounded in neuroscience, nor have other measures incorporated the empathic attitudes component that is relevant to social work. Moreover, previous measures fell short regarding their psychometric properties. For example, one of the earliest and most widely used multidimensional measures of empathy, Davis (1980) Interpersonal Reactivity Index (IRI) includes four factors: perspective taking, fantasy, empathic concern, and personal distress. Critics of this instrument have argued that the personal distress and fantasy factors were inadequate to assess levels of empathy, and that the instrument measured sympathy rather than empathy. In addition, the IRI was not validated by further statistical analysis (Cliffordson, 2002). Similarly, in an evaluation of Hogans (1969) Empathy Scale, Froman and Peloquin (2001) concluded that the model suffered from questionable test-retest reliability, low internal consistency, and poor replication of factor structure. Measures of empathy that have been developed more recently have demonstrated improved psychometric properties; these measures include the Toronto Empathy Questionnaire (Spreng, McKinnon, Mar, & Levine, 2009); the Basic Empathy Scale (Joliffe & Farrington, 2006); the Ethnocultural Empathy Scale (Wang et al., 2003); the E-Scale (Leibetseder, Laireiter, & Kller, 2007); and Hojat et al.s (2001) Jefferson Scale of Physician Empathy. However, some notable limitations may prevent these measures from fully capturing an accurate and multidimensional representation of empathy. For example, the Toronto Empathy Questionnaire (Spreng et al., 2009) presents empathy

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primarily as an emotional process and does not account for cognitive components required for perspective taking and selfother awareness. Conversely, although Hogans (1969) Empathy Scale has been widely used as a measure for cognitive empathy, this scale fails to incorporate the critical component of emotion. Other instruments measure empathy within a specific group, such as the Jefferson Scale of Physician Empathy (Hojat et al., 2001) or individuals empathy toward people of different racial/ethnic backgrounds (Wang et al., 2003). Although important contributions, the scales reviewed here do not offer a measure of empathy with wide-reaching applicability, nor do they reflect the understanding of empathy based in neuroscience. The ability to measure empathy in social work practice settings is relevant to client assessment and the evaluation of evidence-based practice. For example, low levels of empathy have been linked to delinquent and aggressive behavior in adolescents (de Kemp, Overbeek, De Wied, Engels, & Scholte, 2007) and sex offenders (Varker & Devilly, 2007; Whittaker, Brown, Bekett, & Gerhold, 2006). An empathy measure can help guide treatment planning and evaluation of treatment goals in settings within social work and within other disciplines including education, psychology, and medicine. Development of the EAI The EAI was developed to overcome the limitations of current measures of empathy by incorporating five components of empathy: affective response, selfother awareness, perspective taking, emotion regulation, and empathic attitudes. As described by Gerdes and colleagues (2011), survey design protocols were followed in the development of items for each of the five components (DeVellis, 2003). After an exhaustive literature review on each component and a review of current items from existing measures of the five constructs, the researchers composed their own unique items. The goal was to follow Sartori and Pasinis (2007) recommendation that item generation should seek to achieve content validity by creating items that flow logically and theoretically from the conceptualization of each component. Pilot Version of the EAI. The pilot version of the EAI was a 54-item survey that was administered in October 2009 to a nonrandom sample of 312 students (63% response rate; Gerdes et al., 2011). Although this initial version of the EAI demonstrated some promise, a confirmatory factor analysis (CFA) could not be conducted on the five-component pilot data because the selfother awareness items had unacceptable reliability analysis ( =.299). Therefore, the researchers performed an exploratory factor analysis (EFA) using the maximum likelihood extraction method with oblique rotation. The EFA results indicated that in addition to reconceptualizing the selfother awareness construct, several items on the emotion regulation component needed revision or elimination, and the affective response component needed modification. Before the current data were collected, the researchers improved the EAI by eliminating items that did not contribute significant information to the index and, when needed, developing new items that, in turn, would be further tested. (See the Method section for a description of how new items were generated). This article is based on a second round of data collected in September 2010, to validate the psychometric properties of a revised version of the EAI. Method Revising the EAI Based on EFA Pilot Study, Focus Groups, and Expert Reviews Revisions based on the EFA pilot study. Before collecting data for the CFA of the EAI, the researchers returned to the social cognitive neuroscience literature to reconceptualize the items for the selfother awareness component, to modify the affective response component, and to add new items to the emotion regulation and perspective-taking components. In the EAI pilot test, the selfother awareness component was broadly interpreted with an overemphasis on boundaries. For example, the pilot EAI included five selfother awareness items such as Getting over-involved in other peoples lives describes me well, and When a friend has a problem, I am supportive, but let him/her handle it. In addition, one selfother awareness item was unintentionally doublebarreled: I am willing to look at my own behavior and consider how I interact with people. These miscues are likely responsible for the pilot selfother awareness components Cronbach alpha of .299. The researchers reevaluated the selfother awareness component after carefully considering two important aspects of the component. First, selfother awareness allows the empathizer to track the origins of his or her feelings triggered during the affective arousal phase (Lamm, Batson, & Decety, 2007). Second, selfother awareness enables the empathizer to suspend ones own experience in order to conjure up the thoughts and feelings of others (Mitchell, 2009, p. 1314); an ability which is a prerequisite for perspective taking. With this context in mind, the researchers generated 10 new self other awareness items, including I can tell the difference between someone elses feelings and my own, and I am aware of what other people think of me. We also eliminated reverse-scored items in the selfother awareness component because negative items tend to load on a different factor than positive-worded items (Brown, 2003), and we decided these reverse scored items were not necessary for this component.

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The emotion regulation component also required modification because the pilot version items were insufficient. Although we did not choose reverse-scored items for selfother awareness, we considered the approach important for the emotion regulation component. Regulating emotions is about changing the way people think, which, in turn, changes the way they feel; overall, a complex cognitive process (Ochsner, Bunge, Gross & Gabrieli, 2002). Because cognitive components of empathy require increased thought, measurement must reflect that complexity and, therefore, be more cognitively challenging. Developing these items required creating a cognitive challenge without creating undue confusion. Brown (2003) recommended that when reverse-scored items are considered important, researchers should use equal numbers of positively and negatively worded items to better control for method effects. Following this reasoning, the revised emotion regulation component included five negatively worded items and six positively worded. In the next phase of the revision, we sought to further clarify and refine the number of items in each component by seeking feedback from focus groups and content experts. Revisions based on the focus groups. We conducted focus groups with social work students and community professionals to obtain their feedback regarding the overall experience of taking the EAI as well as to gather feedback on specific index items. Six focus groups were conducted with 49 participants; group size ranged from six to 15 participants. Four groups included social work students (n = 24) and two groups were conducted with social work community professionals (n = 25) who were recruited from the School of Social Works field instructor list. Before focus group discussion started, each participant independently completed the online version of the EAI. The focus group participants then provided feedback through a structured, facilitated dialogue that was documented by a note taker. Participants identified several challenging aspects of items, including items deemed difficult to answer using the given the response options; items for which the meaning of a word or phrase was unclear or could be interpreted in multiple ways; and items that were too broad, which hindered participants ability to provide a concrete response. Participants also provided feedback regarding the online process of administration. The sample was chosen based on convenience and because social workers receive training in empathy, making the perspectives of the study sample especially beneficial. However, that same training is also a possible source of bias, and must be considered a limitation of this approach.

Revisions based on the expert reviewers. The expert reviewers included a sample of three researchers identified as experts within the area of empathy. The experts were selected using the following criteria: (a) the person has published substantial original research in the area of empathy or self-report instrumentation, and (b) the person has credentials in developmental psychology, social cognitive neuroscience, or social work. Each of the expert reviewers was asked to comment on face and content validity for the overall measure and identify any wording and items he or she thought could be problematic. The feedback from the expert reviewers was similar to the feedback from focus groups regarding problems with clarity of specific items. Two expert reviewers and several focus group participants recommended the researchers switch from a 5-point Likert scale to a 6-point scale ranging from never (1) to always (6). The 5-point scale had been chosen for the EAI based on guidelines for scale development (DeVellis, 2003), and to provide enough categories to allow for a meaningful variation in the answers. The research team debated between 5- and 6-point scales, opting to go with five response choices in the pilot administration. The choice for an odd number allowed for a central or neutral point. However, focus group feedback indicated the response options did not represent an evenly divided continuum; specifically, respondents noted that the responses of frequently and always represented a greater separation of responses than the other categories (i.e., these responses were further apart than others) . The experts and participants suggested almost always as a sixth choice. Therefore, the current version of the EAI offers a range of six responses. An even number of choices forces the respondent to make at least a weak commitment in the direction of one or the other extreme (DeVellis, 2003, p. 77) and, as such, the variability in answers may be more meaningful. Revision of the EAI. Based on the EFA of pilot data and feedback from the focus groups and expert reviewers, the revisions of several items and generation of new items produced a final revision of the EAI that was ready for testing. To obtain the most valid and useful results possible, the research team created nine to 11 items (some potentially redundant) for each component. In a survival of the fittest process, researchers understood that the items that induced the most reliable and valid scores would emerge from the reliability and factor analyses. This first iteration of the EAI included 50 items and five components: (a) affective response comprised 10 items; (b) perspective taking comprised nine items; (c) selfother awareness comprised 10 items; (d) emotion regulation comprised 11 items; and (e) empathic attitudes comprised 10 items. (See Appendix [p. 124] for a copy of the EAI). The survey also gathered data on eight

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demographic items: sex, age, education level, race/ethnicity, major (if the respondent was a student) or occupation (if respondent was not a student), family-oforigins socioeconomic status, and current household income. CFA Phase: Participants, Procedures, and Data Collection The Arizona State University Institutional Review Board granted the research team permission to recruit students and nonstudents to voluntarily participate in the testing the revised EAI. Because one objective of developing the EAI was for the instrument to have applicability across multiple settings, we used a convenience sampling approach and recruited undergraduate students from a variety of majors as well as recruited some participants who were not students but who represented diverse professional backgrounds. To recruit student participants representing diverse fields of interest, the researchers approached undergraduate students in several general studies courses in which students with a variety of majors enroll. These courses included three course sections of Introduction to Social Work; two course sections of Statistics for Social Workers; two sections of The Living World, an introductory-level biology course; and one section of Macro Economic Principles. When recruiting the students and explaining the study, the EAI instrument was referred to as a human relations survey to avoid social desirability or reactivity that may have occurred if participants were given the names of each measure included in the research. With the exception of one instructor, all instructors of the above courses agreed to offer extra credit to students who participated in the research survey; the economics instructor chose not to offer extra credit for participation. The offer of extra credit was a useful recruitment strategy because it served as an effective incentive to participate. However, this inducement to participate may represent some bias in the reporting. The researchers sent an e-mail invitation to participate to the 935 undergraduate students enrolled in the target courses; those interested in participation could do so by clicking on a hyperlink to a Qualtrics-based survey. Qualtrics is an online survey software package that allows participants to access a website with the revised EAI at their own convenience. The students were told the survey was voluntary, and that the survey would remain active for 72 hours from the time the invitation was issued. Of the 935 students contacted, 688 students (74% response rate) completed the first administration of the index. Four days after the first administration of the EAI, 695 students (all students in the social work classes) were asked to take the survey again. For this retest, 454 students (65%) completed the second administration of the index. In addition, the research team generated a convenience snowball sample of 85 nonstudents. The rationale for including nonstudents held that because the EAI was intended for use with the general population, expanding the research to include community professionals (i.e., nonstudents) had the potential to increase confidence regarding the robustness of the index. The nonstudents were also contacted via e-mail, and invited to participate in the study by clicking on a link to the Web-based survey. In addition, these potential participants were invited to forward the invitation and survey link to colleagues who might be interested in participating. The sample of nonstudents lived in five states: Arizona, Illinois, Wisconsin, Colorado, and South Carolina. Nonstudent participants represented 12 occupations, ranging from construction to finance, with the majority working in the fields of public health and social services. The snowball sampling strategy was used to help increase diversity in the nonstudent sample. The students and nonstudents were combined because no important differences were found on the EAI scores of these subsamples. This finding is explained in more detail in the Results section. The final analytic sample included 773 useable surveys for the CFA and 429 surveys for the test-retest analysis. The sample size (N = 773) met the commonly agreed-on rule that each item should have 10 or more participants (Nunnally & Bernstein, 1994). Kim (2005) indicated that the estimation of sample sizes in structural equation modeling, given a provided power level, depends on the number of variables or degrees of freedom, the strength in relations among variables, and the choices of a particular fit index (e.g., comparative fit index [CFI], root mean square error of approximation [RMSEA]). For example, a five-factor CFA analysis with 15 items needs 417 participants to ensure a power of .80 to detect a CFI value of .95 or above, whereas the same CFA needs only 185 participants to have the same level of power to conclude a RMSEA value of .05 or less. The number of required sample sizes in SEM decreases as the number of variables and the strength in the relations among these variables increase (Kim, 2005). For these reasons, the current sample size (N = 773) appeared to entail sufficient power to detect the differences between the covariance matrix derived from the data and that from the hypothesized model. Additional Measures Cognitive Emotion Regulation Questionnaire and the Mindfulness Attention Awareness Scale. The retest of the EAI (i.e., second round of administration with n = 429 social work students) included additional items

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from two other instruments. In addition to the EAI items, the retest round included nine items from the short-form of the Cognitive Emotion Regulation Questionnaire (CERQ-short; Garnefski & Kraaji, 2006) and eight items from the Mindfulness Attention and Awareness Scale (MAAS; Brown & Ryan, 2003). The intention was to keep the number of items on the survey to a minimum while retaining enough data to demonstrate concurrent validity for the emotion regulation and selfother awareness components. The 18-item CERQ-short focuses on measuring emotion regulation or coping strategies; this scale does not include items that focus on a persons ability to identify his or her emotions or to distinguish emotions. The CERQ-short has demonstrated Cronbach's alphas ranging from .62 to .85 and good factorial validity, discriminative properties, and construct validity (Garnefski & Kraaji, 2006). The MAAS is a 15-item scale designed to measure a persons open or receptive awareness and attention to what is occurring in the present. Further, the MAAS has proven to be predictive of self-regulation and selfawareness (Creswell, Way, Eisenberger, & Lieberman, 2007).The MAAS has been validated with student and general populations, yielding a Cronbach's alpha of .81 and strong psychometric properties, including convergent and divergent validity with other measures of psychological well-being (Brown & Ryan, 2003). Both CERQ-short and MAAS have been validated in several studies, with diverse samples (Brown & Ryan, 2003; Carlson & Brown, 2005; Garnefski & Kraaij, 2007; Jermann, Van, d'Acremont, & Zermatten, 2006; Zhu et al., 2008). Based on theoretical expectation, we hypothesized that the emotion regulation component of the revised EAI would correlate with the CERQ-short items. In addition, based on previous research and theoretical expectation, we hypothesized that both the EAI components of emotion regulation and selfother awareness would correlate with the MAAS items. Analytic Procedures This study involved three types of analyses: missing value analysis, descriptive analyses, and psychometric

analyses. The Qualtrics-based data were first uploaded to PASW 18 (formerly SPSS) for analysis. Two items were eliminated (i.e., Q42, emotion regulation, and Q49, empathic attitudes) because of problems that occurred when the items were uploaded to Qualtrics. Participants were not able to view these items properly and, therefore, did not provide responses for these items. Twenty-one of the 48 items had one to three missing cases, which would result in a loss of 27 cases when using the listwise deletion method. Following recent recommendations (Allison, 2003; Peugh & Enders, 2004) that listwise deletion method is prone to biased estimates, we used the expectation maximization algorithm (Schafer & Graham, 2002) to impute the missing values. A total of 773 cases with complete information were read in PASW 18 for descriptive analyses. Consistent with our intention to refine the EAI, we conducted psychometric analyses (reliability and validity tests) to consider the EAI factor structure and determine the best model fit. We first performed internal consistency reliability tests to examine the inter-item relationship and identify items that would increase the alpha if deleted. On the basis of the reliability test, CFAs were performed using Mplus to identify the best measurement model of the EAI. Mplus was chosen because this software provides several estimation methods to deal with ordinal-level data, and we used the default estimation method WLSMV (weighted least square with mean- and variance- adjusted chi-square tests) in our analysis (Muthn & Muthn, 1998-2010). The WLSMV method generated a weighted matrix based on the asymptotic variance and covariance of polychoric correlations of the observed items (Flora & Curran, 2004). A two-step CFA approach adopted in previous scale validation studies (e.g., Brown, 2003) was used. The two-step process is more feasible than a study replication in that the two-step process enables researchers to run CFA independently on both samples to compare and confirm the results (Schumacker & Lomax, 2004).

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Table 1 Description of Sample (N = 773)
Variable Sex Male Female 196 (25.6%) 568 (74.4%) 176(25.6%) 505(74.4%) 20(23.5%) 63(76.5%) f (Valid %) Students Community Professionals

Race/Ethnicity African American American Indian Asian American Caucasian Latino Mixed Race Other 47 (6.1%) 17 (2.2%) 21 (2.7%) 450 (58.7%) 130 (16.9%) 51 (6.6%) 51 (6.6%) 41 (6.0%) 17 (2.5%) 17 (2.5%) 381 (55.8%) 128 (18.7%) 48 (7.0%) 51 (7.5%) 6 (7.1%) 0 (0%) 4 (4.8%) 69 (82.1%) 2 (2.4%) 3 (3.6%) 0 (0%)

Major Social Work Criminal Justice Psychology Nursing Education Sociology Undecided Other 151 (22.3%) 114 (16.9%) 63 (9.3%) 26 (3.8%) 31 (4.6%) 18 (2.7%) 28 (4.1%) 245 (36.2%)

Employment Field Education, Health, Social Services Public Administration or Management Retail Arts and Entertainment Finance, Insurance, Real Estate Other 41 (55.4%) 13 (17.6%) 9 (12.2%) 3 (4.1%) 1 (1.4%) 7 (9.3%)

Participants were randomly divided into two subsamples of comparable size (n = 389 and n = 384). With the exception of one item, (i.e., Q13), the second subsample had a slightly higher mean score than the first subsample; no significant differences were found in the mean scores of the other 48 items. Model Journal of the Society for Social Work and Research

respecifications were made based on CFA results on the first half sample before the ideal model fit was identified. The final version of the EAI scale was tested on the second half of the sample. There seems to be no established rules regarding the cutoff values for fit indices (Marsh, Hau, & Wen, 2004). Given the lack of 110

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rules, we used the following standards as guidelines for a good model fit: normed chi-square (NC; i.e., the ratio of chi-square vs. df 2.00); CFI .95; the weighted root mean residual (WRMR < .95); and RMSEA < .06 with a confidence interval; Hu & Bentler, 1999; Schreiber, Stage, King, Nora, & Barlow, 2006; Yu, 2002). Finally, the test-retest reliability and convergent validity analyses were conducted using the whole sample data (N = 773) to provide additional evidence of the psychometric strength of the 17-item EAI index Results Sample Description Table 1 describes the gender and race/ethnicity of the sample (N = 773) as well as the major field of student participants and occupation of community professionals. The average age of the sample was 21.37 years. Although students were heavily recruited from social work courses, the student participants represented a variety of majors, with only 22% of the students identifying social work as their major. Considering the EAI was being developed for use beyond social work, the research team was pleased that most participants were involved in occupations or majors beyond social work. However, a limitation is that the sample was primarily female (74.4%), Caucasian (58.7%), and over represents an undergraduate perspective. Mean Differences Across Demographic Variables and the Five EAI Components The use of t-tests indicated no statistically significant differences existed between the student and professionals groups across the means of the five EAI components. However, t-test findings indicated two statistically significant findings based on sex differences. Females scored higher on selfother awareness (p = .046) and perspective taking (p = .025). These results are not unusual in that females tend to score higher than males on self-report empathy measures (Jolliffe & Farrington, 2006). One-way ANOVA results identified no statistically significant differences across racial/ ethnic groups on four of the five components (i.e., affective response, selfother awareness, perspective taking, and emotion regulation). However, African Americans (41.19) and Latinos (41.06) scored higher than Caucasians (37.74) on the empathetic attitude component (p = .001). Students identifying as social work majors also scored higher on empathic attitudes (F = 7.667, p = .001) than

students who identified other majors. However, no other statistically significant differences were found across majors. Finally, participants who grew up in poor or working class families scored higher on the perspective-taking component (F = 6.885, p = .001) and empathic attitudes (F = 7.667, p = .001) component than participants who grew up in middle class, upper class, or wealthy families. The ANOVA results indicate that among the study sample, people of color, people who grew up in lower income families, and students majoring in social work majors had higher levels of empathic attitudes than their counterparts. Internal consistency reliability analysis. An internal consistency analysis was performed on the 50item, five-component EAI using Cronbachs alpha. The results of the analysis for each component were as follows: affective response ( = .84); perspective taking ( = .82); emotion regulation ( = .72); selfother awareness ( = .70); and empathic attitudes ( = .81). These results indicate excellent internal consistency for the affective response, perspective taking, and empathic attitudes components (Streiner, 2003). The emotion regulation and self-other awareness components had acceptable internal consistency. Parenthetically, the CERQ-short and MAAS items had Cronbachs alpha scores of .66 and .75, respectively. Emotion regulation and selfother awareness scales have traditionally had more difficulty achieving excellent internal consistency (see Corcoran, 1982). Therefore, the research team concluded the levels of internal consistency on the emotion regulation and self-other awareness components were reasonable. The items within components that, if deleted, would result in higher alphas were flagged and considered for elimination. In all, eight items were eliminated based on the reliability analysis, particularly interitem correlation coefficients and alpha if item deleted results. The eliminated items were Q4, Q10, Q11, Q13, Q15, Q25, Q28, and Q48. CFA After these items were eliminated, the CFA was conducted on the remaining 40 items using Mplus software. Consistent with Byrnes (1989) suggestion that model specification should be based on theory as well as the modification indices, we compared several alternative models on the first half of the sample (n = 389). The CFA models and results are shown in Table 2.

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Table 2 Model Fit Indices of the CFA on the First Half of the Sample (n = 389) Model Details 2 /Df 2 /Df Ratio CFI WRMR RMSEA (90% CI)

40 item five-factor model

2943.00/730**

4.03

.77

2.19

.088(.085;.092)

24-item five-factor model

694.11/242**

2.87

.92

1.33

.069(.063;.075)

24 item five-factor model with eight error covariance added

400.14/234**

1.71

.96

.94

.043(.035;.050)

17 item five-factor model

213.70/109**

1.96

.97

.88

.05(.040; .060)

17 item five-factor model with correlated error ** p < .01

185.16/107**

1.73

.98

.80

.04 (.033; .054)

The 40-item five-factor model was not a good fit (CFI = .77, WRMR = 2.19, RMSEA = .088). An additional 16 items were eliminated based on the findings for the 40-item model, including small factor loadings (i.e., under .40), cross-loadings (items that could load on more than one factor), highly correlated items, and items that could cause the highest expected decrease in chi-square values according to the modification index (Kline, 2010). The eliminated items were Q14, Q18, Q32, and Q40 from the affective response component; items Q6 and Q23 from the self-other awareness component; items Q7, Q31, Q39, and Q45 from the emotion regulation component; items Q1, Q34, and Q37 from the perspective-taking component; and items Q5, Q19, and Q26 from the empathic attitudes component. The researchers then tested a 24-item measure using the five-factor model. However, based on the good-fit criterion, the 24-item five-factor model was still not an ideal fit (CFI = .92; WRMR = 1.33; and RMSEA = .069). Therefore, in keeping with the model modification index, several measurement error covariances were added in the fivefactor model. The 24-item five-factor model with eight error covariances added improved the model fit (CFI =.96, WRMR =.94; RMSEA =.043). The multiple error covariances indicated that the items could be further refined. Therefore, seven more items were removed (Q9, Q38, Q41, Q22, Q8, Q12, and Q33). These items were removed based on the modifica-

tion index and the possibility of cross-loadings. For example, the measurement error of Q8 is correlated with the measurement error of Q2 and Q3; indicating Q8 might share some commonality with Q2 and Q3, each of which represents a different latent construct. To avoid item redundancy, Q8 was eliminated. As shown in Figure 2, the 17-item five-factor model was a good fit (CFI .97, WRMR =.88; RMSEA =.05). The 17-item five-factor model comprised three affective response items, three self-other awareness items, four perspective-taking items, four emotion regulation items, and three empathic attitude items. As expected, all the factor loadings on the five latent constructs were statistically significant (see Table 3). Further review of the model fit modification indices suggested an addition of two error correlations (i.e., Q24 and Q20, Q43 and Q36). Both item Q20 (Watching a happy movie makes me feel happy) and item Q24 (When I am with a happy person, I feel happy myself) assessed affect sharing and loaded on affective response, suggesting the influence of external forces on personal affect. Although item Q36 (Friends view me as a moody person) and item Q43 (I can imagine what a character is feeling in a well-written book) loaded on different factors (i.e., emotion regulation and perspective taking, respectively), both items tap sensitivity to emotions. For these reasons, the research team considered the two error correlations to be conceptually sound. Adding these two error covariances improved the model fit (CFI =.98; WRMR =.80; and RMSEA=.04).

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Table 3 Confirmatory Factor Analysis of the 17-Item Model on the First Half of the Sample
CFA Model Latent and Observed Variables Affective Response (AR) Q20 Q24 Q44 SelfOther Awareness (SOA) Q17 Q21 Q29 Emotion Regulation (ER) Q27 Q35 Q36 Q47 Perspective Taking (PT) Q2 Q30 Q43 Q50 Empathic Attitudes (EA) Q3 Q16 Q46 .38 .89 .77 .14 .79 .59 .41 .68 .66 .67 .17 .46 .44 .45 .63 .62 .46 .61 .40 .38 .21 .37 .69 .69 .66 .48 .48 .44 .69 .80 .76 .48 .64 .58 R2

Note. is the standardized factor loading of the observed variable on the latent construct. The CFA also yielded results regarding the relationships among the five components (see Table 4). As expected, the five factors are indeed inter-correlated with each other (p < .01).

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Table 4 Standardized Correlation Coefficients Among Latent Factors on the First Sample
Affective Response Affective Response SelfOther Awareness Emotion Regulation Perspective Taking Empathic Attitudes **p < .01 1.00 SelfOther Awareness .58** 1.00 Emotion Regulation .32** .58** 1.00 Perspective Taking .54** .86** .62** 1.00 Empathic Attitudes .18** .23** .19** .20** 1.00

Finally, the 24-item and 17-item five-factor models were applied to the second half of the sample (n = 384). As shown in Table 5, the model fit was satisfactory for the 17-item five-factor model with two error covariances Table 5

added (CFI = .95, WRMR = .97, RMSEA = .06). Thus, the 17-item EAI yielded the best model fit for the data in this study.

Model Fit Indices of the CFA on the Second Subsample (n = 384) Model Details 24 item five-factor model 17 item five-factor model 17 item five-factor model with error covariance **p<.01 Comparisons Across Demographic Variables and Components of the 17-item EAI The use of t-tests indicated there were no statistically significant differences between students and nonstudents. The selfother awareness component approached statistical significance with females scoring higher (difference = .493, p = .061). One-way ANOVA results indicated that the only statistically significant difference among race or ethnic groups was on the empathic attitude component (F = 14.01, p = .001) on which African Americans (m = 12.68) and Latinos (m = 12.55) scored higher than Caucasians (m = 11.45). Likewise, the only statistically significant difference between college majors was found for the empathic attitude component (F = 8.508, p = .001) with social workers having the highest Journal of the Society for Social Work and Research mean (m = 12.87). Psychology majors had a mean of 12.15, criminal justice 11.59, sociology 11.55, education 11.45 and nursing had a mean of 11.37. Empathic attitude was the only component for which a statistically significant difference was found for family-of-origin socioeconomic status (F = 7.426, p = .001). Participants who identified as poor or working class ( m = 12.22) scored higher on the empathic component than participants who identified as middle class (m = 11.69), upper-middle class (m = 11.29), or wealthy (m = 10.47). The mean difference in the total 17-item EAI score by sex was statistically significant (p = .05), with females having higher scores. However, when the empathic attitude component was removed, the statistically 114 2 /Df 694.11/242** 301.68/109** 185.16/107** 2 /Df Ratio 2.87 2.77 1.73 CFI .87 .93 .95 WRMR 1.55 1.07 .97 RMSEA (90% CI) .08(.077; .089) .07(.059; .077) .06(.050; .069)

THE EMPATHY ASSESSMENT INDEX

significant difference between the sexes disappeared. No statistically significant differences in total mean scores were found between students and nonstudents. In addition, the mean differences of total scores across race/ethnicity were not statistically significant with or without the empathic attitude component. This finding is important because it provides evidence that the EAI may be useful with diverse populations. Total mean differences across majors was statistically significant (p =. 003) primarily due to social work majors high mean (m = 75.15). However, when the empathic attitude component was removed, the statistical significance disappeared (p = .20). Finally, the total 17-item EAI mean score difference across family-of-origins socioeconomic status was statistically significant with (p = .01) and without (p = .024) the empathic attitude component. Highest means were found for participants who identified as poor or working class, and the mean scores dropped successively as socioeconomic status increased. This finding is consistent with recent research that has suggested socioeconomic status influences the ways in which people experience emotion and shapes empathic accuracy (Kraus, Cote, & Keltner, 2010; Kraus & Keltner, 2009; Kraus, Piff, & Keltner, 2009). Reliability and Test-Retest Analysis Cronbachs alpha was used to perform an internal consistency analysis on the 17- item EAI ( = .823). In addition, the alphas for each component are as follows: the affective response three-item component ( = .751); the cognitive-based component (11 items; = .785); and the three-item empathic attitude component ( = .671). These results indicate acceptable internal consistency. Finally, a test-retest reliability study was carried out using the data from the students who finished both administrations of the survey within one week of each other. All of the component or component scores for the 17-item EAI for both administrations were significantly correlated (n = 429; p = .001). The correlation coefficients were as follows: affective response (r = .743, Spearmans rho = .739); selfother awareness (r = .686, Spearmans rho = .670); emotion regulation (r = .759, Spearmans rho = .748); perspective taking (r = .771, Spearmans rho = .776); empathic attitude (r = .792

Spearmans rho = .759). These are considered to be strong correlations indicating healthy test-retest reliability (Cohen, 1988). Construct Validity Tests The pilot administration of the EAI (Gerdes et al., 2011) included items from the empathic concern and perspective-taking components of the Interpersonal Reactivity Index (Davis, 1980; 1983). The items were used to demonstrate concurrent validity for the EAIs affective response, perspective-taking and empathic attitudes components. In each case, the results indicated statistically significant correlations between the scales with Pearson rs ranging between .48 and .75. For the current research, the team used correlation coefficients to analyze the concurrent validity of two components from the 17-item EAI: ER and selfother awareness. The first hypothesis predicted a positive relationship between the emotion regulation component and the CERQ-short. The emotion regulation component and the CERQ-short had a statistically significant correlation (n = 429, r = .507, Spearmans rho = .493, p = .001). These findings indicate a moderately strong positive correlation between the two scales (Cohen, 1988). Keep in mind that the CERQ-short is designed to measure emotion regulation coping strategies whereas the emotion regulation component is designed to measure a persons emotion regulation in the context of empathy. It was also hypothesized that the four-item emotion regulation and the three-item selfother awareness components would be negatively correlated with the MAAS score (a lower MAAS score indicates more mindfulness). The emotion regulation and MAAS were modestly correlated (n = 424, r = -.267, Spearmans rho = -.270, p = .001). This result is acceptable given that the emotion regulation and MAAS are measuring independent constructs that are theoretically related but not identical (Creswell et. al, 2007). The selfother awareness and MAAS had a moderate negative correlation (n = 424, r = -.396, Spearmans rho = -.435, p = .001). Presumably, the correlation would have been stronger if the researchers had been measuring self-awareness only rather than self other awareness (Decety & Sommerville, 2003). However, this expected result provides initial evidence for construct validity.

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Figure 1. The 24-item CFA model

Q9 Q20 Q24 Q44 Q17 Q21 Q29 Q38 .72 Q41 Q22 Q27 Q35 Q36 .58 .65 .65 .66 .62

.46

.75
.80 .98

Affective Response

.51 .68

Self/Other Awareness
.47

.31

.49 .66

.42 Emotion Regulation .47 .90

Q47
Q2 Q8 Q30 Q43 Q50 Q3 .36 .66 .63 .65

.61

.42 Perspective Taking .24

.21 .69 .24 .18

Q12
Q16

.55
.88 .53 .77 Empathic Attitudes

Q33 Q46

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Discussion After examining the internal consistency of the 48item EAI, researchers used CFA techniques to test a 40item five-factor model of empathy. The 40-item EAI had insufficient model compatibility; therefore, items were sequentially eliminated until criteria for a good model fit were met. Elimination was based on several criteria: (a) non-significant factor loadings ( < .40), (b) items that loaded significantly on more than one factor, (c) highly correlated items (r >. 80), and (d) items that would cause the highest expected decrease in chi-square values. The resulting model was a 17-item five-factor model that achieved good model fit with half the sample and reasonable model fit with the other half of the sample. The 17-item EAI version has excellent internal consistency and strong test-retest reliability. Convergent validity correlation coefficients for the CERQ-short and the MAAS were statistically significant. The CFA highlighted weak to moderate (.32 to .58) intercorrelations between the affective response component and the three cognitive components (i.e., emotion regulation, selfother awareness, perspective taking). The intercorrelations between the three cognitive components ranged from strong to very strong (.58 to .86). Although the intercorrelations between the empathic attitude component and the four other components were statistically significant, the intercorrelations were very modest (.18 to .23). It is not surprising that the perspective taking and selfother awareness components have the highest intercorrelation (r = .86). The social cognitive neuroscience literature makes it clear that accurate perspective taking requires selfother awareness or that an essential part of empathy is to recognize the other person as like the self while maintaining a clear separation between self and other (Ruby & Decety, 2004, p. 988). It is more difficult to establish discriminant validity between two constructs that are so closely intertwined and function simultaneously, though separately, in the brain. However, the literature supports the assumption that perspective taking and selfotherawareness are isolable and observable neural networks that operate in conjunction with each other (Decety & Grezes, 2006; Ruby & Decety, 2003, 2004). SelfOther awareness has a strong correlation with both perspective taking and affective response. The same personal boundary must be maintained to feel what the other person is feeling (affective response) while maintaining a clear separation between self and other

(Decety & Jackson, 2004; Decety & Meyer, 2008). Given this reality, it might be assumed that the correlation between the two components would be even higher. The moderately strong intercorrelation may be the result of the lack of content validity in the affective response component. After elimination procedures, the three-item affective response component was limited to one aspect of mirroring (i.e., happiness). In the next round of testing of the EAI, the researchers will revise the affective response component by adding items to increase the content validity. Suggestions for these additional items include I understand other peoples emotional signals and I am good at judging other peoples emotional states, which could be added to Hearing laughter makes me smile to bolster the dimensions of measuring affective response. It is not unexpected that the empathic attitude component has the lowest intercorrelations with the other components, with values ranging from .18 to .23. The empathic attitude component is the only factor in the model not grounded in the social cognitive neuroscience literature. The empathic attitude items are a set of social justice attitudes that are intended to be reflective of, and a proxy for, the commitment to change and action that is integral to the social work profession. However, based on these results, it can be argued that attitudes are simply not a good proxy for action. Further research is needed that can measure action that is implemented (i.e., actually taken) rather than estimating action through a set of attitudes. There are limitations to this study. The sampling strategy for the focus groups may have overemphasized the social work perspective, especially considering the intended purpose was to develop the EAI as an instrument for application across multiple disciplines and settings. The use of convenience sampling for the administration phase was also a limitation in that this technique over represented the perspectives of undergraduate students. In addition, the sample was predominantly female and Caucasian; therefore, the sample is not representative of the area in which the study was conducted. Although self-report instruments are an efficient way to collect data, this mechanism is prone to social desirability and bias. The use of extra credit as a participation incentive may have also affected participant reporting. Finally, the sample is relatively high functioning considering that all participants were either students or currently employed. The index should be tested on clinical samples to see whether the EAI is applicable for high-risk groups.

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Figure 2. The 17-item CFA model

Q20 Q24 Q44 Q17 Q21 Q29

Affective Response

SelfOther/ Awareness

Q27 Q35 Q36 Q47 Emotion Regulation

Q2 Q30 Q43 Q50 Q3 Q16 Empathic Attitudes Perspective Taking

Q46

Note. Factor loadings and correlations between factors are reported in Table 3 and Table 4, respectively

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Implications The EAI has many useful applications in practice, policy, and educational settings in social work and other disciplines. Students in social work are encouraged to use empathy in client assessment, interaction, and interventions. However, the essential components of empathy are not consistently incorporated into social work curriculum (Gerdes, Segal, Jackson, & Mullins, 2011). For example, social workers are rarely taught that the simple act of mirroring clients triggers a biological response that can enhance the ability to develop rapport and establish increased level of awareness of the clients feeling state. Understanding the full range of empathic abilities, including affective response, selfother awareness, and the ability to perspective take and regulate emotions may be helpful for practitioners. With the use of the EAI, students and professionals can develop better understandings of boundaries and use these ideas to guide their practice. In addition, by having a clear understanding of these emotional and cognitive mechanisms, social workers may be better able to manage stress, compassion fatigue, and burnout. In addition, recent social cognitive neuroscience research has described the potential for increasing brain elasticity and the brains ability to be retrained, which has introduced important implications for clinical intervention with clients dealing with trauma, brain injuries, and autism. In these cases, the EAI could be used to identify specific components of treatment and assess progress towards goals. Similarly, for client populations thought to have lower levels of empathy, such as sex and interpersonal violence offenders, the EAI offers a tool to treatment programs that are considering how best to incorporate the new science of empathy in ways that can be evaluated. Conclusion In conclusion, the findings indicate the 17-item fivefactor self-report EAI is capable of generating reliable and sufficiently valid scores. However, the evidence also indicates that a purely social cognitive neuroscience fourfactor model of empathy (i.e., affective response, self other awareness, perspective taking and emotion regulation) may yield more useful results. The fifth component, empathic attitudes, was used as a proxy for action. The use of empathic attitudes, which was a social justice extension of the social cognitive neuroscience model of empathy, was not supported by the findings. Therefore, before the next round of data collection, the researchers intend to revise the EAI to a 20-item fourfactor model by eliminating the empathic attitude component. The affective response component will be modified to include five items that demonstrate improved content validity over the current three-item component.

The emotion regulation component appears to be sufficient, whereas the perspective taking and selfother awareness components also require some revision of terminology and possible inclusion of a new item to strengthen the construct. Author Note This research was supported by a grant from the Samuel and Lois Silberman Foundation. Cynthia A. Lietz is an assistant professor in the School of Social Work at Arizona State University. Karen E. Gerdes is an associate professor in the School of Social Work at Arizona State University; kegerdes@asu.edu Fei Sun is an assistant professor in the School of Social Work at Arizona State University; fei.sun.1@asu.edu Jennifer Mullins Geiger is a doctoral student in the School of Social Work at Arizona State University; jennifer.mullins@asu.edu M. Alex Wagaman is a second-year doctoral student in the School of Social Work at Arizona State University; mary.wagaman@asu.edu Elizabeth A. Segal is a professor in the School of Social Work at Arizona State University; esegal@asu.edu Correspondence regarding this article should be sent to Cynthia Lietz at clietz@asu.edu References Allison, P. D. (2003). Missing data techniques for structural equation modeling. Journal of Abnormal Psychology, 112, 545-557. doi:10.1037/0021843X.112.4.545 Batson, C. D., Polycarpou, M., Harmon-Jones, E., Imhoff, H., Mitchener, E., Bednar, L., Highberger, L. (1997). Empathy and attitudes: Can feeling for a member of a stigmatized group improve feelings toward the group? Journal of Personality and Social Psychology, 72, 105-118. doi:10.1037/0022-3514.72.1.105 Boyle, S. W., Hull Jr., G. H., Mather, J. H., Smith, L. L., & Farley, O. W. (2006). Direct practice in social work. Boston, MA: Pearson. Brown, T. A. (2003). Confirmatory factor analysis of the Penn State Worry Questionnaire: Multiple factors or method effects? Behavioral Research

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Appendix The Empathy Assessment Index (EAI) = 50 items (final 17 items are in bold) Five components: Affective Response (AR), Emotion Regulation (ER), Perspective Taking (PT), SelfOther Awareness (SOA), and Empathic Attitudes (EA) ____________________________________________________________________________________
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Q15 Q16 Q17 Q18 Q19 Q20 Q21 Q22 Q23 Q24 Q25 Q26 Q27 Q28 Q29 Q30 Q31 Q32 Q33 Q34 Q35 Q36 Q37 Q38 Q39 Q40 Q41 Q42 Q43 Q44 Q45 Q46 Q47 Q48 Q49 Q50 I am open to listening to the points of view of others. (PT) I can imagine what its like to be in someone elses shoes. (PT) If a person is poor, I believe it is the result of bad personal choices. (EA) When I see a stranger crying, I feel like crying. (AR) I believe unemployment is brought on by individuals failures. (EA) I can tell how I am feeling emotionally by noticing how my body feels. (SOA) When something exciting happens, I get so excited I feel out of control. (ER) I consider other peoples point of view in discussions. (PT) Seeing someone dance makes me want to move my feet. (AR) When someone insults me or verbally attacks me, I dont let it bo ther me. (ER) I am not aware of how I feel about a situation until after the situation is over. (SOA) I believe poverty is brought on by individuals failures. (EA) When a friend is sad and it affects me deeply, it does not interfere with my own quality of life. (ER) When I see a friend crying, I feel like crying. (AR) I feel what another person is feeling, even when I do not know the person. (AR) I believe adults who are poor deserve social assistance. (EA) I am aware of my thoughts. (SOA) When I am with a sad person, I feel sad myself. (AR) I believe government should support our well-being. (EA) Watching a happy movie makes me feel happy. (AR) I can tell the difference between someone elses feelings and my own. (SOA) I have angry outbursts. (ER) I have a physical reaction (such as shaking, crying or going numb) when I am upset. (SOA) When I am with a happy person, I feel happy myself. (AR) When I care deeply for people, it feels like their emotions are my own. (SOA) I think society should help out children in need. (EA) When I am upset or unhappy, I get over it quickly. (ER) I can imagine what it is like to be poor. (PT) I can explain to others how I am feeling. (SOA) I can agree to disagree with other people. (PT) I get overwhelmed by other peoples anxiety. (ER) When a friend is happy, I become happy. (AR) I believe government should be expected to help individuals. (EA) I like to view both sides of an issue. (PT) Emotional evenness describes me well. (ER) Friends view me as a moody person. (ER) It is easy for me to see other peoples point of view. (PT) I am aware of how other people think of me. (SOA) When I get upset, I need a lot of time to get over it. (ER) When a friend is sad, I become sad. (AR) I can distinguish my friends feelings from my own. (SOA) I have large emotional swings. (ER) I can imagine what the character is feeling in a well written book. (PT) Hearing laughter makes me smile. (AR) I rush into things without thinking. (ER) I think society should help out adults in need. (EA) I watch other peoples feelings without being overwhelmed by them. (ER) I am comfortable helping a person of a different race or ethnicity than my own. (EA) I believe the United States economic system allows for anyone to get ahead. (EA) I can simultaneously consider my point of view and another persons point of view. (PT)

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