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This chapter explores the importance of balanced empathy in relation to individual levels of happiness, relationships, health, and life satisfaction. It posits that balanced empathy is not merely a lived experience or emotional state, but an essential component for experiencing one’s best possible life. This chapter also proposes new terms, assessment tools, a new theoretical framework, and a therapeutic approach for enhancing empathy levels in one’s lived experience. This includes the term “balanced empathy,” the Balanced Empathy Theory, the Balanced Empathy Scale, and the Applied Empathy Therapy Approach. The proposed assessment scale, therapeutic approach with exercises and practices, and diagrams to support the proposed theory are included.
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1. Introduction
This chapter discusses the significant role that empathy plays in increasing one’s level of happiness. Empathy is the ability to understand or feel what another is feeling or thinking. According to Inam et al. [1], empathy is not just the ability to understand others’ feelings or thoughts but also to experience some of those feelings and react appropriately [1]. Empathy is a deeper level of understanding and comprehension than sympathy. Sympathy is the ability to feel for another but maintains the perspective of a separate self. Empathy, by contrast, is to feel with another person and understand their perspective. Despite tensions with many dominant cultural paradigms, research consistently shows that empathy supports emotional well-being, health, and happiness. Happiness is defined here as being well in relation to how one evaluates their life subjectively and comprehensively. Yet, empathy is rarely acknowledged as a central pathway to happiness, even though diminished empathy is associated with poorer well-being and reduced happiness [1].
In individualistic cultures, in particular, there tends to be a greater focus on achieving personal goals to experience happiness, and less importance is placed on caring about others, including feeling and understanding others’ experiences. In an individualistic culture, one’s own experience is held as being of the highest importance. However, sustainable and meaningful happiness is experienced through authentic connection with others and strong, positive relationships. A lack of authentic connection and poor relationships creates great unhappiness and negatively impacts mental health and well-being [2, 3].
Empathy is an essential aspect of authentic connection, as well as forming and maintaining strong, positive relationships. Through empathy, we are able to more fully understand others’ experiences, as well as how to positively interact with a variety of different people. Empathetic individuals report experiencing greater happiness and well-being and less negative affect; they are more kind and helpful to others, have a positive self-image, are better able to maintain relationships, and feel more connected and satisfied with their lives. Higher levels of empathy can result in higher levels of altruism, morality, and compassion; this supports greater self-esteem, happiness, stability, and a sense of purpose. A lack of empathy results in poorer relationships that are less authentic in terms of connection, understanding, and depth. Poor empathy also tends to create more self-centered behavior and a greater potential for mental health concerns, such as narcissistic personality disorder or antisocial personality disorder, due to a lack of understanding of others and an imbalanced focus on the self [1, 2].
Empathy can be a natural ability, but it can also be improved through learning, practice, and mental health interventions. The Sanford Institute for Empathy and Compassion at the University of California, San Diego, is a landmark initiative in the study and teaching of empathy. This institute investigates psychological, biological, and social aspects of compassion and empathy. The University of Chicago houses the Empathy and Moral Psychology Lab, which researches the development of empathy in children, neural mechanisms, and moral behavior. The University of Cambridge is home to the Empathy and Autism Research Centre, which focuses on empathy during the course of neurodevelopment and works with the Empathy Quotient (EQ) scale. The Yale Center for Emotional Intelligence investigates how emotions impact learning, relationships, and happiness. The Max Planck Institute for Human Cognitive and Brain Sciences researches the neuroscience of empathy, theory of mind, and compassion. These entities are investigating empathy in response to a growing recognition of its significance at both societal and individual levels.
There are certain clinical and therapeutic approaches that help improve empathy and regulate emotions. Some clinical approaches focus on treating trauma, depression, anxiety, or other mental health challenges that negatively impact one’s ability to empathize and connect with others. Dialectical behavior therapy (DBT), compassion-focused therapy (CFT), mentalization-based therapy (MBT), and family therapy approaches that work to assess system dynamics are all effective interventions for increasing empathy and managing emotions. However, there is currently no mental health therapy model specifically designed for maximizing one’s best overall expression of empathy [4–6].
Specific practices to increase empathy exist, as well as measurement and assessment tools to understand one’s level of empathy. Some of these tools include the EQ scale, the Interpersonal Reactivity Index (IRI), the Reading the Mind in the Eyes Test, the Jefferson Scale of Empathy, and the Compassionate Love Scale. Some of the exercises that can increase empathy include Loving Kindness Metta Meditation practice, Mentalization practice, altruistic and prosocial behavior, empathy journaling, mindfulness practice, perspective-taking, and active listening. However, it is possible to maximize one’s experience of empathy through a structured therapeutic approach. This approach should be based on exercises that can be implemented, measurement scales for context and reference points, and a theoretical foundation that is based on the importance of effective empathy as a path to increasing authentic connection, improving relationships, and sustainable happiness [4–6].
2.2 Happiness and empathy
In the field of psychology, the reality and nature of happiness are somewhat debated. There are aspects to consider regarding whether happiness is: (1) flexible or stable, (2) external or internal, and (3) can be controlled and created, or is uncontrollable. Tullet and Plaks [7] examined whether individual differences in belief systems about happiness could predict empathy. It was found that higher empathy was associated with an individual’s belief that happiness is flexible, uncontrollable, and external. This indicates that one’s mindset about what causes happiness may impact one’s levels of empathy [7]. The mindset and perspective an individual takes regarding their reality predict their response to others’ suffering. One’s perspective also determines whether there is an excessive focus and interest only on one’s own distress and experience. This means that, through a shift in mindset, one can increase their empathy and ability to connect with others, and therefore have closer, more authentic relationships [7].
By contrast, a mindset that has a greater focus on the self to the exclusion of others will struggle to foster more authentic connections, empathy, and an accurate understanding of others. A bias toward self-focus blurs one’s ability to accurately perceive others. This is evident in clinical mental health therapy work with the concept of projection, where one unconsciously projects their perspective and experience onto others because of a general excessive focus on the self. Projection can occur in both negative and positive ways, where an individual projects their own positive view of themselves onto others (even if the others do not actually possess the positive traits or characteristics), the projection of fantasies onto others, or the projection of one’s own faults and shortcomings onto others. However, at its core, an excessive focus on the self negatively influences one’s perceptions and can create conflict, confusion, and poor connection [7, 8].
2.3 Self-compassion, empathy, and happiness
Happiness is an important aspect of life, and it supports individuals in becoming healthy and constructive (versus destructive) members of society. In a study conducted by Inam et al. [1] in South Asia with 566 students, it was found that self-compassion and empathy both significantly predict happiness, and self-compassion served to significantly moderate the association between empathy and happiness. Self-compassion is defined here as being vulnerable and motivated by one’s own suffering, and also feeling non-judgmental kindness and care for one’s perceived inadequacies and failures [1].
Individuals with higher levels of self-compassion are reportedly happier than those with lower levels of self-compassion. Self-compassion helps with emotional regulation, perspective-taking, connectedness, self-worth, health, and well-being. It is an important variable for understanding and relating to oneself and can be useful in developing one’s identity and self-worth. Individuals with a positive sense of self-worth and a positive relationship with their identity are more likely to be happy, flexible, and empathetic. Self-compassion can also serve as a protective factor in the relationship between stress and happiness, as increased levels of stress tend to decrease happiness, perception of self-identity, and feelings of self-worth. It can be used as a tool to increase happiness, and empathy is positively associated with happiness and well-being. Happiness increases when individuals understand themselves, accept themselves non-judgmentally, and care for themselves in difficult times; and when individuals understand others’ thoughts and feelings and respond with kindness or empathy [1].
2.4 World happiness reports
In the World Happiness Report 2025, it was found that benevolent acts (including donating, volunteering, and helping strangers) improved self-perception, self-esteem, well-being, social support, and positive affect toward others. In addition, it was found that observing kindness in one’s community provided a greater happiness increase than the absence of violent crime, mental illness, or achieving a significantly higher income [2]. The 2025 World Happiness Report also found that, in general, the Western industrial countries are now less happy than they were in the period 2005–2010. The United States, in particular, has seen significant drops in happiness from 2022 to 2024 compared to the period 2005–2010 [2, 9].
An important factor in this decrease in Western industrial countries is the rise in deaths of despair. Deaths of despair refer to deaths that are due to suicide, alcohol abuse, and drug overdose. These are preventable deaths associated with extreme levels of unhappiness. The term was originally coined in the United States due to disturbing trends regarding suicide rates, overdose deaths, and alcohol abuse. Research shows that Slovenia had the highest death of despair rate in 2019, but the United States experienced the greatest increase worldwide in deaths of despair from 2000 to 2019. The 2025 World Health Report suggests that prosocial behavior, specifically donating, volunteering, and helping strangers, can help reduce deaths of despair. Deaths of despair are generally associated with hopelessness, extreme distress, social and economic marginalization, decreased social capital and social connections, perceived status loss, occupational injury and pain, and prescription opioids [2, 9]. Increasing prosocial behavior improves individual well-being and fosters supportive, cooperative, and trusting societies.
Furthermore, the 2025 World Health Report also demonstrates that increasing prosocial behavior (i.e., donations, volunteer work, and helping strangers) is positively associated with decreasing suicide rates worldwide. Research on suicide and well-being shows that deaths of despair are less widespread in countries where individuals engage in higher levels of prosocial behavior (behavior done to benefit and help others). Prosocial behavior is also observed through benevolent acts; these include qualities such as kindness, empathy, and compassion. Individuals who participate in prosocial behavior are healthier, happier, have better self-esteem, improved psychological well-being, and more purpose and meaning. Prosocial behavior and benevolent actions also increase and strengthen one’s social networks, which decreases stress and provides support for life challenges and stressors. Decreased levels of empathy can result in decreased levels of benevolent acts, prosocial behaviors, kindness, and compassion [2, 9].
2.5 Positive empathy
According to Morelli et al. [10], positive empathy, or the ability to share, appreciate, and celebrate others’ positive emotions, is another factor that increases well-being and strengthens relationships with others. Positive empathy is different from general positivity and empathy for others’ distress. Positive empathy increases prosocial behavior, social closeness, and well-being, and is a potential intervention approach for treating psychiatric disorders. Another term for positive empathy is empathetic joy, where we experience joy and happiness from others’ success. This is in contrast to the idea of negative empathy, which is the tendency to share and understand others’ emotional states like distress, sadness, anxiety, and so on [10]. Positive empathy may serve as a useful intervention for increasing empathetic states for those with low levels of empathy or who struggle with depression, anxiety, and low self-esteem as a result of negatively comparing themselves to others. Positive empathy, or empathetic joy, may also be a useful intervention for individuals with higher-than-average levels of empathy, as determined by assessment tools such as the Compassionate Love Scale, EQ test, or IRI (to name a few) [11, 12].
Positive empathy can serve to balance one’s experience of negative empathy for highly empathic individuals and has been found to improve personal and social well-being when negative empathy is not a confounding factor [10]. This is important in contrast to positive affect, which involves experiencing personal positive outcomes; positive empathy is where one vicariously experiences positive emotion through others’ positive experiences. This expands one’s ability to experience positive states by benefitting not only from one’s own positive experiences but also from others’ positive experiences [10].
Positive empathy also works to increase prosocial behaviors through increased emotional support, physical assistance, and spending time and resources on others. This leads to increased social connection and well-being and also leads to improved outcomes in psychiatric disorders such as mania, depression, social anxiety, autism spectrum disorder, and psychopathy. Individuals with autism spectrum disorder struggle to empathize and understand what others are thinking and feeling. Individuals with psychopathic or antisocial features are often able to recognize others’ emotions but do not share others’ emotional states. Some research shows that positive empathy may lead to improvements in depression, social anxiety, autism, and psychopathy [10]. Positive empathy can make prosocial behavior feel more rewarding, and individuals are more likely to participate in prosocial behaviors when they feel they will receive appreciation and validation [10].
2.6 Balanced empathy theory and assessment: A proposed framework
To address the need to improve levels of empathy as a means of increasing happiness, a new theory, a new assessment tool, and a new therapy approach are provided in this chapter. The proposed therapeutic approach is titled “Applied Empathy Therapy”. It is based on the “Balanced Empathy Theory”. The balanced empathy theory posits that empathy can be taught, learned, and effectively applied to achieve one’s highest levels of happiness. It also posits that it is highly valuable to increase or navigate one’s level of empathy as a means to improve happiness. Empathy enhances our ability to connect and build more positive relationships. However, applying it effectively requires a shift in one’s moment-to-moment awareness and a mindset change from focusing on one’s own limited experience to a broader perspective that incorporates a deeper understanding and a balanced empathic approach.
A model demonstration of the balanced empathy theory is presented in Figures 1 and 2 of this chapter. Figure 1 demonstrates the relationship between low empathy and low self-compassion on well-being. Figure 2 demonstrates the relationship between balanced empathy and high self-compassion on well-being. These two figures visually display the underlying premise of the proposed balanced empathy theory. This theory posits that empathy can be both taught and learned to create more balanced levels. It also posits that there is a type of empathy that can be categorized as balanced empathy. Balanced empathy is not categorized by high, moderate, or low levels of empathy. It is a unique category for managing the positive and negative aspects of empathy to achieve the best possible outcome. By contrast, lower levels of empathy are associated with decreased levels of happiness, poorer health outcomes, and poor relationship outcomes. Moderate levels of empathy can also be sub-optimal for experiencing higher happiness, health, and relationship outcomes due to remaining imbalances in the ability to perceive others’ experiences and have compassion for them. High levels of empathy, as measured by various assessment tools, are associated with the highest levels of happiness, health, and relationship outcomes when negative empathy is controlled for [10, 13].
Figure 1.
Relationship between low empathy and low self-compassion in well-being.
Figure 2.
Relationship between balanced empathy and high self-compassion on well-being.
Positive empathy was discussed in depth in the previous section. Negative empathy is another form of empathy and refers to the distress one may experience as a result of understanding and feeling another’s negative emotions and negative experiences. Therefore, the balanced empathy theory proposes the necessity of what is being termed here as “balanced empathy.” Balanced empathy refers to the ability of the individual to experience high levels of empathy, as well as positive empathy, and engage in prosocial empathy, while managing and mitigating the negative effects of negative empathy. Furthermore, one can mitigate and manage negative empathy through mindfulness practices, self-compassion exercises, cognitive behavioral therapy (CBT), self-love practices, and boundary setting, with the mindset of maintaining awareness around whether the feelings and thoughts you have are “yours” or related to someone else’s lived experience, and the need to let go of the distress. Higher levels of empathy and self-compassion are positively associated with positive, strong relationships, greater general awareness of self and others, good health, and happiness. This is with the caveat that negative empathy is adequately managed and accounted for. If one’s experience of empathy is high in negative empathy, and it is not managed and mitigated, it can create significant negative impacts on happiness, health, and relationships. Figure 3 of this chapter provides a visual demonstration of the interactive relationship between compassionate love, balanced empathy, relationships, and well-being [13–15].
Figure 3.
The interactive relationship between compassionate love, balanced empathy, relationships, and well-being
Balanced empathy introduces a fourth consideration in empathy assessment, moving beyond simple categorization of high, moderate, or low. In this proposed framework, balanced empathy can be measured by an assessment that accounts for one’s level of empathy as well as the impact of negative empathy. To date, no such assessment tool has been created for balanced empathy. Therefore, a proposed assessment tool is included below in the Assessment Tool section.
2.7 Assessment tools
The balanced empathy theory posits that, in order to apply balanced, effective empathy, it is first necessary to understand your baseline empathy through assessment tools. Some standard empathy tools include the EQ test, the Compassionate Love Scale, and the IRI. The Compassionate Love Scale is a useful tool to measure one’s level of compassionate love or empathy for others. There are multiple versions, including one that is focused on close others, one on strangers/humanity, and another on romantic partners. The most commonly used version is the Compassionate Love Scale for humanity/strangers, created by Sprecher and Fehr. It measures prosocial empathy and is used in empathy-training research and therapy. Higher scores indicate greater compassionate love or empathy for others [12]. The EQ Scale, created by Baron-Cohen [16], measures cognitive empathy, emotional reactivity, and social skills. This is based on a scale of 0–80, with scores below 30 being recommended for further testing for autism spectrum disorder. Another useful assessment tool is the IRI, created by Davis [17]. It is the most widely used empathy scale in research and measures cognitive empathy, affective empathy, vicarious immersion, and self-oriented distress. This 28-item tool is the first widely used multidimensional assessment for empathy. Unlike other assessment tools, the IRI is uniquely attuned to the concerns of balanced empathy, with its emphasis on different empathic dimensions and personal distress [1, 17].
The empathy assessment tool proposed here in the balanced empathy theory is made up of two parts. The first is the IRI created by Davis [17]. The second is the Balanced Empathy Scale created. From these baseline tests, it is possible to understand the level of empathy that needs to be navigated and the vantage point the individual is starting from. The personal distress element of this assessment tool makes it uniquely valuable as an assessment construct for balanced empathy. A challenging aspect of high empathy levels is negative empathy, or feeling great, overwhelming distress due to others’ suffering and pain. High levels of empathy, with high levels of personal distress and negative empathy, create imbalanced empathy that can interfere with everyday functioning and decrease the positive effects of higher empathy. High negative empathy, with accompanying high personal distress, can create a situation where empathy causes harm, and can even be a detriment to another’s life situation. Therefore, the IRI is uniquely suited as a preliminary assessment in balanced empathy for its ability to measure personal distress, along with other empathetic dimensions [1, 18].
Regardless of one’s empathy score, mindfulness, self-compassion practices, and CBT support perspective, balance, and the effective use of empathy [15, 19]. For assessment scores that reveal lower levels of empathy, it may be important for individuals to practice certain exercises, such as perspective-taking, CBT, and systems and family therapy approaches [19, 20]. In addition to this, it is also important to assess trauma. Trauma can lead to a suppression of empathic functioning as an adaptive survival response. If empathy issues are due to trauma, the trauma needs to be directly addressed and therapeutically treated [14, 21].
There is a degree of individuality when learning how empathy can be best applied in one’s life. An individual with high levels of empathy, but who is struggling due to negative relationships and painful connections, will need to have a different treatment approach than an individual who has low or moderate levels of empathy. They may need support with balancing their empathy and understanding the difference between themselves and others, so as not to be overly affected by their empathy [14]. However, they can also serve as connectors in relationships where they understand the deeper layers of dynamics, emotions, and needs of others. Therefore, individuals with high levels of empathy are potentially well-suited to healing and harmonizing relationships. All levels of empathy benefit from compassion-based meditation practice, mindfulness, and self-love practices. Through deepening one’s level of mindfulness and meditation, as well as deepening self-love and compassion, greater insight, understanding, and balance can occur [14, 15].
2.7.1 Proposed “balanced empathy” scale
Unfortunately, there is no empathy scale to date that assesses balanced empathy. Balanced empathy, a term coined by Spowart [34], refers to a level of empathy whereby an individual has strong mindful awareness, intentionality, and the skills to manage their empathetic response on an ongoing basis. High levels of empathy may cause negative empathy when around others’ distress, while someone with moderate empathy levels may struggle to understand different cultures or face challenges in a relationship with a high-empathy partner. An individual with a low level of empathy may struggle to make close connections, build authentic relationships, or demonstrate prosocial behavior. The first step in the balanced empathy approach is awareness and acceptance of one’s general level of empathy. The second step is to work on the Applied Empathy Therapy Approach and its corresponding exercises, as appropriate to one’s empathic perspective.
A two-part assessment approach is proposed below. The first part of this approach is for individuals to take the IRI created by Davis [18]. This scale will provide a baseline assessment of one’s level of empathy that needs to be worked on in order to achieve a balanced empathy level. The second part is an assessment tool created by Spowart [34] below. This assessment tool is in alignment with the balanced empathy theory and the applied empathy approach. The Balanced Empathy Scale for high empathy individuals should be taken to measure balanced empathy levels for those who score higher in empathy on the IRI. The Balanced Empathy Scale for low to moderate empathy individuals should be taken to measure balanced empathy levels for individuals who score low to moderate on the IRI. The proposed Balanced Empathy Scale is provided below:
Balancedempathy scale for high empathy individuals. A 5-point Likert Scale: 1 = “strongly disagree,” 2 = “disagree,” 3 = “neutral,” 4 = “agree,” 5 = “strongly agree”
Please add up the scores from 1 to 5 for each question and compute the average. Average scores of 4 or 5 indicate balanced empathy, while scores below 3 indicate imbalanced empathy.
You generally feel at peace, even around others who are experiencing some level of distress.
You generally feel that you can easily distinguish your emotions and experiences from others’ emotions and experiences.
When someone’s negative emotions and experiences begin to upset you, you are generally able to easily reframe your feelings, manage the upsetting emotions, and maintain a compassionate approach.
You feel confident that you can generally manage your emotions and remain in a positive state, even in a group of individuals experiencing a variety of negative emotions.
You feel you are able to emotionally regulate yourself on a consistent basis.
Balanced empathy scale for low to moderate levels of empathy individuals. A 5-point Likert Scale: 1 = “strongly disagree,” 2 = “disagree,” 3 = “neutral,” 4 = “agree,” 5 = “strongly agree”
Please add up the scores from 1 to 5 for each question and compute the average. Average scores of 4 or 5 indicate balanced empathy, while scores below 3 indicate imbalanced empathy.
You generally attempt to provide help or offer a compassionate response to strangers you encounter who are experiencing distress.
You generally attempt to provide help or a compassionate response to friends or family members you encounter who are experiencing distress.
You generally feel capable of accurately perceiving others’ perspectives and lived experiences.
You generally care enough about others’ suffering to do something positive to assist in some way.
You feel you are able to emotionally regulate yourself on a consistent basis.
2.8 Applied empathy therapy approach
From this proposed theoretical framework and the proposed assessment tool for balanced empathy, a tangible therapeutic approach can be applied. This therapeutic approach is termed applied empathy therapy, created by Spowart [34], and addresses the need and gap in the existing field for a therapy approach that focuses solely on empathy and creating balanced empathy. This is significant for its consequences in improving happiness, life satisfaction, health, relationships, and in reducing the severity of psychiatric disorders such as depression, psychopathology, autism spectrum disorder, and social anxiety. It can also improve prosocial empathy behaviors and levels of compassionate response [10].
Below is a classification that demonstrates the core components of the applied empathy therapy approach. In Appendix A and Appendix B, a breakdown of concrete example exercises and a general format is provided, which can be conducted over a five- to six-session period. Figure 4 of this chapter provides a visual, through a Venn diagram, of components that comprise the applied empathy therapy approach.
Figure 4.
Components of the applied empathy therapy approach.
2.8.1 Practices for higher levels of empathy/imbalanced empathy
Prosocial behaviors, such as volunteering, donating, or helping strangers
Mindfulness meditation exercises
Balanced empathy reflection exercises for daily empathy opportunities
Positive empathy practice
Self-compassion exercises
Happiness-based mindfulness chart (as shown in Figure 5)
2.8.3 Methodology for theoretical foundation
The methodology of ethnography, case study research, and literature review was used for this chapter and the proposal of the balanced empathy theory, the balanced empathy scale, and the applied empathy therapy approach. The researcher is the subject of the ethnographic research, with over 15,000 hours of completed mental health therapy work. The case studies are derived from examples of these clients in relation to the topic of empathy and mental health. The case studies also pertain to the researcher’s colleagues and their reported experiences with clients and in the field of mental health. The literature review encompasses the review of hundreds of articles, narrowed down to fewer than 100 relevant articles on the topic of empathy in relation to a therapeutic approach. No articles were identified on the specific concern of “balanced empathy” or its application as a theory, assessment scale, or mental health therapeutic approach. Therefore, due to this gap in the literature, as well as the observed gap from the researcher’s clinical experience, the balanced empathy theory, scale, and therapy approach are proposed here.
The term “balanced empathy” is not broadly used in academic research as an independent paradigm. Research that points to this concept includes an investigation into the balance between cognitive and emotional empathy through research on autism [22]. Additionally, emotional regulation connected to empathy and a measurement approach is provided through the Balanced Emotional Empathy Scale (BEES), created by [23]. However, the BEES measures only emotional empathy and not cognitive empathy or emotional regulation [23]. The proposed Balanced Empathy Scale comprises two assessment sections to account for this: the use of the IRI first, and the Balanced Empathy Scale second. The Balanced Empathy Scale proposed here is meant to address all three components of empathy. This includes emotional empathy, cognitive empathy, and empathic distress or regulation. Other research efforts that have focused on concepts close to balanced empathy include work on compassion or sympathy as a means to manage empathy and regulate emotional distress [24]. However, the exact concept of balanced empathy is, again, not directly used.
Kristin Neff’s [25] work on self-compassion is relevant to the understanding of balanced empathy here, as self-compassion supports and fosters a balanced experience of empathy. Self-compassion practices are significant for promoting an understanding and application of compassion, which can lead to greater emotional regulation and deeper levels of balanced empathy [25]. Self-compassion can regulate emotional empathy by improving emotional management; it can improve boundaries in understanding ourselves versus others; it can reduce negative empathy through greater self-care and emotional differentiation. Self-compassion, like compassion, can serve as a regulatory tool for balanced empathy [13]. Aspects of the balanced empathy theory, Balanced Empathy Scale, and applied empathy therapeutic approach all include the concept of self-compassion.
Another relevant consideration for balanced empathy is the work of Elizabeth Segal [26] on social empathy. Segal proposed a multidimensional model of social empathy that includes a larger experience of empathy beyond just the individual, encompassing social responsibility and the societal context. Social empathy is the ability to understand and gain insight into larger inequalities and apply this understanding toward social responsibility. It offers a broader perspective toward balanced empathy because it suggests that empathy is not just one’s individual experience. Social empathy also refers to the greater empathic understanding of the larger societal whole and our responsibility arising from this empathic insight and understanding [26]. Aspects of the balanced empathy theory, Balanced Empathy Scale, and applied empathy therapeutic approach incorporate this social empathy element and a greater understanding of social responsibility.
Lastly, the work of Patrick Dolan [27] on empathy education is relevant for applications of balanced empathy [27]. Dolan is associated with social empathy education programs, such as the program Activating Social Empathy. Dolan and colleagues at the UNESCO Child and Family Research Centre at the University of Galway created a post-primary school resource to increase and develop children’s understanding of empathy. It is also meant to help students overcome difficulties with empathy and apply empathy in their school communities. Dolan’s approach to empathy education is relevant for balanced empathy, as balanced empathy can be learned and applied in school-based settings. Balanced empathy can be learned and applied in many settings, including educational environments [27].
2.8.4 The significance of an applied empathy therapy approach
The longest-running study on well-being is the Harvard Life Course Study [28]. This study began in 1938 at Harvard University and is one of the longest-running longitudinal studies of adult life. Originally, it investigated 268 Harvard male sophomores, and then a parallel study of 456 boys from lower-income Boston neighborhoods was conducted. Early in the study, there was a focus on intelligence, social class, and physical health. However, as time went on, the focus shifted with the finding that the quality of our close relationships is the strongest predictor of happiness, health, and longevity. According to this finding, empathy, attachment, relational health, and mental health are critically important for our happiness. In summary, the findings of the Adult Harvard Development Study can be summarized as the capacity for empathy and warm, supportive relationships being central to lifelong well-being and health [3].
This study emphasizes the critical importance of demonstrating, through investigating generations of both Harvard graduates and lower-class residents from Boston, that the most significant variable for happiness and well-being was close, authentic connections and relationships. However, a deeper element of “feeling connected” is actually empathy and prosocial empathy. Empathy is what allows us to form those close, authentic bonds and connections. Prosocial empathy, where we positively contribute to our relationships, further supports our ability to connect and form relationships, as well as maintain a positive relationship with ourselves. Low levels of empathy are associated with poor relationships and unsatisfying connections. Therefore, empathy and prosocial empathy are foundational components for creating strong social bonds and authentic connections. If an individual cannot understand another’s experience, feelings, perspective, thoughts, and lived experience to some extent, how can they authentically connect? [3].
It is well known that authentic relationships provide important support for managing life stressors and challenges, as well as supporting our physical and mental health. It is not necessary to have a large number of friends or relationships; rather, it is important to have authentic, strong, reliable, close relationships. Not only are close relationships important for our happiness, but loneliness, isolation, and a sense of disconnection are detrimental to our physical health, mental health, longevity, and sense of purpose. Therefore, from this perspective, empathy is essential for having a healthy, fulfilling life. Without empathy, it is very hard to have close connections, and you are much more at risk of loneliness, isolation, and disconnection, even if you are surrounded by others. Empathy helps support the ability to connect and can be seen as a tool to facilitate connection [29].
Furthermore, empathy can be both taught and learned. It is an emerging field of study, with multiple academic institutions investigating the importance of empathy and how it can be learned and applied in productive ways. However, no therapy approach is dedicated solely to creating balanced empathy for participants. Every level of empathy (high, moderate, low, etc.) has different challenges and requires methods or interventions to reach a balanced state. Empathy is a very important part of happiness and well-being. However, even more important is “balanced empathy”, where you can navigate and manage your levels of empathy and corresponding reactions in every situation. This is a significant part of forming those strong relationships and emotional bonds that are essential for happiness, fulfillment, and well-being.
2.8.5 Compassionate love
Balanced empathy is important for individual happiness and well-being for many reasons, especially for fostering positive relationships and authentic, close connections. However, balanced empathy is also crucial for societal and cultural well-being. Specifically, prosocial empathy, or compassionate love, is significant for creating and maintaining healthy and happy societies and cultures. Societies that are excessively focused on individualism and encourage lower levels of empathy as a means of obtaining success can become destructive. Prosocial empathy serves as a means of fostering balanced empathy and can counteract the negative consequences of imbalanced individualism. Compassionate love refers to love that is centered on the good of the other and involves giving up oneself for the benefit of the other. Underwood [12] stated that compassionate love is composed of multiple components: free choice and valuing the other, openness and receptivity, and accurate cognitive and emotional understanding of the situation with the other. Other significant aspects of compassionate love include altruism, helpfulness, care, concern, empathy, selflessness, sacrifice, and being non-judgmental and accepting of others. Acceptance of others and being non-judgmental may predict the longevity and quality of close relationships [30, 12].
Practices and awareness of prosocial empathy or compassionate love can be important for creating balanced empathy in individuals with low empathy. These acts of compassionate love may include things such as verbal reassurance to others, helping provide physical comfort to others, and volunteer efforts. The focus on caring for “the other” is an essential component of this. It is empathy in action or applied empathy. The Volunteer Process Model theorizes that acts of volunteering are potential expressions of compassionate love. This is especially true if the volunteerism is focused on others’ care and support [31].
According to the Self-Expansion Model by [32], close interpersonal relationships create self-expansion. This model posits two concepts. The first is that individuals are motivated to self-expand. Self-expansion refers to increasing one’s ability to achieve their desires by seeking out resources that will help one meet future challenges. The second part is that when individuals create close relationships with others, they expand themselves by “including aspects of the other in the self”, referring to the amount of perceived or felt overlap between the self and the other. The closer individuals become, the more the other is treated like the self; that is, empathy [33]. Prosocial empathy or compassionate love can help an individual expand themselves through greater connection and empathy. Therefore, compassionate love and empathy work together to create greater self-expansion, which leads to closer relationships. Closer relationships increase one’s levels of fulfillment and happiness [12].
This chapter demonstrates the significance of empathy for our happiness, well-being, relationships, and overall fulfillment in our lives. It is not merely an individual experience, nor is it a type of emotion. It is a key part of our ability to connect, bond, and maintain the health of our relationships with others. It also functions to help us operate effectively in the world and with a better understanding of interactions, environments, greater compassion, and prosocial behavior. Some individuals seem to have a greater natural propensity for empathy than others, and it may be easier for them to achieve higher levels of empathy. Others may struggle with empathy and find it is a secondary feature that grows with practice, intention, and awareness. But one’s empathy level and the way they navigate and express empathy are not unchangeable or unmanageable. For any level of empathy, practices and a mindset that promote balanced empathy are useful to improve one’s life and one’s ability to experience sustainable happiness.
Appendix A. Example balanced empathy exercises for low to moderate levels of empathy
Adapted balanced empathy REBT exercise example.
Negative belief/thought affected by lower empathy: Everyone is always upset with me, but really, it’s their fault. No one really loves me or sees my perspective.
Harm of this belief/thought: It promotes victimhood, is disempowering, and is not solution-oriented. It exacerbates the problem.
Benefit of this belief/thought: It can provide validation and reassurance to an individual that they hold no accountability for their situation and is self-protective.
More empathetic alternative beliefs/thoughts: I can reflect on recent events and try to understand why there seems to be a pattern of people being unhappy with me. Maybe there is something I am unintentionally doing that is causing harm.
I am not seeing others’ perspectives and, therefore, am not able to see accurately if I am loved.
This mindset is contributing to the problem, and I need to take things less personally and understand how others may be feeling so I can improve the interactions.
Prosocial behaviors such as volunteering, donating, or helping strangers.
What are one or two acts of random kindness I can do each day? Practice these.
Is there somewhere I can donate even $1–$2 or be extra generous in my everyday life? Donate or be extra generous, even if it’s slightly uncomfortable. Remember, you are stretching yourself to think of others.
What is one cause I might care about a little, even if it provides no direct, obvious benefit to me? How can I get involved? Find a way.
Mindfulness meditation exercise for balanced empathy.
Find a comfortable sitting position, close your eyes, and take three slow, deep breaths in and out.
Gently bring your attention to your heart area. Imagine a warm, steady light there — your center for balanced empathy.
As you breathe in, feel this light gently open with understanding. As you breathe out, feel it return to your center, grounding you.
Next, please think of someone you care about and silently say, “May you feel supported. May you feel peaceful and at ease.”
Notice that you can care without absorbing their feelings. Inhale: openness. Exhale: stability.
Take one last slow inhale and exhale, and then gently return your awareness to the room, bringing balanced empathy with you.
Balanced empathy: Reflection exercises for daily empathy opportunities
Journal on the following reflection questions every time others’ distress or unhappiness is causing you harm:
How much did I notice others’ suffering or distress today, from 0-10?
If I noticed any suffering or distress, did I care enough to offer a comforting word or gesture?
How much do I understand that others’ suffering and distress also matter? It is not only my suffering and distress that are important.
Why is it, for my own benefit, to notice, care about, and empathize with others’ suffering, even if it seems to provide me with no direct benefit to care?
Were there any missed opportunities for experiencing both positive or negative empathy today? If yes, what were they? How can I do better tomorrow?
Positive empathy practice
Read, listen to, or talk about someone’s positive experience every day. Maybe find this from individuals in your daily life, positive news, social media, or make a conscious effort to learn about something positive that has happened to someone else today.
Intentionally practice feeling thankful, appreciative, compassionate, or happy for someone else’s positive experience.
Remind yourself that someone else’s positive experience does not take away from your happiness. It is positive for others to be happy as well.
Self-compassionate boundary setting exercise
If you focus too much on your own pain and experience, to the exclusion of others, please consider:
How much am I meeting these feelings of excessive self-focus with self-compassion, from 0 to 10?
How can I increase my self-compassion by 10% each day?
What boundaries can I gently put in place with myself to help balance the excessive focus on my own experience?
How can I approach my negative experiences and pain with compassion instead of excessive self-focus? Remember: “Self-compassion can help create more balance and letting go.”
Appendix B. Balanced empathy exercises for high levels of empathy
Adapted balanced empathy REBT exercise example
Negative belief/thought affected by higher empathy: I can’t be around unhappy people or listen to people’s problems. It’s just too painful for me, and I get overwhelmed and consumed by their negative emotions. I can’t handle it.
Harm of this belief/thought: It limits your functionality in everyday life, is disempowering, promotes victimhood, and is not solution-oriented.
Benefit of this belief/thought: It is self-protective and validates one’s lived experience.
More balanced empathetic alternative belief/thoughts:
I can learn how to be around unhappy people or individuals experiencing problems when it is necessary. I can take self-care measures such as limiting my time with them, trying to talk about positive topics, or practicing compassion, where I can apply my empathy in a constructive way.
I can practice mindfulness skills of detached compassion in difficult situations.
I can remind myself that others’ pain is not mine, trust that they will find a way to navigate their challenges, and direct people toward resources to get help.
I can take breaks from people as needed and focus on positive empathy.
Mindfulness meditation exercise for balanced empathy
Find a comfortable sitting position, close your eyes, and take three slow, deep breaths in and out.
Gently bring your attention to your heart area. Imagine a warm, steady light there—your center for balanced empathy.
As you breathe in, feel this light gently open with understanding. As you breathe out, feel it return to your center, grounding you.
Next, please think of someone you care about and silently say, “May you feel supported. May you feel peaceful and at ease.”
Notice that you can care without absorbing their feelings.
Inhale: openness.
Exhale: stability.
Take one last slow inhale and exhale, and then gently return your awareness to the room, bringing balanced empathy with you.
Self-compassionate boundary setting exercises
When you struggle with negative empathy, or being overly impacted by others’ pain and suffering, first consider:
How much am I meeting these feelings with self-compassion, from 0 to 10?
How can I increase my self-compassion by 10% each day?
What boundaries can I gently put in place to help balance the impact of negative empathy on my life?
How can I approach others’ negative experiences and pain with compassion instead of negative empathy? Remember: “Their pain is not my pain; it is not mine.”
Balanced empathy reflection exercises for negative empathy
Journal on the following reflection questions every time others’ distress or unhappiness is causing you harm:
How much of another’s suffering is my responsibility?
If I have a responsibility to help another, what tangible things can I realistically do?
How much can I trust that sometimes others need their suffering and pain in order to grow and evolve? Reminder: If I try to take on another’s suffering as my own, I am potentially stunting them, harming them in the long-term, and taking away their learning opportunity for growth.
Did I use compassion and mindfulness instead of negative empathy today?
How can I continue to improve my compassion and mindfulness on a regular basis?
Positive empathy practice
Read, listen to, or talk about someone’s positive experience every day. Maybe find this from individuals in your daily life, positive news, social media, or make a conscious effort to learn about something positive that has happened to someone else today.
Intentionally practice feeling thankful, appreciative, compassionate, or happy for someone else’s positive experience.
Remind yourself that, even though many people may experience distress in the world, there are still good things happening. It is important to notice and appreciate the positive and be mindful of it.
I would like to acknowledge all my mentors and clients during my career. It is from the cumulative clinical and academic knowledge that these concepts and ideas came to fruition, and in this chapter, now.
1.InamA, FatimaH, NaeemH, MujeebH, KhatoonR, WajahatT, SherF.Self-compassion and empathy as predictors of happiness among late adolescents. Social Sciences. 2021;10(10):380
2.HelliwellJF, AkninLB, HuangH, NortonM, WangS, CheungF, KonrathS (2025). Caring and sharing: global analysis of happiness and kindness.
3.VaillantGE. Triumphs of Experience: The Men of the Harvard Grant Study. Cambridge, MA: Belknap Press of Harvard University Press; 2012
4.GilbertP.The origins and nature of compassion-focused therapy. British Journal of Clinical Psychology. 2014;53(1):6–41
5.HuZ, WenY, WangY, LinY, ShiJ, YuZ, WangY. Effectiveness of mindfulness-based interventions on empathy: a meta-analysis. Frontiers in Psychology. 2022;13:992575
6.WinterR, IssaE, RobertsN, NormanRI, HowickJ.Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials. BMJ Open. 2020;10(9):e036471
7.TullettAM, PlaksJE.Testing the link between empathy and lay theories of happiness. Personality and Social Psychology Bulletin. 2016;42(11):1505–1521
8.HolmesDS. Projection as a defense mechanism. Psychological Bulletin. 1978;85(4):677–688. DOI: 10.1037/0033-2909.85.4.677
9.O’ConnorKJ, PeroniC, SarracinoF, WuF, SlaterG (2025). Supporting others: how prosocial behaviour reduces deaths of despair.
10.MorelliSA, LiebermanMD, ZakiJ.The emerging study of positive empathy. Social and Personality Psychology Compass. 2015;9(2):57–68
11.ConoleyCW, PontrelliME, OromendiaMF, Carmen BelloBD, NagataCM.Positive empathy: a therapeutic skill inspired by positive psychology. Journal of Clinical Psychology. 2015;71(6):575–583
12.UnderwoodLG. Compassionate love: a framework for research. The Science of Compassionate Love: Theory, Research, and Applications. 2008;1–25
13.SingerT, KlimeckiOM.Empathy and compassion. Current Biology. 2014;24(18):R875–R878
14.CerqueiraA, AlmeidaTC.Adverse childhood experiences: relationship with empathy and alexithymia. Journal of Child & Adolescent Trauma. 2023;16(3):559–568
15.SilveiraS, GodaraM, SingerT. Boosting empathy and compassion through mindfulness-based and socioemotional dyadic practice: randomized controlled trial with app-delivered trainings. Journal of Medical Internet Research. 2023;25:e45027
16.Baron-CohenS, WheelwrightS.The Empathy Quotient: an investigation of adults with Asperger syndrome or high-functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders. 2004;34(2):163–175
17.DavisMH.Measuring individual differences in empathy: evidence for a multidimensional approach. Journal of Personality and Social Psychology. 1983;44(1):113126
18.DavisMH. A multidimensional approach to individual differences in empathy. Journal of Personality and Social Psychology. 1980;10(85)
19.SongMK, ChoiSH, LeeDH, LeeKJ, LeeWJ, KangDH.Effects of cognitive-behavioral therapy on empathy in patients with chronic pain. Psychiatry Investigation. 2018;15(3):285
20.CarrA.The evidence base for family therapy and systemic interventions for child focused problems. Journal of Family Therapy. 2014;36(2):107–157
21.FourieMM, WartonFL, Derrick-SleighT, CodringtonH, SolmsM, DecetyJ, SteinDJ.Childhood abuse and neglect are differentially related to perceived discrimination and structural change in empathy-related circuitry. Scientific Reports. 2025;15(1):16361
22.ShalevI, WarrierV, GreenbergDM, SmithP, AllisonC, Baron-CohenS, EranA, UzefovskyF. Reexamining empathy in autism: empathic disequilibrium as a novel predictor of autism diagnosis and autistic traits. Autism Research: Official Journal of the International Society for Autism Research. 2022;15(10):1917–1928. DOI: 10.1002/aur.2794
23.MehrabianA. Manual for the Balanced Emotional Empathy Scale (BEES). Monterey, CA: Albert Mehrabian; 1996
24.YavuzHM, ColasanteT, GalarneauE, MaltiT. Empathy, sympathy, and emotion regulation: a meta-analytic review. Psychological Bulletin. 2024;150(1):27–44. DOI: 10.1037/bul0000426
25.NeffKD. Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self and Identity. 2003;2(2):85–101. DOI: 10.1080/15298860390129863
26.SegalEA. Social empathy: a model built on empathy, contextual understanding, and social responsibility that promotes social justice. Journal of Social Service Research. 2011;37(3):266–277. DOI: 10.1080/01488376.2011.564040
27.DolanP, SilkeC, DavittE, FlynnN, MurrayC. Activating Social Empathy: Junior Cycle Resource. Galway: UNESCO Child and Family Research Centre, University of Galway; 2023
28.WaldingerR, SchulzM. The Good Life: Lessons from the World’s Longest Scientific Study of Happiness. New York, New York: Simon and Schuster; 2023
29.RiessH.The science of empathy. Journal of Patient Experience. 2017;4(2):74–77
30.SmithTW (2008). Loving and caring in the United States: trends and correlates of empathy, altruism, and related constructs.
31.OmotoAM, MalschAM, BarrazaJA. Compassionate acts: motivations for and correlates of volunteerism among older adults. The Science of Compassionate Love: Theory, Research, and Applications. 2008;257–282
32.AronA, Aron, EN, & Norman, CC. Self-expansion model of motivation and cognition in close relationships and beyond. In M.Baldwin (Ed.). Interpersonal cognition. 2005. (pp. 478–501). Guilford Press.
33.BrodyS, WrightSC, AronA, McLaughlin‐VolpeT. Compassionate love for individuals in other social groups. The Science of Compassionate Love: Theory, Research, and Applications. 2008;283–308
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