Online Socio-emotional Dyad Training for Healthcare Students' Well-being and Social Skills

One-quarter to one-third of university students experience a common mental health disorder each year, with evidence indicating rising distress and declining well-being over time. Healthcare students appear particularly vulnerable, showing increasing levels of burnout associated with poorer academic engagement and impaired professional development. Mindfulness- and compassion-based interventions, as well as socio-emotional learning programs, have shown promise in improving mental health outcomes such as depression, anxiety, stress, and burnout, and in strengthening resilience among healthcare students.

In recent years, classic mindfulness-based interventions focusing on individual mental practices have been expanded to include partner-based social practices, known as Dyads, which particularly target social skills such as empathy, (self-)compassion, and social cohesion. However, despite growing research on student well-being, partner-based Dyadic interventions have not yet been systematically investigated in healthcare student populations. Available evidence suggests that Dyads may be more effective than solitary mindfulness practices in reducing loneliness and social stress, strengthening social connection and cohesion, and enhancing resilience and optimism. Moreover, findings indicate that dyadic social practices engage mechanisms that differ from those underlying traditional mindfulness-based interventions.

Empathy, (self-)compassion, and deep listening are core socio-emotional skills in healthcare, supporting effective communication and emotional understanding. However, empathy can lead to empathic distress when individuals are repeatedly exposed to others' suffering, whereas compassion is considered more protective, as it relies on altruistic and care-based motivational systems associated with positive affect and regulatory processes that buffer emotional overwhelm. Despite this distinction, empathy and compassion have not yet been systematically taught to healthcare students in an evidence-based manner. To address this gap, the Edu:Social Health Care project implements the empathy-compassion Dyad training program (EmCo), which trains students to distinguish between empathy and empathic listening and empathy regulation to avoid moving into empathic distress during the first four weeks, and (self)compassion and compassionate listening during the subsequent four weeks.

The EmCo program builds on the Affect Dyad developed in the ReSource project and the online Dyad coaching format implemented in the CovSocial project, both of which demonstrated the effectiveness of partner-based dyadic mental training in inducing brain plasticity, reducing stress, enhancing psychological resilience, and strengthening social cohesion across multiple indicators of biopsychosocial health. In contrast, to the ReSource and CovSocial projects, the present program, includes a novel empathy versus compassion listening component to it. Further, compared with earlier 10-week online Dyad programs, EmCo reduces the intervention duration to eight weeks, aligning with standard mindfulness-based interventions such as MBSR and MBCT and improving feasibility for implementation in healthcare and educational settings.

Accordingly, the study is implemented as a randomized controlled trial in a sample of healthcare students (target N = 360). A multimethod assessment strategy will be used, including self-report validated trait and state questionnaires, behavioral computer tasks delivered at home through webapp, and ecological momentary assessment (EMA) methods based on push-notifications by the app. These different assessments are capturing changes across mental health, resilience, social cohesion and support, social skills, coping and emotion regulation, and social behaviors (e.g., listening, attachment behaviors).

After providing informed consent, participants will be randomized to one of two groups: (1) an empathy-compassion training group (EmCo), based on the Affect Dyad mental practice, or (2) a waitlist control group (WCG). All participants will first complete the pre-test assessment phase including baseline psychometrics, computer-based tasks, and EMA measures. The intervention group will then be onboarded into the intervention with two Online onboarding I and II sessions lead by professional Dyad teachers and then complete the EmCo training program delivered via a dedicated web and smartphone application with daily partner-based Dyads as well as weekly 1.5 hours online coaching sessions. During this period, participants will complete brief weekly self-report questionnaires, Ecological Momentary Assessments (EMA) and daily pre-post Dyad practice ratings (DPR), to capture changes in key psychological and social processes to be used as mediator variables. At the end of the intervention, all participants will complete a post-test phase similar to the pre-test but with an additional final feedback questionnaire.

Following completion of the initial post-test (T1), participants in the waitlist control group will subsequently receive the same 8-week socio-emotional Dyad intervention (EmCo) and complete an additional post-test assessment (T2).

The study was preregistered on the Open Science Framework (OSF) and is publicly available at https://osf.io/3t8s4.

• Experimental: Empathy- and compassion-based socio-emotional mental training (EmCo) (Behavioral): 1. Participants engage in a structured 13-minute partner-based contemplative exercise. Each dyad reflects on two experiences from the previous 24 hours: one involving a difficult emotion and one involving gratitude. Partners take turns speaking while the other listens non-judgmentally. During weeks 1-4, the practice emphasizes empathic listening; during weeks 5-8, compassionate listening. Participants are instructed to attend to bodily sensations associated with the emotions described. The practice aims to improve coping with difficult emotions, empathic and compassionate listening, (self)acceptance, compassion, gratitude, resilience. 2. Participants also attend eight 1.5-hour online group sessions led by Expert Dyad teachers. The coaching sessions help deepen the Dyad practice and educate teachers about body language, coping better with difficult emotions/stress, the benefits of empathy versus compassion and the act of listening from a mindset of empathy versus compassion.
• Waitlist Control Group (WCG) (Other): Participants in the control group will not receive the intervention. They will complete pre- and post-test procedures consisting primarily of self-report questionnaires, and behavioral tasks, as well as ecological momentary assessment (EMA) conducted on four days within two weeks at pre-test and post-test 1 \& 2.

Primary outcomes

• Depression Anxiety Stress Scale (DASS-21) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: A scale measuring depression, anxiety, and stress (Henry \& Crawford, 2005; Nilges \& Essau, 2021). Higher scores indicate more depression, anxiety, and stress.
• Maslach Burnout Inventory-Students Survey (MBI-SS) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: A scale measuring burnout (Gumz et al., 2013; Maslach \& Jackson, 1981). Higher scores indicate more burnout.
• UCLA Loneliness Scale (UCLA) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: A scale measuring loneliness severity (Döring \& Bortz, 1993; Russell et al., 1980). Higher scores indicate more loneliness.
• Connor Davidson Resilience Scale (CD-RISC) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: A scale measuring psychological resilience (Connor \& Davidson, 2003; Sarubin et al., 2015). Higher scores indicate more resilience.
• Social closeness (IOS per profession) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: A scale measuring the felt closeness between persons or groups/communities using a visual representation (Aron et al., 1992; Kinnunen \& Windmann, 2013). Higher score indicates more social closeness.
• Interprofessionalism Scale (IPAS-D) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: A scale (Norris et al., 2015; Pedersen et al., 2020) measuring attitudes that relate to the Core Competencies for Interprofessional Collaborative Practice (IPEC Report, 2011). Higher scores indicate more positive attitudes toward collaborative practice.
• Social Support Scale (F-SozU K-6) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: A scale measuring the subjective feeling of having support available (Kliem et al., 2015). Higher scores indicate greater perceived social support.
• Socio-Affective Video Task (SoVT) [Assessed at baseline (pre-test), after 4 weeks of empathic listening training (mid-intervention) and after the 4 weeks of compassionate listening training (post-test 1 & 2)]: This task assesses behavioral empathy and compassion using emotional video clips (Klimecki et al., 2014). Higher scores indicate more empathy or more compassion.
• Sussex-Oxford Compassion Scale for Self and Others (SOCS) [Assessed at baseline (pre-test), after 4 weeks of empathic listening training (mid-intervention) and after the 4 weeks of compassionate listening training (post-test 1 & 2)]: A scale measuring self-compassion (SOCS-S) and compassion for others (SOCS-O; Gu et al., 2020). Higher scores indicate more compassion.
• Mentalization Scale (MENTS) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2).]: A scale measuring the capacity of envisioning one's and others' behaviors with reference to the underlying mental states (Dimitrijević et al., 2018). Higher scores suggesting a more sophisticated capacity for mentalizing.
• Prosodic Features of Vocalized Emotional Expressions [Assessed weekly from week 1 to week 8, as part of the Dyad Voice Assessment (DYVA)]: Acoustic assessment of prosodic speech features during participants' daily Dyad practice, analyzed using audEERING devAIce software. The following parameters will be assessed: pitch (Hz), loudness (unitless), speaking rate (syllables per second), and intonation (unitless).
• Affect Dimensions of Vocalized Emotional Expressions [Assessed weekly from week 1 to week 8, as part of the Dyad Voice Assessment (DYVA)]: Assessment of continuous affective dimensions of vocalized emotional expressions during participants' daily Dyad practice using audEERING devAIce software. The following parameters will be assessed: arousal, valence, and dominance (each ranging from -1 to 1). Based on arousal-valence scores, the following affect quadrant values will be calculated: high-arousal-high-valence, low-arousal-high-valence, low-arousal-low-valence, and high-arousal-low-valence.
• Affect Categories of Vocalized Emotional Expressions [Assessed weekly from week 1 to week 8, as part of the Dyad Voice Assessment (DYVA)]: Classification of vocalized emotional expressions into affect categories during participants' daily Dyad practice using audEERING devAIce software. The following categories will be assessed: angry, happy, and sad, expressed as unitless values ranging from 0 to 1 representing category likelihood.
• Stress intensity [Assessed using an EMA design with five push-notification measurements per day, distributed across five 3-hour intervals, on four days within a two-week period, at pre-test (Baseline) and after the 8-week intervention period (post-intervention).]: Custom items based on the Stress Appraisal Measure (SAM; Delahaye et al., 2015; Peacock \& Wong, 1990) measuring stress intensity. Higher scores indicate more intense stress.
• Coping strategies [Assessed using an EMA design with five push-notification measurements per day, distributed across five 3-hour intervals, on four days within a two-week period, at pre-test (Baseline) and after the 8-week intervention period (post-intervention).]: Custom items based on the Brief-COPE (Carver, 1997; Knoll et al., 2005) and Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski et al., 2001; Loch et al., 2011) measuring Coping Strategies (Acceptance, Positive Reinterpretation, Social Support, Rumination, Self-Blame, Distraction). Higher scores indicate a higher use of the specified coping strategies.
• Active Empathic Listening Scale (AELS) [Assessed at baseline (pre-test), after 4 weeks of empathic listening training (mid-intervention) and after the 4 weeks of compassionate listening training (post-test 1 & 2)]: A scale measuring active empathic listening (Bodie, 2011). Higher scores indicate more active empathic listening.
• Attachment behavior (ASQ) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: A self-report questionnaire measuring attachment-related behaviors in interpersonal relationships, including proximity seeking, avoidance, and security (Hexel, 2004). Higher scores indicate more pronounced attachment-related behaviors.

Secondary outcomes

• Positive Affect (Affect Grid) (explanatory mechanism) [Assessed weekly during the course of 8 weeks of intervention]: Assessment of emotional state (valence) and arousal (Russell et al., 1989). Higher scores on valence and arousal indicate more positive affect and higher arousal.
• Emotion Acceptance (EAQ) (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A self-report questionnaire measuring emotional awareness, and acceptance of emotions (Beblo et al., 2011; Kisley et al., 2025). Higher scores indicate greater emotion awareness and acceptance
• Gratitude Questionnaire-6 (GQ-5-G) (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A scale measuring gratitude (Hudecek et al., 2021; McCullough et al., 2002). Higher scores indicate more gratitude.
• Self-Kindness Scale (SCS-SF) (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A self-report questionnaire measuring self-kindness and compassionate attitudes toward oneself (Hupfeld \& Ruffieux, 2011; Raes et al., 2011). Higher scores indicate greater self-kindness.
• Positive Interpretation Bias (ERT) (explanatory mechanism) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: This task assesses the tendency to judge persons' facial expressions more positively using morphed sequences of facial expressions (DeBruine \& Jones, 2017; Griffiths et al., 2015). Higher scores indicate a stronger positive interpretation bias.
• Mentalizing (MENTS) Scale (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A self-report questionnaire measuring the capacity to understand one's own and others' mental states (Dimitrijević et al., 2018). Higher scores indicate greater mentalizing ability.
• Short Loneliness Scale (SLS) (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A short scale measuring frequency, intensity, and duration of loneliness (Hughes et al., 2004; Qualter et al., 2021). Higher scores indicate more loneliness.
• Perceived Stress (PSS-10) (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A self-report questionnaire measuring the degree to which situations in one's life are appraised as stressful (Cohen et al., 1983; Klein et al., 2016). Higher scores indicate greater perceived stress.
• Depression (PHQ-2) (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A brief self-report screening measure assessing core depressive symptoms, including depressed mood and anhedonia (Kroenke et al., 2003). Higher scores indicate greater depressive symptom severity.
• Empathic Concern & Distress (IRI) (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A scale measuring different facets of social emotions, including personal distress and empathic concern (Davis, 1980; Paulus, 2009). Higher scores indicate higher personal distress or empathic concern.
• Trust (KUSIV3) (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: A self-report questionnaire measuring generalized interpersonal trust, including trust in others' reliability and integrity (Beierlein et al., 2012). Higher scores indicate greater interpersonal trust.
• In-group-Out-group bias (ERT) (explanatory mechanism) [Assessed at baseline (pre-test) and after the 8-week intervention period (post-test 1 & 2)]: This task assesses the tendency to judge persons from one's own group to be more positive in facial emotion recognition using morphed sequences of facial expressions (DeBruine \& Jones, 2017; Griffiths et al., 2015). Higher scores indicate a stronger in-group-out-group bias.
• Coping strategies (explanatory mechanism) [Assessed weekly during the course of 8 weeks]: Custom items based on the Brief-COPE (Carver, 1997; Knoll et al., 2005) and Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski et al., 2001; Loch et al., 2011) measuring Coping Strategies (Acceptance, Positive Reinterpretation, Social Support, Rumination, Self-Blame, Distraction). Higher scores indicate a higher use of the specified coping strategies.
• DPR-Affect (Affect Grid; explanatory mechanism) [Assessed for 8 weeks during intervention period, before the daily exercise]: Assessment of emotional state (valence) and arousal (Russell et al., 1989) just before starting the Dyad. Higher scores on valence and arousal indicate more positive affect and higher arousal.
• DPR-involvement (explanatory mechanism) [Assessed for 8 weeks during intervention period, only in the intervention group, after the daily exercise]: Assessment of listening involvement (1 custom item; only post-Dyad exercise). Higher scores indicate more listening involvement.
• Dyad closeness - Inclusion of Other in Self Scale (explanatory mechanism) [Assessed for 8 weeks during intervention period, only in the intervention group, after the daily exercise]: Assessment of how close participants felt to their Dyad partner (post-Dyad exercise). Higher scores indicate more closeness (Aron et al., 1992; Kinnunen \& Windmann, 2013).
• Dyad listening quality (DPR- listening-quality) [Assessed weekly from week 1 to week 8, after the Dyad practice]: Custom items (self-generated) measuring the quality of listening to the Dyad partner. Higher scores indicate a higher degree of active, attentive listening
• DPR-Emotions [Assessed weekly from week 1 to week 8, as part of the Dyad Voice Assessment (DYVA)]: Emotion intensities (of e.g., happiness, gratitude, sadness, anger) rated by the speaker and by the listener of a Dyad directly after the Dyad.
• DPR-Listening-Affect [Assessed weekly from week 1 to week 8, after the Dyad practice]: Custom items (self-generated) measuring the self-rated affective state during listening to the Dyad partner's telling of the difficult situation and the event that they are grateful for. Higher scores indicate a more positive affect.
• Dyad empathic and compassionate listening skills (DPR-listening-skills) [Assessed weekly from week 1 to week 8, after the Dyad practice]: Custom items (self-generated) measuring the self-rated skill of listening empathically and compassionately to the Dyad partner's telling of the difficult situation and the event that they are grateful for. Higher scores indicate a higher degree of empathic or compassionate listening respectively.

Other outcomes

• Patient Health Questionnaire (PHQ-9; pre-screening) [Assessed before the intervention, only once, to pre-screen out from the study individuals who have clinical levels of depressive symptoms]: A scale assessing depression (Löwe et al., 2004; Martin et al., 2006). Higher scores indicate more depression.
• Generalized Anxiety Disorder (GAD-7; pre-screening) [Assessed prior to the intervention, only once, to pre-screen out from the study individuals who have clinical levels of anxious symptoms]: A scale assessing generalized anxiety (Spitzer et al., 2006; Löwe et al., 2007). Higher scores indicate more anxiety.
• Toronto Alexithymia Scale (TAS-20; pre-screening) [Assessed before the intervention, only once, to pre-screen out from the study individuals who have high levels of alexithymia]: A scale assessing alexithymia (Bagby et al., 1994; Ritz \& Kannapin, 2000). Higher scores indicate more alexithymia.
• Standardized Assessment of Personality - Abbreviated Scale (SAPAS; pre-screening) [Assessed before the intervention, only once, to pre-screen out from the study individuals who have high levels of personality disorders symptoms]: A self-report scale used to screen personality disorders (Moran et al., 2003; Söchtig et al., 2012).
• General demographic questions [Assessed before the intervention, only once, to collect demographic information]: Self-generated demographic items.

Sex: All, ages: 18 Years to 65 Years, accepts healthy volunteers

Inclusion Criteria:

1. Between 18- and 65-years old.
2. actively enrolled student at the PMU.
3. Proficient in German.
4. Informed consent.
5. No symptoms of psychiatric disease within the past two years.
6. Stable internet access and necessary technical equipment (computer or laptop or tablet, and mobile phone with internet access).
7. No regular contemplative practice (≤ 50 hours total within the past six months); healthy population, non-clinical population.

   Exclusion Criteria:
8. Insufficient German proficiency.
9. Lack of stable internet access or required devices (computer or laptop or tablet, and mobile phone with internet access).
10. No informed consent.
11. Not actively enrolled at PMU.
12. Regular contemplative practice (> 50 hours in the past six months (e.g., dyad, mindfulness, compassion-based practices).
13. Current psychiatric diagnosis or therapy, or reaching screening cutoffs on:

    * Patient Health Questionnaire-9 (PHQ-9; Martin et al., 2006; Löwe et al., 2004; Cutoff ≥ 10),
    * Generalized Anxiety Disorder-7 (GAD-7; Löwe et al., 2007; Spitzer et al., 2006; Cutoff ≥ 10),
    * Toronto Alexithymia Scale-20 (TAS-20; Bagby et al., 1994; Ritz \& Kannapin, 2000; Cutoff ≥ 61)
    * Standardized Assessment of Personality - Abbreviated Scale (SAPAS; Moran et al., 2003; Söchtig et al., 2012, Cutoff ≥ 4).
    * Moreover, participants endorsing suicidality on the PHQ-9 will be excluded.

• 1. Aron, A., Aron, E. N., & Smollan, D. (1992). Inclusion of Other in the Self Scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63(4), 596-612. https://doi.org/10.1037/0022-3514.63.4.596
• Auerbach RP, Mortier P, Bruffaerts R, Alonso J, Benjet C, Cuijpers P, Demyttenaere K, Ebert DD, Green JG, Hasking P, Murray E, Nock MK, Pinder-Amaker S, Sampson NA, Stein DJ, Vilagut G, Zaslavsky AM, Kessler RC; WHO WMH-ICS Collaborators. WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. J Abnorm Psychol. 2018 Oct;127(7):623-638. doi: 10.1037/abn0000362. Epub 2018 Sep 13. PMID 30211576
• Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, Hwang I, Kessler RC, Liu H, Mortier P, Nock MK, Pinder-Amaker S, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Benjet C, Caldas-de-Almeida JM, Demyttenaere K, Florescu S, de Girolamo G, Gureje O, Haro JM, Karam EG, Kiejna A, Kovess-Masfety V, Lee S, McGrath JJ, O'Neill S, Pennell BE, Scott K, Ten Have M, Torres Y, Zaslavsky AM, Zarkov Z, Bruffaerts R. Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med. 2016 Oct;46(14):2955-2970. doi: 10.1017/S0033291716001665. Epub 2016 Aug 3. PMID 27484622
• Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994 Jan;38(1):23-32. doi: 10.1016/0022-3999(94)90005-1. PMID 8126686
• Barbosa P, Raymond G, Zlotnick C, Wilk J, Toomey R 3rd, Mitchell J 3rd. Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Educ Health (Abingdon). 2013 Jan-Apr;26(1):9-14. doi: 10.4103/1357-6283.112794. PMID 23823667
• 6. Beblo, T., Scheulen, C., Fernando, S. C., Griepenstroh, J., Aschenbrenner, S., Rodewald, K. & Driessen, M. (2011). Psychometrische Analyse eines neuen Fragebogens zur Erfassung der Akzeptanz von unangenehmen und angenehmen Gefühlen (FrAGe). Zeitschrift Für Psychiatrie, Psychologie Und Psychotherapie, 59(2), 133-144. https://doi.org/10.1024/1661-4747/a000063
• Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Pract. 2002 Jan-Feb;15(1):25-38. PMID 11841136
• 8. Beierlein, C., Kemper, C. J., Kovaleva, A., & Rammstedt, B. (2012). Kurzskala zur Messung des zwischenmenschlichen Vertrauens: die Kurzskala Interpersonales Vertrauen (KUSIV3). (GESIS-Working Papers, 2012/22). Mannheim: GESIS - Leibniz-Institut für Sozialwissenschaften. https://nbn-resolving.org/urn:nbn:de:0168-ssoar-312126
• 9. Bodie, G. D. (2011). The Active-Empathic Listening Scale (AELS): Conceptualization and Evidence of Validity Within the Interpersonal Domain. Communication Quarterly, 59(3), 277-295. https://doi.org/10.1080/01463373.2011.583495
• Bullock G, Kraft L, Amsden K, Gore W, Prengle B, Wimsatt J, Ledbetter L, Covington K, Goode A. The prevalence and effect of burnout on graduate healthcare students. Can Med Educ J. 2017 Jun 30;8(3):e90-e108. eCollection 2017 Jun. PMID 29098051
• Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92-100. doi: 10.1207/s15327558ijbm0401_6. PMID 16250744
• 12. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). Perceived Stress Scale [Database record]. APA PsycTests. https://doi.org/10.1037/t02889-000
• Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82. doi: 10.1002/da.10113. PMID 12964174
• Curran T, Hill AP. Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016. Psychol Bull. 2019 Apr;145(4):410-429. doi: 10.1037/bul0000138. Epub 2017 Dec 28. PMID 29283599
• 15. Davis, M. H. (1980). A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected Documents in Psychology, 1980, 10, p. 85. https://www.uv.es/friasnav/Davis_1980.pdf
• 16. DeBruine, L. & Jones, B. (2017). Face Research Lab London Set. figshare. Dataset. https://doi.org/10.6084/m9.figshare.5047666.v5
• Delahaye M, Stieglitz RD, Graf M, Keppler C, Maes J, Pflueger M. [German translation and validation of the Stress Appraisal Measure (SAM)]. Fortschr Neurol Psychiatr. 2015 May;83(5):276-85. doi: 10.1055/s-0034-1399727. Epub 2015 May 27. German. PMID 26018395
• Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013 Jan;63(606):e76-84. doi: 10.3399/bjgp13X660814. PMID 23336477
• Dimitrijevic A, Hanak N, Altaras Dimitrijevic A, Jolic Marjanovic Z. The Mentalization Scale (MentS): A Self-Report Measure for the Assessment of Mentalizing Capacity. J Pers Assess. 2018 May-Jun;100(3):268-280. doi: 10.1080/00223891.2017.1310730. Epub 2017 Apr 24. PMID 28436689
• 20. Döring, N., & Bortz, J. (1993). Psychometrische Einsamkeitsforschung: Deutsche Neukonstruktion der UCLA Loneliness Scale. Diagnostica, 39(3), 224-239.
• Gandia-Carbonell N, Molla-Esparza C, Lorente S, Viguer P, Losilla JM. Strategies to assess and promote the socio-emotional competencies of university students in the socio-educational and healthcare fields: A scoping review. PLoS One. 2025 May 22;20(5):e0324531. doi: 10.1371/journal.pone.0324531. eCollection 2025. PMID 40403089
• 22. Garnefski, N., Kraaij, V., & Spinhoven, P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual differences, 30(8), 1311-1327. https://doi.org/10.1016/S0191-8869(00)00113-6
• Godara M, Hecht M, Singer T. Training-related improvements in mental well-being through reduction in negative interpretation bias: A randomized trial of online socio-emotional dyadic and mindfulness interventions. J Affect Disord. 2024 Jun 1;354:662-672. doi: 10.1016/j.jad.2024.03.037. Epub 2024 Mar 12. PMID 38484880
• Godara M, Silveira S, Matthaus H, Heim C, Voelkle M, Hecht M, Binder EB, Singer T. Investigating differential effects of socio-emotional and mindfulness-based online interventions on mental health, resilience and social capacities during the COVID-19 pandemic: The study protocol. PLoS One. 2021 Nov 4;16(11):e0256323. doi: 10.1371/journal.pone.0256323. eCollection 2021. PMID 34735441
• Godara M, Singer T. 10-Week Trajectories of Candidate Psychological Processes Differentially Predict Mental Health Gains from Online Dyadic versus Mindfulness Interventions: A Randomized Clinical Trial. J Clin Med. 2024 Jun 3;13(11):3295. doi: 10.3390/jcm13113295. PMID 38893006
• Godara M, Singer T. Resilient Stress Reactivity Profiles Predict Mental Health Gains from Online Contemplative Training: A Randomized Clinical Trial. J Pers Med. 2024 May 4;14(5):493. doi: 10.3390/jpm14050493. PMID 38793075
• Griffiths S, Jarrold C, Penton-Voak IS, Munafo MR. Feedback training induces a bias for detecting happiness or fear in facial expressions that generalises to a novel task. Psychiatry Res. 2015 Dec 30;230(3):951-7. doi: 10.1016/j.psychres.2015.11.007. Epub 2015 Nov 19. PMID 26619915
• Gu J, Baer R, Cavanagh K, Kuyken W, Strauss C. Development and Psychometric Properties of the Sussex-Oxford Compassion Scales (SOCS). Assessment. 2020 Jan;27(1):3-20. doi: 10.1177/1073191119860911. Epub 2019 Jul 29. PMID 31353931
• Gumz A, Erices R, Brahler E, Zenger M. [Factorial structure and psychometric criteria of the German translation of the Maslach Burnout Inventory--Student Version by Schaufeli et al. (MBI-SS)]. Psychother Psychosom Med Psychol. 2013 Feb;63(2):77-84. doi: 10.1055/s-0032-1323695. Epub 2013 Feb 13. German. PMID 23408302
• Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005 Jun;44(Pt 2):227-39. doi: 10.1348/014466505X29657. PMID 16004657
• 31. Hexel, M. (2004). Validierung der deutschen Version des Attachment Style Questionnaire (ASQ) bei Personen mit und ohne psychiatrische Diagnosen. Zeitschrift für Klinische Psychologie und Psychotherapie, 33(2), 79-90. Hogrefe Verlag. https://doi.org/10.1026/0084-5345.33.2.79
• 32. Hudecek, M. F. C., Blabst, N., Morgen, B., & Lermer, E. (2021). Eindimensionale Skala zur Messung von Dankbarkeit (GQ-5-G). Zusammenstellung sozialwissenschaftlicher Items und Skalen (ZIS). https://doi.org./10.6102/zis300
• Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies. Res Aging. 2004;26(6):655-672. doi: 10.1177/0164027504268574. PMID 18504506
• 34. Hupfeld, J., & Ruffieux, N. (2011). Validierung einer deutschen Version der Self-Compassion Scale (SCS-D). Zeitschrift Für Klinische Psychologie Und Psychotherapie, 40(2), 115-123. https://doi.org/10.1026/1616-3443/a000088
• Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982 Apr;4(1):33-47. doi: 10.1016/0163-8343(82)90026-3. PMID 7042457
• 36. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156. https://doi.org/10.1093/clipsy.bpg016
• 37. Kinnunen, S. P., & Windmann, S. (2013). Inclusion of Other in Self Scale--German Version [Database record]. APA PsycTests. https://doi.org/10.1037/t62377-000
• Kisley MA, Beblo T, Lac A. Emotion Acceptance Questionnaire (EAQ): Factor Analysis and Psychometric Evaluation. J Pers Assess. 2025 Jul-Aug;107(4):516-529. doi: 10.1080/00223891.2024.2444448. Epub 2025 Jan 14. PMID 39807807
• Klein EM, Brahler E, Dreier M, Reinecke L, Muller KW, Schmutzer G, Wolfling K, Beutel ME. The German version of the Perceived Stress Scale - psychometric characteristics in a representative German community sample. BMC Psychiatry. 2016 May 23;16:159. doi: 10.1186/s12888-016-0875-9. PMID 27216151
• Kliem S, Mossle T, Rehbein F, Hellmann DF, Zenger M, Brahler E. A brief form of the Perceived Social Support Questionnaire (F-SozU) was developed, validated, and standardized. J Clin Epidemiol. 2015 May;68(5):551-62. doi: 10.1016/j.jclinepi.2014.11.003. Epub 2014 Nov 13. PMID 25499982
• Klimecki OM, Leiberg S, Ricard M, Singer T. Differential pattern of functional brain plasticity after compassion and empathy training. Soc Cogn Affect Neurosci. 2014 Jun;9(6):873-9. doi: 10.1093/scan/nst060. Epub 2013 Apr 10. PMID 23576808
• 42. Knoll, N., Rieckmann, N., & Schwarzer, R. (2005). Coping as a mediator between personality and stress outcomes: a longitudinal study with cataract surgery patients. European Journal of Personality, 19(3), 229-247. https://doi.org/10.1002/per.546
• Kok BE, Singer T. Phenomenological Fingerprints of Four Meditations: Differential State Changes in Affect, Mind-Wandering, Meta-Cognition, and Interoception Before and After Daily Practice Across 9 Months of Training. Mindfulness (N Y). 2017;8(1):218-231. doi: 10.1007/s12671-016-0594-9. Epub 2016 Aug 19. PMID 28163798
• Kok BE, Singer T. Effects of Contemplative Dyads on Engagement and Perceived Social Connectedness Over 9 Months of Mental Training: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Feb 1;74(2):126-134. doi: 10.1001/jamapsychiatry.2016.3360. PMID 28030741
• Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003 Nov;41(11):1284-92. doi: 10.1097/01.MLR.0000093487.78664.3C. PMID 14583691
• Liedtke C, Kohl W, Kret ME, Koelkebeck K. Emotion recognition from faces with in- and out-group features in patients with depression. J Affect Disord. 2018 Feb;227:817-823. doi: 10.1016/j.jad.2017.11.085. Epub 2017 Nov 21. PMID 29689696
• 47. Loch, N., Hiller, W., & Witthöft, M. (2011). Der Cognitive Emotion Regulation Questionnaire (CERQ). Erste teststatistische Überprüfung einer deutschen Adaption [The Cognitive Emotion Regulation Questionnaire (CERQ). Psychometric evaluation of a German adaptation]. Zeitschrift für Klinische Psychologie und Psychotherapie: Forschung und Praxis, 40(2), 94-106. https://doi.org/10.1026/1616-3443/a000079
• Lowe B, Kroenke K, Herzog W, Grafe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord. 2004 Jul;81(1):61-6. doi: 10.1016/S0165-0327(03)00198-8. PMID 15183601
• 49. Löwe, B., Müller, S., Brähler, E., Kroenke, K., Albani, C., & Decker, O. (2007). Validierung und Normierung eines kurzen Selbstratinginstrumentes zur Generalisierten Angst (GAD-7) in einer repräsentativen Stichprobe der deutschen Allgemeinbevölkerung. PPmP-Psychotherapie Psychosomatik· Medizinische Psychologie, 57(02), A050.
• Martin A, Rief W, Klaiberg A, Braehler E. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006 Jan-Feb;28(1):71-7. doi: 10.1016/j.genhosppsych.2005.07.003. PMID 16377369
• 51. Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of organizational behavior 2(2), 99-113. https://doi.org/10.1002/job.4030020205
• Matthaeus H, Heim C, Voelkle MC, Singer T. Reducing neuroendocrine psychosocial stress response through socio-emotional dyadic but not mindfulness online training. Front Endocrinol (Lausanne). 2024 Jun 24;15:1277929. doi: 10.3389/fendo.2024.1277929. eCollection 2024. PMID 38978617
• Matthaeus H, Godara M, Silveira S, Hecht M, Voelkle M, Singer T. Reducing Loneliness through the Power of Practicing Together: A Randomized Controlled Trial of Online Dyadic Socio-Emotional vs. Mindfulness-Based Training. Int J Environ Res Public Health. 2024 Apr 29;21(5):570. doi: 10.3390/ijerph21050570. PMID 38791785
• Mccullough ME, Emmons RA, Tsang JA. The grateful disposition: a conceptual and empirical topography. J Pers Soc Psychol. 2002 Jan;82(1):112-27. doi: 10.1037//0022-3514.82.1.112. PMID 11811629
• Moran P, Leese M, Lee T, Walters P, Thornicroft G, Mann A. Standardised Assessment of Personality - Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder. Br J Psychiatry. 2003 Sep;183:228-32. doi: 10.1192/bjp.183.3.228. PMID 12948996
• 56. Nilges, P. & Essau, C. (2021). DASS. Depressions-Angst-Stress-Skalen - deutschsprachige Kurzfassung [Verfahrensdokumentation und Fragebogen mit Auswertung]. In Leibniz-Institut für Psychologie (ZPID) (Hrsg.), Open Test Archive. Trier: ZPID. https://doi.org/10.23668/psycharchives.4579
• Norris J, Carpenter JG, Eaton J, Guo JW, Lassche M, Pett MA, Blumenthal DK. The Development and Validation of the Interprofessional Attitudes Scale: Assessing the Interprofessional Attitudes of Students in the Health Professions. Acad Med. 2015 Oct;90(10):1394-400. doi: 10.1097/ACM.0000000000000764. PMID 25993280
• O'Malley B, Linz R, Engert V, Singer T. Testing the monitor and acceptance theory: the role of training-induced changes in monitoring- and acceptance-related capacities after attention-based, socio-emotional, or socio-cognitive mental training in reducing cortisol stress reactivity. Stress. 2024 Jan;27(1):2345906. doi: 10.1080/10253890.2024.2345906. Epub 2024 Jun 6. PMID 38841737
• 59. Paulus, C. M. (2009). Der Saarbrücker Persönlichkeitsfragebogen SPF(IRI) zur Messung von Empathie: Psychometrische Evaluation der deutschen Version des Interpersonal Reactivity Index. Saarbrücken: Universität des Saarlandes.
• 60. Peacock, E. J., & Wong, P. T. (1990). The stress appraisal measure (SAM): A multidimensional approach to cognitive appraisal. Stress medicine, 6(3), 227-236. https://doi.org/10.1002/smi.2460060308
• Pedersen TH, Cignacco E, Meuli J, Habermann F, Berger-Estilita J, Greif R. The German interprofessional attitudes scale: translation, cultural adaptation, and validation. GMS J Med Educ. 2020 Apr 15;37(3):Doc32. doi: 10.3205/zma001325. eCollection 2020. PMID 32566734
• Prendergast M, Cardoso Pinto AM, Harvey CJ, Muir E. Burnout in early year medical students: experiences, drivers and the perceived value of a reflection-based intervention. BMC Med Educ. 2024 Jan 3;24(1):7. doi: 10.1186/s12909-023-04948-0. PMID 38172864
• Qualter P, Petersen K, Barreto M, Victor C, Hammond C, Arshad SA. Exploring the Frequency, Intensity, and Duration of Loneliness: A Latent Class Analysis of Data from the BBC Loneliness Experiment. Int J Environ Res Public Health. 2021 Nov 16;18(22):12027. doi: 10.3390/ijerph182212027. PMID 34831780
• Raes F, Pommier E, Neff KD, Van Gucht D. Construction and factorial validation of a short form of the Self-Compassion Scale. Clin Psychol Psychother. 2011 May-Jun;18(3):250-5. doi: 10.1002/cpp.702. Epub 2010 Jun 8. PMID 21584907
• 65. Ritz, T., & Kannapin, O. (2000). Zur Konstruktvalidität einer deutschen Fassung der Toronto Alexithymia Scale [The construct validity of a German version of the Toronto Alexithymia Scale]. Zeitschrift für Differentielle und Diagnostische Psychologie, 21(1), 49-64. https://doi.org/10.1024/0170-1789.21.1.49
• Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. 1980 Sep;39(3):472-80. doi: 10.1037//0022-3514.39.3.472. PMID 7431205
• 67. Russell, J. A., Weiss, A., & Mendelsohn, G. A. (1989). Affect grid: a single-item scale of pleasure and arousal. Journal of personality and social psychology, 57(3), 493. https://doi.org/10.1037/0022-3514.57.3.493
• 68. Sarubin, N., Gutt, D., Giegling, I., Bühner, M., Hilbert, S., Krähenmann, O., Wolf, M., Jobst, A., Sabaß, L., Rujescu, D., Falkai, P., & Padberg, F. (2015). Erste Analyse der psychometrischen Eigenschaften und Struktur der deutschsprachigen 10- und 25-Item Version der Connor-Davidson Resilience Scale (CD-RISC). European Journal of Health Psychology, 23(5). https://doi.org/10.1026/0943-8149/a000142
• Silveira S, Godara M, Singer T. Boosting Empathy and Compassion Through Mindfulness-Based and Socioemotional Dyadic Practice: Randomized Controlled Trial With App-Delivered Trainings. J Med Internet Res. 2023 Jul 26;25:e45027. doi: 10.2196/45027. PMID 37494106
• Sinclair S, McClement S, Raffin-Bouchal S, Hack TF, Hagen NA, McConnell S, Chochinov HM. Compassion in Health Care: An Empirical Model. J Pain Symptom Manage. 2016 Feb;51(2):193-203. doi: 10.1016/j.jpainsymman.2015.10.009. Epub 2015 Oct 26. PMID 26514716
• Singer T. A neuroscience perspective on the plasticity of the social and relational brain. Ann N Y Acad Sci. 2025 May;1547(1):52-74. doi: 10.1111/nyas.15319. Epub 2025 Apr 3. PMID 40178439
• Singer T, Engert V. It matters what you practice: differential training effects on subjective experience, behavior, brain and body in the ReSource Project. Curr Opin Psychol. 2019 Aug;28:151-158. doi: 10.1016/j.copsyc.2018.12.005. Epub 2018 Dec 12. PMID 30684917
• Singer T, Klimecki OM. Empathy and compassion. Curr Biol. 2014 Sep 22;24(18):R875-R878. doi: 10.1016/j.cub.2014.06.054. PMID 25247366
• 74. Singer, T., Kok, B. E., Bornemann, B., Bolz, M., & Bochow, C. (2015). The ReSource Project: Background, design, samples, and measurements (1st ed.). Leipzig: Max Planck Institute for Human Cognitive and Brain Sciences. https://hdl.handle.net/21.11116/0000-0003-FEC8-E
• Sochtig A, Kliem S, Kroger C. Diagnostic efficiency of the German version of the Standardized Assessment of Personality--Abbreviated Scale. Psychopathology. 2012;45(6):381-9. doi: 10.1159/000337970. Epub 2012 Jul 31. PMID 22854192
• Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092. PMID 16717171
• Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000 Aug;68(4):615-23. doi: 10.1037//0022-006x.68.4.615. PMID 10965637
• Wang Z, Wu P, Hou Y, Guo J, Lin C. The effects of mindfulness-based interventions on alleviating academic burnout in medical students: a systematic review and meta-analysis. BMC Public Health. 2024 May 27;24(1):1414. doi: 10.1186/s12889-024-18938-4. PMID 38802770

• Tania Singer, Ph.D., Principal investigator, Social Neuroscience Lab, Max Planck Society