Discussion

This rapid review of 4 studies involving 715 mental health professionals found improvements in empathy following culturally informed training interventions, although none directly measured kindness or compassion. Three studies demonstrated clear gains in empathy, two quantitatively and one qualitatively, with one showing subscale-specific improvement without overall change. Across interventions, improvements appeared related to both training duration and cultural adaptation.

Lewis et al reported a significant increase in empathic awareness on the ethnocultural empathy scale (p = 0.019), although total empathy scores did not change. ^{Reference Lewis, Myhra, Hartwell and Smith17} Rodríguez-González et al identified significant linear growth in the interpersonal reactivity index subscales (perspective taking and empathic concern) at 6-month follow-up. ^{Reference Rodríguez-González, Schweer-Collins, Greenman, Lafontaine, Fatás and Sandberg18} Pollio et al found that 92% of Ukrainian therapists reported professional benefits and empathy gains, supported by significant improvement in coping skills (p = 0.010). ^{Reference Pollio, Deblinger, Cooper, Garbade, Harrison and Pfeiffer20} McDonald et al found qualitative evidence of enhanced empathy and professional identity among providers serving refugees. ^{Reference McDonald, Dahlin and Bäärnhielm19} Collectively, these findings suggest that structured, culturally informed training can enhance empathy, although certainty is low due to heterogeneity and small sample sizes.

The modest effect observed by Lewis et al is consistent with prior work showing limited gains from single-session interventions. ^{Reference Lewis, Myhra, Hartwell and Smith17} Meta-analytic evidence by Teding Van Berkhout and Malouff ^{Reference Teding Van Berkhout and Malouff21} found a pooled moderate effect (Hedges’ g = 0.61); and Riess et al, ^{Reference Riess, Kelley, Bailey, Dunn and Phillips22} for example, reported a larger improvement following an 8 h empathy course. Compared with these, Lewis et al’s effect (η² = 0.041) suggests that brief, single-exposure workshops may not allow sufficient depth for sustained empathy growth. ^{Reference Lewis, Myhra, Hartwell and Smith17} Multi-session or experiential models, such as Rodríguez-González’s 4-day externship, appear more effective, probably due to repeated opportunities for reflection and interpersonal practice. ^{Reference Rodríguez-González, Schweer-Collins, Greenman, Lafontaine, Fatás and Sandberg18}

McDonald et al’s cross-cultural competence training provides further insight. ^{Reference McDonald, Dahlin and Bäärnhielm19} Although quantitative change was not detected, qualitative data revealed perceived gains in empathy and professional role awareness. This aligns with Lamothe et al, who found that most empathy interventions showed qualitative improvements even when standardised scales failed to capture change. ^{Reference Lamothe, Boujut, Zenasni and Sultan23} Such discrepancies may arise because empathy is contextually and culturally embedded; existing measures may not be sensitive to these nuances. As demonstrated in a meta-analysis by Hall et al, culturally adapted health interventions tend to produce stronger effects (g = 0.47 v. 0.15). ^{Reference Hall, Ibaraki, Huang, Marti and Stice24} McDonald et al’s findings support this view, that cultural adaptation appears to enhance provider empathy and role clarity even when numerical scales underrepresent the effect. ^{Reference McDonald, Dahlin and Bäärnhielm19}

These findings emphasise that evaluating empathy and compassion in culturally diverse contexts may require mixed-methods designs; ^{Reference Kariyawasam, Ononaiye, Irons and Kirby25–Reference Portz and Burns27} relying solely on self-report scales can underestimate meaningful attitudinal or relational growth. ^{Reference Sunahara, Rosenfield, Alvi, Wallmark, Lee and Fulford28–Reference Jiang, Wang, Mei, Zhao, Lin and Zhang30} Culturally sensitive evaluation tools are essential to capture change accurately, particularly when working across linguistic and cultural boundaries. ^{Reference Serrada-Tejeda, Sánchez-Herrera-Baeza, Rodríguez-Pérez, Máximo-Bocanegra, Martínez-Piédrola and Trugeda-Pedrajo31,Reference Sharma and Jensen32}

Pollio et al further illustrated this point. ^{Reference Pollio, Deblinger, Cooper, Garbade, Harrison and Pfeiffer20} Their trauma-focused CBT programme for Ukrainian therapists produced significant gains in coping skills and self-reported empathy, along with reductions in burnout and secondary traumatic stress, although the latter were not statistically significant. Qualitative feedback indicated enhanced collegial trust and professional confidence, markers of improved relational capacity. These findings echo prior research suggesting that compassion-based or empathy-focused interventions can strengthen well-being and professional connectedness. ^{Reference Lamothe, Boujut, Zenasni and Sultan23,Reference Deblinger, Pollio, Cooper and Steer33} The small sample and brief duration may explain the non-significant quantitative outcomes; larger studies with extended follow-up may reveal more robust effects.

Duration and intensity appear critical. Pollio et al’s 8-session course showed benefits for coping and empathy, and Rodríguez-González et al’s 4-day externship yielded the strongest results, with substantial proportions of variance in empathy growth explained (pseudo-R ² = 22–38%). ^{Reference Rodríguez-González, Schweer-Collins, Greenman, Lafontaine, Fatás and Sandberg18,Reference Pollio, Deblinger, Cooper, Garbade, Harrison and Pfeiffer20} This suggests that immersive, experiential and culturally grounded models may be most effective. The significant and sustained increases in empathy and self-compassion observed by Rodríguez-González et al mirror Jazaieri et al, who found moderate effect sizes (Cohen’s d ≈ 0.45) for compassion cultivation training among healthcare workers. ^{Reference Jazaieri, Jinpa, McGonigal, Rosenberg, Finkelstein and Simon-Thomas34} Such parallels indicate that empathy and self-compassion are mutually reinforcing; enhancing one may promote the other and buffer against burnout.

Despite these encouraging findings, kindness and compassion were notably absent as direct outcome measures. This reflects a wider literature gap: although empathy is routinely assessed, kindness and compassion are often implied but unmeasured. ^{Reference Vieten, Rubanovich, Khatib, Sprengel, Tanega and Polizzi35–Reference Sinclair, Kondejewski, Hack, Boss and MacInnis37} Future studies could integrate validated measures such as the Santa Clara Brief Compassion Scale or Compassion for Others Scale to capture these constructs explicitly. ^{Reference Plante and Mejia38–Reference Pommier, Neff and Tóth-Király40} Doing so would enable a fuller understanding of how interventions influence both emotional understanding and compassionate action.

The concept of intelligent kindness provides a useful framework for interpreting these findings. ^{Reference Ballatt and Campling7} It extends beyond empathy to emphasise the deliberate, context-sensitive application of kindness in professional interactions, transforming empathic awareness into constructive, prosocial behaviour. ^{Reference Ballatt and Campling7} Intelligent kindness involves awareness, ethical intent and responsive action aimed at reducing suffering and promoting well-being. In clinical settings it manifests through micro-affirmations, collaborative safety planning and culturally grounded communication that fosters trust and dignity. ^{Reference Ballatt and Campling7,Reference Martinez-Torres, Boorom, Nogueira Peredo, Camarata and Lense41,Reference Rowe42}

Although none of the reviewed interventions explicitly targeted intelligent kindness, several incorporated its principles implicitly. Lewis et al’s decolonising workshop invited participants to reflect on historical trauma and unconscious bias, an act of culturally intelligent awareness. ^{Reference Lewis, Myhra, Hartwell and Smith17} McDonald et al’s cross-cultural course promoted perspective-taking across refugee and provider experiences, ^{Reference McDonald, Dahlin and Bäärnhielm19} whereas Pollio et al’s programme fostered solidarity and mutual support among clinicians during wartime stress. ^{Reference Pollio, Deblinger, Cooper, Garbade, Harrison and Pfeiffer20} Rodríguez-González et al’s experiential training emphasised attunement and emotional presence, foundational to compassionate practice. ^{Reference Rodríguez-González, Schweer-Collins, Greenman, Lafontaine, Fatás and Sandberg18} These interventions collectively illustrate the practical relevance of intelligent kindness, even when unnamed.