Is there a way we all grieve? Claudia Hammond interviews Ruth Davies Konigsberg All in the Mind, Radio 4, 14.06.11

Introduction

Is there a way we all grieve? The five stages of grief - denial, anger, bargaining, depression and acceptance were proposed more than forty years ago by the psychiatrist Elizabeth Kubler-Ross and are now taught across the world. But with little evidence that these stages are what people really experience when they are bereaved - how did they become so popular and what research has been done into the process of grief?

Text of interview

Claudia Hammond (CH): When a person’s bereaved we’re told they will go through a grief process that consists of five stages: Denial, Anger, Bargaining, Depression and then finally Acceptance. These stages were proposed more than 40 years ago by psychiatrist Elizabeth Kubler-Ross. The stages have become so well-known that they’re now taught across the world and have even made it into popular culture with appearances in the Simpsons and The Office. Damien Hurst even did a series of paintings called DABDA named after the acronym for the stages. But despite 40 years of fame, there’s surprisingly little evidence that these are the experiences people really have when they’re grieving. Ruth Davies Konigsberg has looked in depth at this subject and is the author of The Truth About Grief. I asked her what the concept behind the stages is.  

Ruth Davies Konigsberg (RDK):  The sort of overarching idea behind the stages, of course, is that you need to go through them in order to come out the other side: as painful as it might be it’s beneficial in the end to have that whole experience. And you need to take your time to go through them. They were always conceived of as being sequential, so that one always has to follow the other – you can’t just skip them and go straight to depression for example or acceptance; they are all necessary steps along the, quote/ unquote, ‘journey’ of grief.

CH: And how did the idea of these stages of grief come about? 

RDK: Well, Elizabeth Kubler-Ross popularised the notion of the five stages, although they’d been brewing in the social sciences a little bit. What Kubler-Ross did, she applied them to one’s own death and that was how they were originally conceived in her own book, On Death and Dying, that was published in 1969. She was very interested in ‘end of life issues’ and to her credit she brought a lot of attention to these issues and she was doing revolutionary interviews with dying patients at the University of Chicago which she then turned into her theory about how one goes through these stages when one is facing one’s own death.

CH: What evidence is there to support the idea that you do go from denial to anger to bargaining to depression and finally get to this acceptance stage?

RDK: Very little. In fact what the evidence shows, and there’s some very interesting studies being done where people who were bereaved were actually interviewed on a daily basis, and the fluctuations are very vast on a day to day basis. And they are probably vast even hour to hour. So the experiences are very up and down. You may experience some of the emotions that are described in some of those stages but they certainly don’t go in any kind of progression, and moreover you don’t have to experience them in order to grieve successfully.

CH: So I suppose with something like anger, you might feel angry if you blame someone else for the death, but if an older relative dies at the end of their life, anger might not be something you feel.

RDK: Absolutely. You might feel angry, you might feel depression, you might feel a whole bunch of different things – the checklist of grief symptoms is very long. And moreover you might feel angry one minute and have happy memories the next. So it’s very up and down and it’s much less predictable than the Stages might have you believe.

CH: So why do you think this idea has taken hold and has persisted for so many decades if it doesn’t actually fit in with what people’s real experiences are?

RDK: It’s very sort of appealing in a way – it’s very neat and tidy and again it helps practitioners because it gives them a sense of something they can tell their clients or tell people who are bereaved. And the other thing is that there’s always confirmation bias: once those stages were out there, people would remember, of course, or take into account when they are experiencing one of the so-called stages, but disregard when they’re not. So it shows the power of theories and how once a theory gets popularised they become self-perpetuating.

CH: Does it matter if it’s not quite what happens if it still gives people some idea of the huge, overwhelming range of emotions that people can feel?

RDK: Well, it matters only for those who don’t experience it. It’s very reassuring for people who do maybe experience some of the emotions, but it’s also very stigmatising for people who don’t. So that’s where it becomes harmful, I think: if it doesn’t line up with what you’re actually experiencing you might feel you are grieving incorrectly or there’s something wrong with you or you’re in denial and you need help. So that’s where it becomes problematic.

CH: So what research has been done into how people do actually grieve? What can we tell people for how they do it – is there an average length for grieving and then moving on?

RDK: One thing you always hear is that everyone’s grief is unique and there is no timeline for grief. But there actually have been quantitative studies where some patterns have emerged. George Bonanno up at Columbia University has been doing some work looking at widows and widowers and what he found was that for people whose spouses died of natural causes that for the most part, the majority of people, their most intense symptoms seemed to abate by about six months. And that it’s really a small minority, probably about 10 to 15 percent of people, who have really prolonged difficulties. And that’s probably past a year where, if you’re still having a hard time and really unable to function, where you still haven’t got back on your feet. Those people are now what physicians consider to be suffering from ‘complicated grief’.

CH: That sounds like quite a low percentage who actually have real, long-lasting difficulty with it. You talk in your book about the extent of grief counselling that’s on offer in the United States. Would you say that we are pathologising grief, when for many people it’s just a very normal process?

RDK: Yes, I think there is that tendency. The idea that everyone should see a counsellor certainly I think is an overreach. What the research has shown is that the small percentage who are having the hardest time are obviously the ones who really can be helped by bereavement interventions. So for everybody else, grief more or less gets better with time on its own. When you compare people who had interventions, whether it’s support groups or individual counselling, with the group of people who didn’t have interventions, both get better in the same amount of time. So what that means is that counselling for the majority of people doesn’t measurably benefit the recipients.

And I think another thing that the Stages did was that they actually lengthened our expectations of grief, of how long it’s supposed to last. And so now certainly I think, although there are double standards in this in terms of gender, one thing that the Stages have done is lengthened our expectations. Grief can be very hard on some people and on others it isn’t so hard. It’s definitely something that we seem to have a natural resilience to be able to handle.

The other thing is that when I say that symptoms of grief alleviate by a certain time or what have you, I certainly don’t mean that those bereaved people still don’t miss their lost loved one – it doesn’t mean you’re a cold person if you’re back on your feet and able to smile or laugh. People still think and feel about their lost loved one for years and years and years. But that’s not grief. Loss is for ever, but thankfully, grief is not.

CH: Ruth Davies Konigsberg.      

Two Big Myths about Grief People are not always devastated by a death and should be allowed to recover in their way By Hal Arkowitz and Scott O. Lilienfeld | January 5, 2012

Virtually all of us experience the loss of a loved one at some point in our life. So it is surprising that the serious study of grief is not much more than 30 years old. Yet in that time, we have made significant discoveries that have deepened our understanding of this phenomenon—and challenged widely held assumptions.
In this column, we confront two common misconceptions about grief. The first is that the bereaved inevitably experience intense symptoms of distress and depression. The second is that unless those who have experienced the death of a loved one “work through” their feelings about the loss, they will surely experience delayed grief reactions, in which strong emotions may be triggered by events unrelated to the loss, even long after it occurred. As we will show, neither belief holds up well to scientific scrutiny.
Bouncing Back
Most people believe that distress and depression almost always follow the death of someone close, according to psychologists Camille B. Wortman of Stony Brook University and Kathrin Boerner of Mount Sinai School of Medicine. Symptoms of distress include yearning for the deceased, feeling that life has lost its meaning, having anxiety about the future and experiencing shock at the loss. Depression involves feeling sad and self-critical, having suicidal thoughts, lacking energy, and undergoing disturbed appetite and sleep.
To examine this belief, several groups of investigators tracked bereaved people, mostly widows and widowers, for up to five years. Results revealed that between 26 and 65 percent had no significant symptoms in the initial years after their loss; only 9 to 41 percent did. (The variability results partly from differences in how the symptoms were measured.) And the depression of some may be chronic rather than a reaction to the death.
Psychologist George A. Bonanno of Columbia University and his colleagues examined this possibility and other questions in a prospective study published in 2002. They followed about 1,500 elderly married individuals over several years. During that time 205 subjects lost a spouse, after which the investigators continued to track them for 18 months. Surprisingly, about half of the bereaved spouses experienced no significant depression either before or after the loss. Nor did they display serious distress, although some did feel sad for a short time. Eight percent of the participants were depressed before losing his or her partner—and stayed that way. For about 10 percent—individuals who had reported being very unhappy in their marriage—the death actually brought relief from preexisting depression.
The spouse’s death did precipitate depression in 27 percent. Of these individuals, a substantial proportion (about 11 percent of the total) started improving after six months and became symptom-free within 18 months. The rest of that subgroup did not get better—but even so, more than 70 percent of the study’s participants neither developed depression nor became more depressed as a result of their spouse’s demise. (The small number of remaining subjects fit various other patterns.) These results tell a clear story, at least where an elderly partner is concerned: most people are resilient and do not become seriously depressed or distressed when someone close to them dies.
Working It Out
In her 1980 book The Courage to Grieve, social worker Judy Tatelbaum wrote that after the death of a loved one “we must thoroughly experience all the feelings evoked by our loss,” and if we don’t “problems and symptoms of unsuccessful grief” will occur. The idea that people need to work through grief originated with Sigmund Freud and is still pervasive. It usually includes expressing feelings about the loss, reviewing memories about the deceased and finding meaning in the loss. According to this view, those who do not explore their emotions will suffer the consequences later.
Yet grief work may be unnecessary for the large proportion of people who do not become significantly distraught after a loss. And when researchers have tested the common grief-work techniques of writing or talking about the death, some have found small benefits for the procedures, but most have not. In addition, the jury is still out on grief counseling, in which professionals or peers try to facilitate the working-through process. Results from two quantitative reviews of the efficacy of such therapy found no significant gains from it, and a third found just a modest positive effect. One caveat: the benefits might be slightly greater than these studies indicate because most of the subjects were recruited by the researchers, and these individuals may be less in need of counseling than those who seek help.
Finally, two teams of researchers followed bereaved persons, including spouses, adult children and parents, for up to five years after their loss and found little or no evidence of a delayed grief reaction. When such reactions have been found, they occur only in a very small percentage of the bereaved. Thus, the overall risk of reexperiencing a flood of negative emotions appears to be quite minimal.
Given that most people who have experienced the death of a loved one show few signs of distress or depression, many bereaved individuals may need no particular advice or help. The few who experience intense and lasting despair may benefit from interventions, although traditional grief counseling may not be the best choice. Instead people might consider seeking empirically supported psychotherapies for depression [see “The Best Medicine?” by Hal Arkowitz and Scott O. Lilienfeld; Scientific American Mind, October/November 2007].
That said, our conclusions are based largely on studies of Caucasian American widows and widowers. We cannot say for sure that they extend to people of all ages, ethnicities and genders. In addition, reactions to a loss may depend on a person’s relationship to the deceased—be it a parent, sibling or child—as well as whether the death was sudden, violent or drawn out. The consequences of these varying perspectives and circumstances have yet to be carefully explored.
Nevertheless, we can confidently say that just as people live their lives in vastly different ways, they cope with the death of others in disparate ways, too. Despite what some pop-psychology gurus tell us, grief is not a one-size-fits-all experience

Diagnosis of Borderline Personality Disorder Is Often Flawed

True sufferers are often troubled—and yet time and treatment can often improve their lives

By Scott O. Lilienfeld and Hal Arkowitz  | January 4, 2012

This past June renowned clinical psychologist Marsha M. Linehan of the University of Washington made a striking admission. Known for her pioneering work on borderline personality disorder (BPD), a severe and intractable psychiatric condition, 68-year-old Linehan announced that as an adolescent, she had been hospitalized for BPD. Suicidal and self-destructive, the teenage Linehan had slashed her limbs repeatedly with knives and other sharp objects and banged her head violently against the hospital walls. The hospital’s discharge summary in 1963 described her as “one of the most disturbed patients in the hospital.” Yet despite a second hospitalization, Linehan eventually improved and earned a Ph.D. from Chicago’s Loyola University in 1971.
Many psychologists and psychiatrists were taken aback by Linehan’s courageous admission, which received high-profile coverage in the New York Times. Part of their surprise almost surely stemmed from an uncomfortable truth: people with BPD are often regarded as hopeless individuals, destined to a life of emotional misery. They are also frequently viewed as so disturbed that they cannot possibly achieve success in everyday life. As a consequence, highly accomplished individuals such as Linehan do not fit the stereotypical mold of a former BPD sufferer. But as Linehan’s case suggests, much of the intense pessimism and stigma surrounding this disorder are unjustified. Indeed, few psychological disorders are more mischaracterized or misunderstood.
Fuzzy Borders
New York psychoanalyst Adolf Stern coined the term “borderline” in 1938, believing this condition to lie on the murky “border” between neurosis and psychosis. The term was a misnomer because BPD bears little relation to most psychotic disorders. The name may have perpetuated a widespread misimpression that the disorder applies to people on the edge of psychosis, who have at best a tenuous grasp of reality. Not surprisingly, the popular conception of BPD, shaped by such films as the 1987 movie Fatal Attraction (featuring actress Glenn Close as a woman with the condition), is that of individuals who often act in bizarre and violent ways.
An error committed by some clinicians is presuming that patients who do not respond well to treatment or who are resistant to therapists’ suggestions are frequently “borderlines.” Some mental health workers even seem to habitually attach the label “borderline” to virtually any client who is extremely difficult to deal with. As Harvard University psychiatrist George Valliant observed in a 1992 article, the BPD diagnosis often reflects clinicians’ frustrated responses to challenging patients.
In reality, BPD is meant to apply to a specific subgroup of individuals who are emotionally and interpersonally unstable. Indeed, Linehan has argued that a better name for the condition is “emotion dysregulation disorder.” Much of the everyday life of individuals with BPD is an emotional roller coaster. Their moods often careen wildly from normal to sad or hostile at the slightest provocation. As Linehan pointed out in a 2009 interview with Time magazine, “Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin.” Their perceptions of other people are inconsistent, and they often vacillate between worshipping their romantic partners one day and detesting them the next. Their identity is similarly unstable; patients may lack a clear sense of who they are. And their impulse control is poor; they are prone to explosive displays of anger toward others—and themselves. [For more on the symptoms, causes and treatment of BPD, see “When Passion Is the Enemy,” by Molly Knight Raskin; Scientific American Mind, July/August 2010.]
Further fuelling the stigma attached to BPD is the assumption that nearly all individuals who engage in self-cutting, such as wrist slashing, are so-called borderlines. In fact, in a 2006 study of 89 hospitalized adolescents who engaged in cutting and related forms of nonsuicidal self-injury, Harvard psychologist Matthew Nock and his colleagues found that 48 percent did not meet criteria for BPD. The lion’s share of these individuals exhibited other personality disorders, such as avoidant personality disorder, which is associated with a pronounced fear of rejection.
Once Borderline Always Borderline?
Two allied myths about BPD are that patients virtually never improve over time and are essentially untreatable. Yet a number of recent studies indicate that many patients with BPD shed their diagnoses after several years. In a 2006 investigation, for example, psychologists C. Emily Durbin and Daniel N. Klein, both then at Stony Brook University, found that although 16 percent of 142 psychiatrically disturbed adults initially met criteria for BPD, only 7 percent did after a decade. Moreover, the average levels of BPD symptoms in the sample declined significantly over time. Work by psychologist Timothy J. Trull and his colleagues at the University of Missouri–Columbia similarly suggests that many young adults who display some features of BPD do not exhibit these features after only a two-year period, indicating that early signs of BPD often abate.
BPD is not easy to treat. Yet Linehan has shown that an intervention she calls “dialectical behavior therapy” (DBT) is modestly helpful to many sufferers of the condition. DBT encourages clients to accept their painful emotions while acknowledging that they are unhealthy and need help. It teaches patients specific coping skills, such as mindfulness (observing their own thoughts and feelings nonjudgmentally), tolerating distress and mastering negative emotions. Controlled studies, reviewed by Duke University psychologist Thomas R. Lynch and his colleagues in 2007, indicate that DBT somewhat reduces the suicidal and self-destructive behaviors of patients. Lynch and his collaborators also found that DBT may lessen feelings of hopelessness and other symptoms of depression. Still, DBT is not a panacea, and no clear evidence exists that DBT can stabilize patients’ identity or relationships. Preliminary but promising data suggest that certain medications, including such mood stabilizers as Valproate, can alleviate the interpersonal and emotional volatility that characterize BPD, according to a 2010 review by psychiatrist Klaus Lieb of University Medical Center in Mainz, Germany, and his colleagues.
A Continuing Challenge
Not all BPD patients improve on their own or with treatment, and even those who do typically continue to battle the demons of emotional and interpersonal volatility. Nevertheless, the extreme negative views of this condition are undeserved, as is the mislabeling of a wide swath of the psychiatric population as borderline. It is also undeniable that many clinicians must become more judicious in their use of the BPD label and avoid attaching it to virtually any patient who is oppositional or unresponsive to treatment.
Fortunately, there is room for cautious optimism. As psychiatrist Len Sperry of Barry University noted in a 2003 review, BPD is the most researched of all personality disorders, a fact that remains true today. The fruits of that work promise to yield an improved understanding of BPD, which may reduce the stigma surrounding this widely misunderstood diagnosis. If so, perhaps the day will soon come when successful people who once struggled with BPD, such as Marsha Linehan, are no longer perceived as exceptions that prove the rule.

A Silver Lining in Borderline Personality Disorder Bret Stetka, MD; Christopher J. Hopwood, PhD

Medscape
Editor's Note:
At the 2012 annual meeting of the American Psychiatry Association, held in Philadelphia, Pennsylvania, Medscape spoke with Christopher J. Hopwood, PhD, Assistant Professor in the Department of Psychology at Michigan State University, on new research that suggests a silver lining for patients with borderline personality disorder (BPD).
Medscape: Can you give us a brief summary of the work on BPD that you presented today?
Dr. Hopwood: A interesting finding that has emerged recently is the idea that personality disorders are less stable than previously thought; people's symptoms actually decline eventually, and they get better, which is really good news.
I presented on the stability of underlying personality traits among people with BPD compared with people with other personality disorders. It's interesting from a scientific perspective, because the issue of normal trait stability has been a long-standing debate. One of the findings has been that personality traits are generally stable, meaning they're relatively consistent over time in adulthood. But new findings show that people with clinical conditions tend to have less stable personality traits than people without such conditions.
Because BPD is defined in part by such traits as instability of emotions, interpersonal behavior, and self-esteem, a hypothesis is that instability in the underlying personality system might be implicated as an etiologic factor in BPD. And in fact, we know that normal trait instability over time has heritable components. So it might be that some people have a propensity to have less stable personalities and that people who are extreme in this propensity maybe end up demonstrating symptoms that we describe as BPD. That is, the characteristic instability we see in BPD may be a consequence of instability in the underlying normative trait system.
Medscape: Meaning that everyone has personality trait variability, but that in some people this variability is more extreme, pushing them over the edge into a pathology? But also that this instability isn't consistent, or stable, throughout one's life?
Dr. Hopwood: Yes. What we know from cross-sectional research is that people with BPD are more neurotic, but our research shows that these people also change more in neuroticism over time. Neuroticism is a trait involving negative emotions, such as anger, sadness, and anxiety. So those with BPD were more neurotic at baseline than the other sample, but their neuroticism also declined much more rapidly. This suggests that the average level of neuroticism might be an important factor when considering whether a person has BPD pathology, but also that variability in this trait over time might be a relevant and independent factor.
Medscape: What other traits are important, particularly in terms of stability, when assessing BPD?
Dr. Hopwood: It's interesting, because there are different kinds of stability. We looked at average changes over time, or absolute stability, but there is also differential stability -- the rank ordering of people over time. For example, when considering 2 people, person A may be more neurotic than person B at baseline, but at follow-up person B may be more neurotic than person A. Whereas absolute stability is evaluated by comparing group means over time, differential stability is assessed by computing retest correlations on a trait over time.
There is also individual-level stability, which refers to variability around a mean change. So our study showed that individuals with BPD change, on average, more than others, but different people within those groups may change more rapidly than others. The amount of variability within a group in change over time on a trait is referred to as individual level-stability.
Each of these kinds of stability are independent of one another and may indicate different psychological processes. It turns out that different traits have different stability effects when patients with BPD are compared with other groups, depending on which kind of stability you're looking at. For example, across 2 longitudinal samples, conscientiousness changes more in terms of rank order and individual stability for patients with BPD than for those with other personality disorders. But it's not all clear yet, and we're still working on this.
Medscape: You looked at stability in BPD over 16 years. What does the typical disease course look like in BPD? What are the chances of remission?
Dr. Hopwood: Mary Zanarini^[1] just published on this in The American Journal of Psychiatry. In this paper she builds on previous findings from her McLean Study of Adult Development, as well as other studies, such as the Collaborative Longitudinal Personality Disorders Study, showing that BPD symptoms decline more rapidly than was once thought. She also showed, however, that some patients have recurrences despite an initial remission, and that functioning does not always improve despite symptom remission.
So this is a mixed picture. On the one hand, when you identify individuals with BPD at their worst, I think we can be optimistic that they will improve, particularly with treatment. On the other hand, it is a pernicious disease that is highly disruptive to individuals' lives, and we still have a lot to learn about how to best help individuals with BPD.
In terms of clinical course, generally speaking BPD symptoms are most severe during adolescence, and they tend to decline over time. This tracks very nicely with the course of normal personality traits: Adolescence is typically a time of high neuroticism, low agreeableness, and low conscientiousness, but this tends to change and improve over time.
BPD remains one of the most severe conditions in psychiatric classification. However, many psychosocial treatments for BPD have proven effective in randomized controlled trials in the past couple of decades, including dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy, and cognitive therapy. Although we still have a long way to go to better understand how to benefit individuals with BPD, recent findings on course and remission from longitudinal research, coupled with the development of effective treatments, permits more optimism than ever about the ability of clinicians to treat individuals with this difficult condition.

References

1. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2012;169:476-483. Abstract

Overuse of antidepressants is not just a problem for us

Kate Ravilious

for National Geographic News

Published July 16, 2010

There's no happy ending for shrimp exposed to the mood-booster Prozac, according to a new study.
Remnants of antidepressant drugs flushed into waterways worldwide are altering shrimp behavior and making them easier prey, experts say.
(See "Cocaine, Spices, Hormones Found in Drinking Water.")
To mimic conditions in the wild, scientists exposed the estuary-dwelling shrimp Echinogammarus marinus to the antidepressant fluoxetine at levels detected in average sewage-treatment waste. Fluoxetine is the key ingredient in the drugs Prozac and Sarafem.
Shrimp normally gravitate toward safe, dark corners. But when exposed to fluoxetine, the animals were five times more likely to swim toward a bright region of water, the team discovered.
"This behavior makes them much more likely to be eaten by a predator, such as a fish or bird," said study co-author Alex Ford, a biologist at U.K.'s University of Portsmouth.
The fluoxetine likely makes shrimp's nerves more sensitive to serotonin, a brain chemical known to alter moods and sleep patterns, according to the study, recently published in the journal Aquatic Toxicology.
Prozac Rise May Harm Other Animals
Antidepressant use is rising rapidly—more than 10 percent of U.S. citizens, or about 27 million people, used the drugs in 2005, according to a 2009 paper in the journal Archives of General Psychiatry.
(Related: "Is Salt Nature's Antidepressant?")
It's so widespread that animals other than shrimp likely suffer from these high doses of fluoxetine, the authors noted. (Get the facts on freshwater threats.)
"We focused on shrimp because they are common and important in the food chain, but serotonin is also linked to behavioral changes in other species, including fish," Ford said.
(Read about chemicals changing male fish to female in a U.S. river.)
Ford believes that many other common prescription drugs—such as antiinflammatory drugs and painkillers—could also be causing problems for aquatic life.
But there are ways of protecting aquatic creatures from the drugs we take, Ford noted.
For instance, more public awareness about responsible drug disposal and better technology for breaking down pharmaceuticals at sewage works, among other solutions, could help to solve the problem, he said.

Slow Ride to Turin

Please take a look at this website of Maddy Corbin's - http://www.slowridetoturin.co.uk/index.html . Her daughter, Philippa, sadly took her own life at the age of 27 after becoming profoundly depressed.
Maddy's feeling is that Philippa might still be here if there was better treatment for the illness more widely available. The ride she and her team are doing is to raise money for two charities, the HGF being one, and the other is The Charlie Waller Memorial Trust ( http://www.cwmt.org.uk/ ) that is concerned with raising awareness about depression and provides training and information.

http://www.slowridetoturin.co.uk/index.html

http://www.cwmt.org.uk/

Rapport goes further than we think

Dogs copy their owners' yawns

Dogs are compelled to yawn if they hear their owners do the same, according to a new study.

Researchers claimed that dogs responded to an audio cue such as a yawn even if they didn't see the action taking place.
The study found this was particularly noticeable when the dogs were listening to the yawns of people they knew.
Scientists suggested the findings, presented at the National Ethology Congress in Lisbon, showed canines had empathy to human behaviours.
"These results suggest that dogs have the capacity to empathise with humans," said lead author Karine Silva, from the University of Porto, Portugal.
For their study, researchers selected 29 dogs that had lived with their owners for at least six months.
They recorded the owners yawning before playing it back to the pets, along with recordings of the yawn of a stranger.
The study said nearly half of all dogs yawned when they heard a recording of a human being making a yawning noise
But the results also found the dogs were five times more likely to yawn when they heard their owners' voices played back.