@mastersthesis{bal2025literary,
  author = {Bal, Onur},
  title = {Literary Work Readership and Its Relationship with Mentalisation and Empathy},
  school = {Yeditepe University},
  year = {2025},
  type = {Master's thesis},
  url = {https://onurbal.com/en/academics/thesis/}
}

5.3. Clinical Implications

A growing body of experimental and clinical research supports the therapeutic potential of literary fiction. Randomised controlled trials have demonstrated that brief exposure to literary texts, compared to popular or non-fiction material, can improve performance on theory of mind and emotion attribution tasks (Kidd & Castano, 2013; Pino & Mazza, 2016). These findings are often attributed to mechanisms such as narrative transportation and character identification, which are thought to engage readers in the simulation of social experiences. Neuroimaging studies further support this account, showing activation of the default mode network (closely associated with mentalisation and autobiographical reasoning) during both literary reading and social cognition tasks (Mar, 2011; Tamir et al., 2016).

Interventions such as the United Kingdom’s “Get into Reading” programme have reported improvements in mood and interpersonal connectedness among participants with depressive symptoms, attributing these effects to facilitated group reflection and identification with complex characters (Dowrick et al., 2012). In autism-spectrum populations, guided literary reading has been shown to foster mutual understanding and shared emotional vocabulary across the so-called “double empathy” problem (Chapple et al., 2021), particularly when combined with reflective writing or therapist-led discussion.

The present study contributes to this literature by highlighting the role of existential concern in moderating the effects of literary exposure on empathy. While literary exposure alone predicted higher cognitive and affective empathy, individuals reporting greater existential concern appeared especially likely to benefit, suggesting that reflective engagement with life’s ultimate concerns may enhance the reader’s openness to fictional others. This finding situates the empathic impact of fiction within an existential framework, echoing studies showing that exposure to existentially themed novels, such as those by Dostoevsky, Camus, or Kafka, can elicit meaning-making and increase a feeling of purpose in life (Landau et al., 2011).

Although literary exposure was not associated with mentalisation in the present sample, prior studies suggest that richly contextualised fiction can nevertheless offer clinical value for populations with mentalising difficulties. In Mentalisation-Based Therapy (MBT), for instance, literary narratives may function as a regulated space in which clients can explore complex interpersonal motives at a safe distance. For individuals with borderline or narcissistic traits (groups often characterised by dysregulated affect and impaired reflective functioning) curated fiction, when accompanied by therapeutic guidance or structured journalling, may support the reactivation and consolidation of mentalising capacities (Bateman & Fonagy, 2016). In such contexts, the emphasis lies not on the volume of reading but on the reader’s active engagement with the narrative’s psychological depth.

Taken together, the findings of the present study suggest that literary fiction may be a valuable tool for enhancing empathy and facilitating existential reflection, particularly when embedded within therapeutic frameworks that prioritise meaning-making and self-other understanding.