Jinni A. Harrigan

Nonverbal behavior in clinician—patient interaction

Abstract Empirical studies on nonverbal communication in clinician—patient interaction are reviewed for both the psychotherapeutic and medical settings. Nonverbal behavior is considered both as the consequence of antecedent variables, such as individual or relationship characteristics, and as a predictor of clinical effectiveness and patient outcomes. The concept of rapport is considered in relation to nonverbal behavior, both theoretically and empirically. Also, the relevance of a patients nonverbal behavior to the diagnostic goals of the clinical visit is demonstrated by research on nonverbal cues to psychopathology, Type A/B personality, and pain. Although the topic of nonverbal behavior and clinician—patient interaction has had a promising start, much research is still needed, especially that which experimentally manipulates either antecedent variables or nonverbal behavior itself to demonstrate cause and effect relations.

Rapport expressed through nonverbal behavior

Family Medicine residents were videotaped in interviews with a new and a return-visit patient. Two coders recorded nonverbal behavior performed by the residents for two, one-minute segments of each interview. Categories of movement included: proxemic behaviors of distance, orientation, and trunk lean, and head, hand/arm, and leg/foot movement, facial expression, and direction of gaze.Each of the 36 video segments were rated by a group of psychiatric nurses using bipolar adjective scales assessing dimensions of rapport. Significant differences in nonverbal behavior were found between high and low rapport doctors. Physicians were rated more positively when they sat directly facing the patient, with uncrossed legs, and arms in symmetrical, side-by-side positions. High rapport doctors also engaged in moderate, but less extensive eye contact, with the patient than low rapport doctors. Discussion focuses on the impact of nonverbal behavior on physician-patient communication and the establishment of rapport.

The effects of task order on children's identification of facial expressions

Children 3, 6, 9, and 12 years of age were assessed on their ability to recognize and identify facial expressions of emotion. In an emotion recognition (ER) task, children were presented with three facial photographs and were asked to select the photo representing a particular emotion (e.g., happiness, disgust, sadness). Another task, emotion labeling (EL), required that the child name the emotional state expressed in a facial photograph. An age trend was found for both tasks: Accuracy in judging emotional states increased with age. Results showed that scores on the ER task were significantly better than scores on the EL task, suggesting that recognition of an emotional state was less difficult than verbally identifying an emotional state. The order in which the two tasks were given significantly affected results on the EL task: When the ER task preceded the EL task, scores on EL were higher than when EL was given first. Accuracy in judging the individual emotion categories also varied with the order of tasks.

Disclosure and anxiety : a test of the fever model

According to the fever model of Disclosure, the relationship of Disclosure (utterances that reveal subjective information) to psychological distress is analogous to the relationship of fever to physical infection: Both are indicators of some underlying disturbance and part of a restorative process. High and moderate trait anxious university students (but not the low trait anxious students) used higher percentages of Disclosure when speaking about an anxiety-arousing topic than when speaking about a happy topic. With topic order counterbalanced, students tended to use more Disclosure during their 1st presentation than during their 2nd. These results support the fever models suggestion that people tend to Disclose when they are distressed.

How do you look when feeling anxious? facial displays of anxiety

Abstract Although anxiety is a frequent and disabling emotional state, the display of this affect through facial actions has not been previously studied. Participants were videotaped while describing an anxious past event, and answering stressful and nonstressful questions regarding reactions to the anxiety-producing experience. High and low self-rated anxious segments were coded using the Facial Action Coding System (FACS). Results showed that more facial movements involving elements of the fear expression and more eye blinks were displayed during high vs low anxious segments. There was also an increase in total facial movement during high vs low anxiety. Nonenjoyment smiles were exhibited more often than enjoyment smiles, and females smiled less than males as anxiety increased. Facial actions indicative of other affect states (anger, sadness) did not distinguish anxiety level. Level of anxiety could be differentiated on the basis of specific facial movements related to fear and arousal.

Detecting State and Trait Anxiety from Auditory and Visual Cues: A Meta-Analysis

Observers’ ability to detect state anxiety and trait anxiety in others was evaluated in a meta-analysis that also included a critical moderator variable, communication channel. The overall effect size (r) for accuracy was. 39 for the 46 state anxiety studies and. 26 for the 34 trait anxiety studies. However, the effect of communication channel was very substantial in magnitude and highly significant; it also interacted with the type of anxiety. State anxiety was correctly identified more often from audio-only stimuli (M r =. 49) compared with video-only cues (r =. 24), whereas the opposite was true for trait anxiety, where video-only cues resulted in greater accuracy (r =. 31) compared with audioonly stimuli (r =. 05). Results indicated that the moment-to-moment change in emotion (state anxiety) may be better communicated with vocal/verbal stimuli, whereas more stable features of personality (trait anxiety) may be more apparent from body and facial cues.

Self-touching as an indicator of underlying affect and language processes

In this study of 28 physicians and their patients during the medical interview, information is presented on a class of nonverbal behavior, self-touching, thought to represent states of negative affect. A more recent perspective suggests that self-touching is associated with cognitive processing. The results of the present study focused on differences in types of self-touching by patients and physicians, semantic content of utterances when self-touching was displayed, and temporal location of self-touching within the speech stream. These are considered with respect to affective and psycholinguistic theories of self-touching. The results lend support to the notion that self-touching is exhibited in relation to information processing and production, in addition to negative affect.

Nonverbal expressions of anxiety in physician-patient interactions.

NONVERBAL expressions of anxiety were analyzed during patient presentation of conflicted emotional topics (i.e., hidden agendas) while consulting with family medicine practitioners. It was hypothesized that underlying anxiety would be revealed in higher frequencies of specific types of nonverbal behavior. As predicted, hand-to-body self-touching occurred significantly more often during presentation of anxiety-producing topics, while frequencies of speech-illustrative gestures did not differ for type of agenda presented. Applications for these findings are discussed with reference to medical and psychotherapy encounters.

LISTENERS' BODY MOVEMENTS AND SPEAKING TURNS

In conversation, speaking turns are exchanged rapidly and without explicit decisions about turn allocation. This suggests that participants cue each other in the process of switching speaker-listener roles. The verbal and nonverbal behaviors of five interactants engaged in conversation were analyzed in detail in relation to turn-taking. A significant number of speaking turns, compared to feedback responses, were prefaced by nonverbal behavior. The distinction between speaking turns and feedback responses was also reflected in the types of body movement preceding them; hand gestures occurred more often before speaking turns, and emblematic acts were associated with feedback. Differences in head/gaze direction were noted between successful interruptions and unsuccessful interruptions. Results were discussed with respect to functions of body movements in speech.

Children and Young Adults' Recognition of Anxiety

Previous research has shown that decoders (judges) accurately identified state anxiety in peers when provided with brief, single channel (audio-only, video-only) stimuli, and appropriately differentiated trait anxiety. Using a similar approach in the present study with decoders and encoders from three distinct age groups, we discovered that the ability to detect state anxiety transcended age. Children and young adults showed an ability to identify level of state anxiety in young adult and elder encoders. Young adults differentiated levels of state and trait anxiety in young adult and elder encoders. Discussion is focused on the adaptive and practical value of cross-generational identification of state anxiety and trait anxiety, and the difficulty of inferring personality traits in individuals from different peer groups.