Patients respond more positively to physicians who focus on their ideal affect

Topic and Content of Personal Narratives of Children from Three East Asian Cultures and Three English-Speaking Cultures: A Collaborative Qualitative Analysis

PURPOSE/INTRODUCTION

Narrative language skills are critical for effective social interactions and academic success. Consequently, narratives are regularly an aspect of assessment and intervention for children with communication impairments, supporting the need for information about typical development from children across cultures. Development of coherent personal narratives is associated with growth of both one's individual identity and cultural identity which are linked to psychological well-being. The topics and contents of children's personal stories can provide insight into cultural influences on what children consider important, how they interpret experiences, and their values and beliefs, which in turn contribute to their developing individual and cultural self-identity. The purpose of this study was to investigate the topics and content of personal narratives told by typically developing 10-year-old children from East Asian and Western English-speaking cultures.

METHODS

There were 20 children in each of three East Asian language groups - Mandarin, Cantonese, and Korean; and 62 children in the English-speaking groups (22 in the USA and 20 each in the Australian and New Zealand groups). In each group, half were boys and half were girls. Children responded to prompts from the Global TALES protocol to elicit personal narratives. All language samples were transcribed, translated, and coded for topic choices using qualitative content analysis in collaborative discussions by the four authors, who included an English-speaking author from the USA (C.E.W.), and three authors, who are native speakers of the three East Asian languages, Mandarin (K.-M.C.), Cantonese (A.M.-Y.W.), and Korean (J.P.L.).

RESULTS

Results on topics in stories from East Asian and Western English-speaking cultures are described in relation to literature on anthropology. English-speaking children and East Asian children in this study talked about similar topics in their personal narratives, but the frequency of these topics within their stories varied. Possible explanations for differences in story topics are discussed within a framework on cultural dimensions.

CONCLUSION

Evaluation of the topics of children's personal narratives provides insight into what is important to the children and the way they view their worlds. This information may inform clinical approaches to assessment and intervention with children with communication impairments, encouraging clinicians to go beyond analysis of language structure to consider multiple factors that influence communicative competence.

The influence of affect on HPV vaccine decision making in an HPV vaccine naïve college student population

The HPV vaccine is recommended for all adolescents starting at age 11, but coverage is low, especially in the young adult population. The CDC is prioritizing catch-up vaccination and has expanded recommendations for all young adults to age 26. College students may be ideal targets for HPV vaccine interventions as they typically have on-site clinics that offer prevention services and students are in the position to make decisions about their own healthcare. We examined the risk perceptions of 101 HPV vaccine-naïve college students, both in terms of risk cognition (beliefs about susceptibility to HPV-related cancers and genital warts) and affect (worry and fear regarding HPV-related health outcomes) as they relate to HPV vaccine intentions. Participants completed an online survey, reporting absolute and comparative risk perceptions for HPV-related cancers/genital warts, fear and worry related to getting HPV-related cancer and/or genital warts, desire for positive emotions, affective associations with the HPV vaccine, and intentions to get the HPV vaccine. More fear/worry about vaccination was directly associated with increased vaccine intentions. The perceived risk to intentions relation included an indirect effect via fear/worry. Desire for positive affect strengthened this relation. Positive affective associations with the HPV vaccine were also related to increased vaccine intentions. Given the public health impact of increasing HPV vaccine coverage for young adults, educational strategies framing the HPV vaccine positively while decreasing fear/worry related to negative health outcomes might increase interest in on-campus catch-up vaccination.

Seeing the Whole Picture? Avoided Negative Affect and Processing of Others' Suffering

Noticing someone's pain is the first step to a compassionate response. While past research suggests that the degree to which people want to avoid feeling negative ("avoided negative affect"; ANA) shapes how people respond to someone's suffering, the present research investigates whether ANA also predicts how people process others' suffering. In two studies, using complex photographs containing negative aspects (i.e., suffering), we found that the higher people's ANA, the fewer details of negative aspects they correctly recognized, and the fewer negative words they used in their image descriptions. However, when asked to process negative content, the higher people's ANA, the more negatively they rated that content. In Study 3, we report cultural differences in people's sensitivity to notice suffering in an ambiguous image. ANA mediated these cultural differences. Implications for research on compassion are discussed.

When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction

Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of competence, or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of warmth, or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.

Differential emotional abnormalities among schizotypy clusters

Schizotypy, a multidimensional personality organization that reflects liability to develop schizophrenia-spectrum disorders, has been associated with a number of emotional abnormalities. Yet, the exact nature of any emotional abnormalities in schizotypy is relatively unclear. Using an ethnically diverse nonclinical sample (N = 2637), the present study identified homogenous clusters of individuals based on positive and negative schizotypy dimensions and explored three interrelated domains of emotion traits closely tied to functional outcomes and quality of life: affective experience, emotional awareness, and meta-level emotions. Consistent with prior research, four schizotypy clusters were obtained: low ("nonschizotypic"), high positive, high negative, and mixed (high positive and high negative). Regarding emotion correlates of schizotypy clusters, the mixed cluster was found to be the most deviant on almost all emotion traits (e.g., heightened trait negative affect, diminished emotional clarity), suggesting that the effects of positive and negative schizotypy are additive. In addition, positive and negative schizotypy clusters were associated with differential abnormalities, with the negative cluster presenting a wider range of, and more severe, impairments compared to the low cluster (e.g., reduced trait positive affect and reduced attention to positive emotion). The current study highlights the heterogeneity in emotional traits among schizotypy dimensions and the importance of studying the mixed schizotypy in terms of emotional dysfunction.

Multivariate associations of ideal affect with clinical symptoms

Prior research has indicated that ideal affect (i.e., the affective states that people value and would ideally like to experience) may be relevant to mental health outcomes. Studies to date, however, have not used comprehensive multivariate models that account for covariation among facets of ideal affect and incorporate multiple clinical outcomes. In the present studies, we used structural equation modeling to examine the multivariate effects of ideal affect on symptoms of depression, anxiety, and alcohol abuse in 2 moderately large samples of undergraduates (N = 293 and N = 146). Exploratory results of Study 1 indicated that valuation of high arousal positive affective states was significantly associated with lower depression symptoms but higher anxiety and alcohol abuse symptoms and that valuation of high arousal negative states was specifically associated with greater anxiety symptoms. These results were shown to be structurally invariant across samples and ethnicities in Study 2, which also found that ideal-actual affect discrepancies were significantly associated with symptoms of depression and anxiety. These findings support and extend the hypothesis that ideal affect is implicated in clinical outcomes by highlighting the importance of jointly considering multiple facets of ideal and actual affect as they relate to a range of clinical syndromes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Moving Beyond a One-Size-Fits-All View of Positive Affect in Health Research

Although the literature that connects positive affect (PA) to health has exploded over the last 20 years, the approach to studying this topic has remained simplistic. Specifically, researchers overwhelmingly rely on the principle that all PA is healthful, all of the time. Here, we review recent studies indicating that a more nuanced approach is valuable. In particular, we demonstrate that a more thoughtful approach to factors such as arousal, culture, timing, and measurement type results in a more complex picture of when PA is helpful and when it is not. Taking these issues into account also has implications for the types of mechanisms underlying these associations, as well as how other moderators might operate. Thus, we argue that considering these gradations will allow researchers to develop successful and theoretically based health interventions, untangle mixed findings, and enable a deeper understanding of the connection between PA and health.

Asian Americans respond less favorably to excitement (vs. calm)-focused physicians compared to European Americans

OBJECTIVES

Despite being considered a "model minority," Asian Americans report worse health care encounters than do European Americans. This may be due to affective mismatches between Asian American patients and their European American physicians. We predicted that because Asian Americans value excitement (vs. calm) less than European Americans, they will respond less favorably to excitement-focused (vs. calm) physicians.

METHOD

In Study 1, 198 European American, Chinese American, and Hong Kong Chinese community adults read a medical scenario and indicated their preference for an excitement-focused versus calm-focused physician. In Study 2, 81 European American and Asian American community college students listened to recommendations made by an excitement-focused or calm-focused physician in a video, and later attempted to recall the recommendations. In Study 3, 101 European American and Asian American middle-aged and older adults had multiple online encounters with an excitement-focused or calm-focused physician and then evaluated their physicians' trustworthiness, competence, and knowledge.

RESULTS

As predicted, Hong Kong Chinese preferred excitement-focused physicians less than European Americans, with Chinese Americans falling in the middle (Study 1). Similarly, Asian Americans remembered health information delivered by an excitement-focused physician less well than did European Americans (Study 2). Finally, Asian Americans evaluated an excitement-focused physician less positively than did European Americans (Study 3).

CONCLUSIONS

These findings suggest that while physicians who promote and emphasize excitement states may be effective with European Americans, they may be less so with Asian Americans and other ethnic minorities who value different affective states. (PsycINFO Database Record

Ideal affect in daily life: implications for affective experience, health, and social behavior

Over the last decade, researchers have increasingly demonstrated that ideal affect-the affective states that people value and ideally want to feel-shapes different aspects of daily life. Here I briefly review Affect Valuation Theory (AVT), which integrates ideal affect into existing models of affect and emotion by identifying the causes and consequences of variation in ideal affect. I then describe recent research that applies AVT to the valuation of negative states as well as more complex states, examines how ideal affect shapes momentary affective experience, suggests that ideal affect has both direct and indirect effects on health, and illustrates that people's ideal affect shapes how they judge and respond to others. Finally, I discuss the implications of cultural and individual differences in ideal affect for clinical, educational, work, and leisure settings.

Valuing calm enhances enjoyment of calming (vs. exciting) amusement park rides and exercise

Do people derive more enjoyment from activities that match how they ideally want to feel (their "ideal affect")? Affect valuation theory (AVT) predicts that they do; however, no study has directly examined whether this is the case. Therefore, the authors conducted 4 studies that examined whether valuing calm and other low arousal positive states (LAP) increased enjoyment of calming (vs. exciting) activities. In Study 1, the more participants valued LAP, the more enjoyment they recalled during calming (vs. exciting) episodes from their lives. In Studies 2-3, the more participants valued LAP, the more enjoyment they experienced during calming (vs. exciting) amusement park rides, both in the United States and Hong Kong. To assess causality, in Study 4, participants were randomly assigned to either a "value LAP" or control condition and then engaged in either low or high intensity exercise. Participants in the value LAP condition who engaged in low intensity exercise reported greater enjoyment than those who engaged in high intensity exercise; these differences did not emerge in the control condition. People's trait levels of experienced LAP ("actual LAP") were not related to their enjoyment of calming (vs. exciting) activities. Together, these findings provide evidence that people derive more enjoyment from activities that match their ideal affect. The authors discuss the implications of these findings for AVT as well as interventions aimed at enhancing well-being. (PsycINFO Database Record

The grass is not as green as you think: Affect evaluation in people with internalizing disorders

BACKGROUND

Affect evaluation - how people evaluate their emotion experiences - has important implications for mental health.

METHODS

We examined how 70 adults diagnosed with Major Depressive Disorder and/or Generalized Anxiety Disorder or no psychiatric disorders (control group) believe they should feel in the moment (should affect). We repeatedly assessed participants' current affect and should affect over one week using experience sampling. To examine the psychometric properties of should affect, participants rated their level of rumination at each survey and completed trait measures of brooding and ideal affect at the lab.

RESULTS AND CONCLUSIONS

Independent of group status, participants reported that they should be feeling more positive affect and less negative affect. Even after accounting for mean affect, the clinical groups' reports were generally more extreme than were those of the control group. We documented good convergent and discriminant validity of should affect. Finally, we describe clinical implications and directions for future research.

Neural evidence for cultural differences in the valuation of positive facial expressions

European Americans value excitement more and calm less than Chinese. Within cultures, European Americans value excited and calm states similarly, whereas Chinese value calm more than excited states. To examine how these cultural differences influence people's immediate responses to excited vs calm facial expressions, we combined a facial rating task with functional magnetic resonance imaging. During scanning, European American (n = 19) and Chinese (n = 19) females viewed and rated faces that varied by expression (excited, calm), ethnicity (White, Asian) and gender (male, female). As predicted, European Americans showed greater activity in circuits associated with affect and reward (bilateral ventral striatum, left caudate) while viewing excited vs calm expressions than did Chinese. Within cultures, European Americans responded to excited vs calm expressions similarly, whereas Chinese showed greater activity in these circuits in response to calm vs excited expressions regardless of targets' ethnicity or gender. Across cultural groups, greater ventral striatal activity while viewing excited vs. calm expressions predicted greater preference for excited vs calm expressions months later. These findings provide neural evidence that people find viewing the specific positive facial expressions valued by their cultures to be rewarding and relevant.

Leaders' smiles reflect cultural differences in ideal affect

Cultures differ in the emotions they teach their members to value ("ideal affect"). We conducted 3 studies to examine whether leaders' smiles reflect these cultural differences in ideal affect. In Study 1, we compared the smiles of top-ranked American and Chinese government leaders, chief executive officers, and university presidents in their official photos. Consistent with findings that Americans value excitement and other high-arousal positive states more than Chinese, American top-ranked leaders (N = 98) showed more excited smiles than Chinese top-ranked leaders (N = 91) across occupations. In Study 2, we compared the smiles of winning versus losing political candidates and higher versus lower ranking chief executive officers and university presidents in the United States and Taiwan/China. American leaders (N = 223) showed more excited smiles than Taiwanese/Chinese leaders (N = 266), regardless of election outcome or ranking. In Study 3, we administered self-report measures of ideal affect in college student samples from 10 different nations (N = 1,267) and then 8 years later, coded the smiles that legislators from those nations showed in their official photos (N = 3,372). The more nations valued excitement and other high arousal positive states, the more their leaders showed excited smiles; similarly, the more nations valued calm and other low-arousal positive states, the more their leaders showed calm smiles. These results held after controlling for national differences in democratization, human development, and gross domestic product per capita. Together, these findings suggest that leaders' smiles reflect the affective states valued by their cultures.

Wanting to maximize the positive and minimize the negative: implications for mixed affective experience in American and Chinese contexts

Previous studies have demonstrated that European Americans have fewer mixed affective experiences (i.e., are less likely to experience the bad with the good) compared with Chinese. In this article, we argue that these cultural differences are due to "ideal affect," or how people ideally want to feel. Specifically, we predict that people from individualistic cultures want to maximize positive and minimize negative affect more than people from collectivistic cultures, and as a result, they are less likely to actually experience mixed emotions (reflected by a more negative within-person correlation between actual positive and negative affect). We find support for this prediction in 2 experience sampling studies conducted in the United States and China (Studies 1 and 2). In addition, we demonstrate that ideal affect is a distinct construct from dialectical view of the self, which has also been related to mixed affective experience (Study 3). Finally, in Study 4, we demonstrate that experimentally manipulating the desire to maximize the positive and minimize the negative alters participants' actual experience of mixed emotions during a pleasant (but not unpleasant or combined pleasant and unpleasant) TV clip in the United States and Hong Kong. Together, these findings suggest that across cultures, how people want to feel shapes how they actually feel, particularly people's experiences of mixed affect.