A Lens Model Approach to the Communication of Pain

"Saving us to Death": Ideology and Communicative (Dis)enfranchisement in Misapplications of the 2016 CDC Opioid Prescribing Guidelines

Guided by the theory of communicative (dis)enfranchisement (TCD), this study interrogates how interactions in which chronic pain patients are force tapered from their prescribed opioids are constrained and afforded by the hegemonic ideologies. To interrogate the harms caused for chronic pain patients by ideological policies enacted by the Centers for Disease Control and Prevention and assess what communicative mechanisms reify and resist such ideologies, this research analyzes 238 posts authored by chronic pain patient Reddit users. Reflexive thematic analysis illuminated a hegemonic ideology of opiophobia, (im)material ramifications of (a) discrimination by doctors, and (b) political and legal interference; mechanisms of reification: (a) positioning suicide as a rational option, (b) advocating for the use of illicit substances, and (c) stopping opioids voluntarily; and mechanisms of resistance: (a) counter-organizing and (b) counter-generating knowledge. We offer theoretical implications for the TCD and practical implications for patients, providers, patient advocacy organizations, and policymakers.

Facial representations of complex affective states combining pain and a negative emotion

Pain is rarely communicated alone, as it is often accompanied by emotions such as anger or sadness. Communicating these affective states involves shared representations. However, how an individual conceptually represents these combined states must first be tested. The objective of this study was to measure the interaction between pain and negative emotions on two types of facial representations of these states, namely visual (i.e., interactive virtual agents; VAs) and sensorimotor (i.e., one's production of facial configurations). Twenty-eight participants (15 women) read short written scenarios involving only pain or a combined experience of pain and a negative emotion (anger, disgust, fear, or sadness). They produced facial configurations representing these experiences on the faces of the VAs and on their face (own production or imitation of VAs). The results suggest that affective states related to a direct threat to the body (i.e., anger, disgust, and pain) share a similar facial representation, while those that present no immediate danger (i.e., fear and sadness) differ. Although visual and sensorimotor representations of these states provide congruent affective information, they are differently influenced by factors associated with the communication cycle. These findings contribute to our understanding of pain communication in different affective contexts.

"It's All in Your Head": A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions

Interactions between female patients with chronic pain and their medical providers in which providers question or contest the "realness" or nature of their illness experience (e.g. "It's all in your head") have been reported extensively in the extant qualitative literature, particularly for poorly understood ("contested") chronic pain syndromes. Many terms have been offered to describe this talk (e.g. invalidating, dismissive), resulting in conceptual fragmentation and isolated silos of research which together report about one communicative phenomenon. To rectify this fragmentation, the present study offers a meta-synthesis which explores, analyzes, and integrates the findings of 82 qualitative interview studies representing the patient-provider communication experiences of 2,434 female patients living with one or more of 10 chronic overlapping pain conditions (COPCs). COPCs are costly, gendered, and poorly understood. From the meta-synthesis, three key concepts are identified: (1) Functions of disenfranchising talk: Discrediting, silencing, and stereotyping; (2) Effects of disenfranchising talk: Harmed agency, credibility; access to care, support, and resources; and perception of patient-provider relationship; and (3) Responses to disenfranchising talk: Submission, critique, and resistance. Findings confirm the centrality of gender in the experience of disenfranchising talk, underscore the need to adopt an intersectional approach to the study of this talk along additional axes of race and class, and offer heuristic value toward conceptually unifying research about female COPC patients' experiences of disenfranchising talk from providers.

Interpersonal Consequences of Deceptive Expressions of Sadness

Emotional expressions evoke predictable responses from observers; displays of sadness are commonly met with sympathy and help from others. Accordingly, people may be motivated to feign emotions to elicit a desired response. In the absence of suspicion, we predicted that emotional and behavioral responses to genuine (vs. deceptive) expressers would be guided by empirically valid cues of sadness authenticity. Consistent with this hypothesis, untrained observers (total N = 1,300) reported less sympathy and offered less help to deceptive (vs. genuine) expressers of sadness. This effect was replicated using both posed, low-stakes, laboratory-created stimuli, and spontaneous, real, high-stakes emotional appeals to the public. Furthermore, lens models suggest that sympathy reactions were guided by difficult-to-fake facial actions associated with sadness. Results suggest that naive observers use empirically valid cues to deception to coordinate social interactions, providing novel evidence that people are sensitive to subtle cues to deception.

Patient-clinician brain concordance underlies causal dynamics in nonverbal communication and negative affective expressivity

Patient-clinician concordance in behavior and brain activity has been proposed as a potential key mediator of mutual empathy and clinical rapport in the therapeutic encounter. However, the specific elements of patient-clinician communication that may support brain-to-brain concordance and therapeutic alliance are unknown. Here, we investigated how pain-related, directional facial communication between patients and clinicians is associated with brain-to-brain concordance. Patient-clinician dyads interacted in a pain-treatment context, during synchronous assessment of brain activity (fMRI hyperscanning) and online video transfer, enabling face-to-face social interaction. In-scanner videos were used for automated individual facial action unit (AU) time-series extraction. First, an interpretable machine-learning classifier of patients' facial expressions, from an independent fMRI experiment, significantly distinguished moderately painful leg pressure from innocuous pressure stimuli. Next, we estimated neural-network causality of patient-to-clinician directional information flow of facial expressions during clinician-initiated treatment of patients' evoked pain. We identified a leader-follower relationship in which patients predominantly led the facial communication while clinicians responded to patients' expressions. Finally, analyses of dynamic brain-to-brain concordance showed that patients' mid/posterior insular concordance with the clinicians' anterior insula cortex, a region identified in previously published data from this study¹, was associated with therapeutic alliance, and self-reported and objective (patient-to-clinician-directed causal influence) markers of negative-affect expressivity. These results suggest a role of patient-clinician concordance of the insula, a social-mirroring and salience-processing brain node, in mediating directional dynamics of pain-directed facial communication during therapeutic encounters.

Nonverbal pre-performance expressions of professional darts players distinguish between good and poor performance

The present research attempted to extend prior research that showed that thin-slices of pre-performance nonverbal behavior (NVB) of professional darts players gives valid information to observers about subsequent performance tendencies. Specifically, we investigated what kind of nonverbal cues were associated with success and informed thin-slice ratings. Participants (N = 61) were first asked to estimate the performance of a random sample of videos showing the preparatory NVB of professional darts players (N = 47) either performing well (470 clips) or poorly (470 clips). Preparatory NVB was assessed via preparation times and Active Appearance Modeling using Noldus FaceReader. Results showed that observers could distinguish between good and poor performance based on thin-slices of preparatory NVB (p = 0.001, d = 0.87). Further analyses showed that facial expressions prior to poor performance showed more arousal (p = 0.011, ƞ²_p = 0.10), sadness (p = 0.040, ƞ²_p = 0.04), and anxiety (p = 0.009, ƞ²_p = 0.09) and preparation times were shorter (p = 0.001, ƞ²_p = 0.36) prior to poor performance than good performance. Lens model analyses showed preparation times (p = 0.001, rho = 0.18), neutral (p = 0.001, rho = 0.13), sad (rho = 0.12), and facial expressions of arousal (p = 0.001, rho = 0.11) to be correlated with observers’ performance ratings. Hence, preparation times and facial cues associated with a player’s level of arousal, neutrality, and sadness seem to be valid nonverbal cues that observers utilize to infer information about subsequent perceptual-motor performance.

Capturing Behavior in Small Doses: A Review of Comparative Research in Evaluating Thin Slices for Behavioral Measurement

Thin slices are used across a wide array of research domains to observe, measure, and predict human behavior. This article reviews the thin-slice method as a measurement technique and summarizes current comparative thin-slice research regarding the reliability and validity of thin slices to represent behavior or social constructs. We outline decision factors in using thin-slice behavioral coding and detail three avenues of thin-slice comparative research: (1) assessing whether thin slices can adequately approximate the total of the recorded behavior or be interchangeable with each other (representativeness); (2) assessing how well thin slices can predict variables that are different from the behavior measured in the slice (predictive validity), and (3) assessing how interpersonal judgment accuracy can depend on the length of the slice (accuracy-length validity). The aim of the review is to provide information researchers may use when designing and evaluating thin-slice behavioral measurement.

Cues used by dentists in the early detection of oral cancer and oral potentially malignant lesions: findings from the National Dental Practice-Based Research Network

OBJECTIVE

The aim of this study was to assess the influence of clinical cues on risk assessment of cancer-associated mucosal abnormalities.

STUDY DESIGN

We differentiated lesions with a low risk from those with a high risk for premalignancy or malignancy by using 4 cues: (1) color, (2) location, (3) induration, and (4) pain on exploration. Combinations of color and location were presented through 8 photographs, with induration and pain status variably presented in the standardized history and physical findings. This created 16 clinical scenarios (vignettes) that were permutations of the 4 cues. Three questions assessed the extent to which each cue was used in obtaining a clinical impression as to whether a lesion was benign, premalignant, or malignant.

RESULTS

Completed vignette questionnaires were obtained from 130 of 228 invited dentists, (two-thirds males; 79% white; mean age 52 years; average weekly hours of practice 33 hours). Only 40% of the responding dentists had statistically significant decision policies to assign a clinical diagnosis of a lesion as benign, premalignant, or malignant. Lesion location and color were the 2 dominant cues. As a cue, induration was used as a cue by more of the respondents in determining a clinical diagnosis of malignancy, and pain was infrequently used as a cue.

CONCLUSIONS

Many dentists do not to have a decision strategy for the clinical diagnosis and risk stratification of oral potentially malignant lesions.

The Provider's Body in the Therapeutic Relationship: How Complementary and Alternative Medicine Providers Describe Their Work as Healers

Although the body is central to health outcomes, the provider's body has been largely absent in the provider-patient relationship. Drawing upon semi-structured interviews with complementary and alternative medicine (CAM) providers (N = 17), this study examines how CAM providers use their body to characterize their work as healers. The findings suggest the provider's self-reflexive awareness of their own body's illness and faith experiences informs their understanding of the patients' experience of health and disease. The study foregrounds the intersubjective nature of the provider-patient relationship as an embodied interaction in the mutual construction of therapeutic goals. Provider reflection on their own bodies to make sense of their patients' experiences emphasizes provider-patient coproduction of meaning and suggests ways for including the provider's self-reflexive awareness of their own body in a patient-centered healthcare relationship in ways that benefit both the patient and the provider.

Measuring nonverbal behavior in clinical interactions: A pragmatic guide

OBJECTIVE

Understanding nonverbal behavior is key to the research, teaching, and practice of clinical communication. However, the measurement of nonverbal behavior can be complex and time-intensive. There are many decisions to make and factors to consider when coding nonverbal behaviors.

METHODS

Based on our experience conducting nonverbal behavior research in clinical interactions, we developed practical advice and strategies for coding nonverbal behavior in clinical communication, including a checklist of questions to consider for any nonverbal coding project.

RESULTS

We provide suggestions for beginning the nonverbal coding process, operationalizing the coding approach, and conducting the coding.

CONCLUSION

A key to decision-making around nonverbal behavior coding is establishing clear research questions and using these to guide the process.

PRACTICE IMPLICATIONS

The field needs more coding of nonverbal behavior to better describe what happens in clinical interactions, to understand why nonverbal behaviors occur, and to determine the predictors and consequences of nonverbal behaviors in clinical interactions. A larger evidence base can inform better teaching practices and communication interventions.

Nonverbal Communication as a Pain Reliever: The Impact of Physician Supportive Nonverbal Behavior on Experimentally Induced Pain

Despite the evidence for the potential of supportive communication to alleviate physical pain, no study to date has assessed the impact of supportive nonverbal behavior on the objective and subjective experience of pain. This analogue study examined the impact of an actor-physician's supportive nonverbal behavior on experimentally induced pain. Participants (N = 205) were randomly assigned to interact with a videotaped physician conveying high or low supportive nonverbal behaviors. Participant pain was assessed with subjective and objective measures. Participants interacting with the high nonverbal support physicians showed increased pain tolerance and a reduction in the amount of pain expressed compared to those interacting with the low nonverbal support physicians. For subjectively rated pain, a gender difference existed such that for men, high physician nonverbal support decreased pain ratings and memory of pain, but for women, high physician nonverbal support increased pain ratings and memory of pain. These results highlight the importance of nonverbal communication in altering pain with broad implications for clinical care.