The secret life of pronouns: flexibility in writing style and physical health

Validating computer-generated measures of linguistic style matching and accommodation in patient-clinician communication

OBJECTIVE

To explore the validity of computer-analyzed linguistic style matching (LSM) in patient-clinician communication.

METHODS

Using 330 transcribed HIV patient encounters, we quantified word use with Linguistic Inquiry and Word Count (LIWC), a dictionary-based text analysis software. We measured LSM by calculating the degree to which clinicians matched patients in the use of LIWC "function words" (e.g., articles, pronouns). We tested associations of different LSM metrics with patients' perceptions that their clinicians spoke similiarly to them.

RESULTS

We developed 3 measures of LSM: 1) at the whole-visit level; (2) at the turn-by-turn level; and (3) using a "rolling-window" approach, measuring matching between clusters of 8 turns per conversant. None of these measures was associated with patient-rated speech similarity. However, we found that increasing trajectories of LSM, from beginning to end of the visit, were associated with higher patient-rated speech similarity (β 0.35, CI 0.06, 0.64), compared to unchanging trajectories.

CONCLUSIONS

Our findings point to the potential value of clinicians' adapting their communication style to match their patients, over the course of the visit.

PRACTICE IMPLICATIONS

With further validation, computer-based linguistic analyses may prove an efficient tool for generating data on communication patterns and providing feedback to clinicians in real time.

[Study of agency in the discourse of women suffering from post-traumatic stress disorder in the aftermath of domestic violence]

INTRODUCTION

In the absence of appropriate care, psychotraumatic consequences (revival, hyperarousal, avoidance strategies, dissociation and other clinical forms of post traumatic symptoms) can take control of a large part of the subject's existence (psychological, physical, social) and affect the ability of the victim to regain ground on the intrusions that harass, and to take up new life projects. More objective than the current semiological and psychometric approaches, and in the absence of biomarkers that may be used in clinical practice, psycholinguistics opens up an epistemological renewal of the conception of trauma and its clinical consequences, in particular through the definition of the Psycho Linguistic Traumatic Syndrome (SPLIT). If such conceptions have been developed based on the analysis of traumatic accounts of subjects injured in war and attacks, other forms of psychotraumatic confrontations also deserve to be considered. In this paper, our objective was to better characterize the pronominal forms of agency in the traumatic and non-traumatic narratives produced by women victims of domestic and/or sexual violence.

METHODS

Nineteen women aged 20 to 60 victims of domestic violence and diagnosed with post-traumatic stress disorder (Mini International Neuropsychiatric Interview) as well as a matched control group participated in the study. The subjects completed the French versions of Post Traumatic Checklist (PCL-5), Dissociative Experience Scale (DES) and Hospital and Anxiety Depression Scale (HAD). Traumatic and non-traumatic narratives were linguistically coded and scored on the SPLIT-10 scale.

RESULTS

Traumatic narratives contained significantly more first person singular pronouns than the non-traumatic narratives of controls or the non-traumatic narratives of psychically injured people. Traumatic narratives contained significantly more of the direct object pronoun "me" as well as indirect object pronouns. In traumatic narratives, the frequency of use of the subject pronoun "I" tended to correlate negatively with the HAD-A, HAD-D and SPLIT-10, while the frequency of use of the direct object pronoun "me" tended to correlate positively with DES, HAD-A, HAD-D as well as SPLIT-10. Finally, traumatic narratives contained significantly more verbs in the passive voice than non-traumatic narratives.

DISCUSSION

There was a gradient in the use of the first person singular pronoun that was inversely correlated to the degree of traumatic valence of the narratives: the control group used "I" less often than the psychically injured people who appeared to use this pronoun all the more as their narratives had a traumatic valence. In other words, even in the so-called "non-traumatic" narratives produced by subjects suffering from post-traumatic stress disorder, the trauma seemed to be inscribed in the discourse, testimony to dissociation, as the seen in the correlation of this pronominal expression dimension of "I" with the SPLIT-10 scale. The use of the direct object complement was correlated with greater psycho-traumatic morbidity (dissociative, depressive and anxious) than the use of the "I", the latter remaining however a pathological mark instead of the use of the pronouns "we" or "one". Saying "I" translated less symptomatology than saying "me", but it was when the subject said "we" or "one" that he appeared to have returned to a normal discourse, no longer suffering from the torments of reliving or pathological dissociation. The identification of linguistic markers deserves to be pursued in order to better objectively describe post-traumatic psychiatric disorders, to better identify them in clinical practice in the field and to monitor the efficiency of the recommended psychotherapies. More generally, we may put forward the hypothesis that the direct modification of the patient's language, thanks to the intervention of the practitioner, from a speech composed of linguistic markers testifying to the trauma towards a normalized speech could help to treat post-traumatic symptoms.

The Association Between Emotional Expressivity in Autobiographies from Early Adulthood and the Risk of Dementia in the Context of Written Language Skills

Background

Risk factors for dementia, such as Alzheimer's disease, are complex and span a lifetime. Exploring novel factors, such as characteristics of writing, may provide insight into dementia risk.

Objective

To investigate the association between emotional expressivity and risk of dementia in the context of a previously identified risk factor, written language skills.

Methods

The Nun Study recruited 678 religious sisters aged 75 + years. Of these, 149 U.S.-born participants had archived autobiographies handwritten at a mean age of 22 years. The autobiographies were scored for frequency of emotion word usage and language skills (e.g., idea density). The association of emotional expressivity and a four-level composite variable (combining high/low emotional expressivity and high/low idea density) with dementia was assessed using logistic regression models adjusted for age, education, and apolipoprotein E.

Results

Within the composite variable, odds of dementia increased incrementally, with opposing effects of emotional expressivity across the two idea density levels. Compared to the referent category (low emotional expressivity/high idea density), the risk of dementia increased in those with high emotional expressivity/high idea density (OR = 2.73, 95% CI = 1.05-7.08), while those with low emotional expressivity/low idea density had the highest risk (OR = 18.58, 95% CI = 4.01-86.09).

Conclusion

Dementia risk is better captured by inclusion of multiple measures relating to characteristics of writing. Emotional expressivity may be protective when individuals are at increased risk due to poor written language skills (i.e., low idea density), but detrimental when not at risk (i.e., high idea density). Our findings indicate that emotional expressivity is a contextually-dependent novel risk factor for dementia.

Describing a critical life event and its psychological consequences: The type of language used by patients suffering from depression and its relationship with personality development

Information on personality development (and its linguistic predictors) in the aftermath of a critical life event among depressive patients is relatively limited. The study’s aim was to verify two hypotheses: (1) Participants with depression will use concrete rather than abstract language to describe their most recent critical life event and its psychological consequences and (2) The more abstract the language used, the higher the level of personality development. 16 Cognitive Behavioral Therapy patients suffering from depression participated in the study (M = 34 years old; SD = 4.02). Their level of personality development was assessed qualitatively by two independent coders. The coding system was based on the Positive Disintegration Theory (Dąbrowski 1964). We used typology from the Linguistic Category Model (Semin and Fiedler 1991) to analyse the level of abstractness vs. concreteness. Depressed patients were classified as either abstract language speakers or concrete language speakers. There were equal numbers of both types of speakers. Moreover participants consistently used one type of language, regardless of whether they were describing the critical life event itself or its psychological consequences. As expected, using higher levels of language abstractness when speaking correlated with possessing higher levels of personality development. Our findings provide practitioners with useful knowledge on the benefits of using abstract language to improve supportive strategies when dealing with people in crisis and modify the psychotherapeutic protocols used to treat depression.

Improving Web-Based Treatment Intake for Multiple Mental and Substance Use Disorders by Text Mining and Machine Learning: Algorithm Development and Validation

BACKGROUND

Text mining and machine learning are increasingly used in mental health care practice and research, potentially saving time and effort in the diagnosis and monitoring of patients. Previous studies showed that mental disorders can be detected based on text, but they focused on screening for a single predefined disorder instead of multiple disorders simultaneously.

OBJECTIVE

The aim of this study is to develop a Dutch multi-class text-classification model to screen for a range of mental disorders to refer new patients to the most suitable treatment.

METHODS

On the basis of textual responses of patients (N=5863) to a questionnaire currently used for intake and referral, a 7-class classifier was developed to distinguish among anxiety, panic, posttraumatic stress, mood, eating, substance use, and somatic symptom disorders. A linear support vector machine was fitted using nested cross-validation grid search.

RESULTS

The highest classification rate was found for eating disorders (82%). The scores for panic (55%), posttraumatic stress (52%), mood (50%), somatic symptom (50%), anxiety (35%), and substance use disorders (33%) were lower, likely because of overlapping symptoms. The overall classification accuracy (49%) was reasonable for a 7-class classifier.

CONCLUSIONS

A classification model was developed that could screen text for multiple mental health disorders. The screener resulted in an additional outcome score that may serve as input for a formal diagnostic interview and referral. This may lead to a more efficient and standardized intake process.

Linguistic Features and Psychological States: The Case of Virginia Woolf

This study investigated the relation between psychological states and linguistic features with the case of Virginia Woolf. We analyzed the data from The Diary of Virginia Woolf and Virginia Woolf: Biography by automatic text analysis and statistical analysis, including stepwise multiple regression and Deep Learning algorithm. The results suggested that the significant linguistic features can jointly predict the psychological states of Virginia Woolf, including the emotional value of anger, the absolutist word "everything," and the total of first-person plural pronouns. In addition, we found that the total use of first-person plural pronouns and the emotional value of anger were negatively related to mental health of Virginia Woolf. While the use of the absolutist word "everything" was positively related to mental health of Virginia Woolf. Meanwhile, we developed a model that can predict the psychological states of Virginia Woolf, with 86.9% accuracy. We discussed the findings and enumerated the limitations of this study at the end of the paper. The results not only complemented previous studies in the understanding of the relation between language and psychological health, but also facilitated timely identification, intervention, and prevention of mental disorders.

Social Media Use and Its Link to Physical Health Indicators

Social media use has become an integral part of many young adults' daily lives. Although much research has examined how social media use relates to psychological well-being, little is known about how it relates to physical health. To address this knowledge gap, the present research investigated how the amount of social media people use relates to various indices of physical health. Young adults provided a blood sample that was analyzed for C-reactive protein (CRP), a marker of chronic inflammation. They also completed self-report measures of social media use, somatic symptoms, illness-related physician or health center visits, and whether they sought medical care for infection-related illnesses in the last 3 months. Social media use was positively correlated with higher levels of CRP, more somatic symptoms, and more visits to the doctor or health centers for an illness. Although directionally consistent, the correlation with likelihood of seeking medical care for infection-related illnesses was nonsignificant (p = 0.061). All of these results held after controlling for factors such as sociodemographic information and depressive symptoms. Given the prevalence of social media use in daily life, these findings underscore the need for more research examining how social media use relates to physical health.

Detecting Presence of PTSD Using Sentiment Analysis From Text Data

Rates of Post-traumatic stress disorder (PTSD) have risen significantly due to the COVID-19 pandemic. Telehealth has emerged as a means to monitor symptoms for such disorders. This is partly due to isolation or inaccessibility of therapeutic intervention caused from the pandemic. Additional screening tools may be needed to augment identification and diagnosis of PTSD through a virtual medium. Sentiment analysis refers to the use of natural language processing (NLP) to extract emotional content from text information. In our study, we train a machine learning (ML) model on text data, which is part of the Audio/Visual Emotion Challenge and Workshop (AVEC-19) corpus, to identify individuals with PTSD using sentiment analysis from semi-structured interviews. Our sample size included 188 individuals without PTSD, and 87 with PTSD. The interview was conducted by an artificial character (Ellie) over a video-conference call. Our model was able to achieve a balanced accuracy of 80.4% on a held out dataset used from the AVEC-19 challenge. Additionally, we implemented various partitioning techniques to determine if our model was generalizable enough. This shows that learned models can use sentiment analysis of speech to identify the presence of PTSD, even through a virtual medium. This can serve as an important, accessible and inexpensive tool to detect mental health abnormalities during the COVID-19 pandemic.

Embarrassing Product, Image Type, and Personal Pronoun: The Mediating Effect of Body Imagery

Consumers often feel embarrassed when buying products like condoms, hemorrhoid cream, and beriberi cream in crowded pharmacies. There is an interesting phenomenon in life: Some beriberi creams use the images of a "real foot", while others use the images of a "cartoon foot." Imagine if a young woman needed to go to a retail store for beriberi cream that would embarrass her, she would choose a "real foot image" or a "cartoon foot image" beriberi cream? It has been shown that the embarrassment of these products has a strong negative impact on consumer buying behavior. Previous researches have explored how changing packaging elements of embarrassing products (e.g., color/design/image placement) can effectively reduce consumer embarrassment. However, few have examined the impact of different image types of embarrassing product packaging (artificial vs. natural) with embarrassment. Therefore, this research explores the effect of image types (artificial vs. natural) on consumers' willingness to purchase embarrassing products and reveals the mechanisms of the underlying effects. The results show that natural images can lead to lower purchase intention of embarrassing products when the advertisement uses first-person pronouns due to the mediating role played by negative body imagery. However, there is no significant difference in purchase intention between different image types in the third-person pronouns. Finally, this paper discusses its contributions and limitations.

Focus Within or On Others: The Impact of Reviewers’ Attentional Focus on Review Helpfulness

When reviewers write online reviews, they differ in the focus of their attention: some focus on their own experiences, whereas some direct their attention to others—prospective consumers who may read the reviews in the future. This paper explores how, why, and when reviewers’ attentional focus can influence the helpfulness evaluation of reviews beyond the impact of substantive review content. Drawing on the attentional focus and persuasion literatures, we develop a theoretical model proposing that reviewers’ attentional focus may influence consumers’ perception of review helpfulness through opposing processes, and that its overall effect is contingent on the review’s two-sidedness. Results of one archival analysis and five controlled experiments provide consistent support for our hypotheses. This work challenges the predominant view of the positive impact of other-focus (vs. self-focus), explores the interpersonal impact of a reviewer’s attentional focus on prospective consumers who are total strangers, and reveals an important, context-specific boundary condition.

Behavioral Activation and Depression Symptomatology: Longitudinal Assessment of Linguistic Indicators in Text-Based Therapy Sessions

BACKGROUND

Behavioral activation (BA) is rooted in the behavioral theory of depression, which states that increased exposure to meaningful, rewarding activities is a critical factor in the treatment of depression. Assessing constructs relevant to BA currently requires the administration of standardized instruments, such as the Behavioral Activation for Depression Scale (BADS), which places a burden on patients and providers, among other potential limitations. Previous work has shown that depressed and nondepressed individuals may use language differently and that automated tools can detect these differences. The increasing use of online, chat-based mental health counseling presents an unparalleled resource for automated longitudinal linguistic analysis of patients with depression, with the potential to illuminate the role of reward exposure in recovery.

OBJECTIVE

This work investigated how linguistic indicators of planning and participation in enjoyable activities identified in online, text-based counseling sessions relate to depression symptomatology over time.

METHODS

Using distributional semantics methods applied to a large corpus of text-based online therapy sessions, we devised a set of novel BA-related categories for the Linguistic Inquiry and Word Count (LIWC) software package. We then analyzed the language used by 10,000 patients in online therapy chat logs for indicators of activation and other depression-related markers using LIWC.

RESULTS

Despite their conceptual and operational differences, both previously established LIWC markers of depression and our novel linguistic indicators of activation were strongly associated with depression scores (Patient Health Questionnaire [PHQ]-9) and longitudinal patient trajectories. Emotional tone; pronoun rates; words related to sadness, health, and biology; and BA-related LIWC categories appear to be complementary, explaining more of the variance in the PHQ score together than they do independently.

CONCLUSIONS

This study enables further work in automated diagnosis and assessment of depression, the refinement of BA psychotherapeutic strategies, and the development of predictive models for decision support.

Effects of Web-Based Social Connectedness on Older Adults' Depressive Symptoms: A Two-Wave Cross-Lagged Panel Study

Background

Depressive symptoms are the most prevalent mental health concern among older adults (possibly heightened during the COVID-19 pandemic), which raises questions about how such symptoms can be lowered in this population. Existing research shows that offline social connectedness is a protective factor against depression in older adults; however, it is unknown whether web-based social connectedness can have similar effects.

Objective

This study investigates whether social connectedness on a support website protects older adults against depressive symptoms over the course of a year, above and beyond the protective effect of offline social connectedness. The secondary aim is to determine whether older adults with increased depressive symptoms are more likely to engage in social connectedness on this website. Thus, we examine depressive symptoms as both an outcome and predictor of web-based social connectedness to fully understand the chain of causality among these variables. Finally, we compare web-based social connectedness with offline social connectedness in their ability to lower depressive symptoms among older adults.

Methods

A total of 197 adults aged 65 years or older were given access to a social support website, where they were able to communicate with each other via a discussion forum for a year. Participants’ social connectedness on the web-based platform, conceptualized as message production and consumption, was measured using behavioral log data as the number of messages participants wrote and read, respectively, during the first 6 months (t₁) and the following 6 months (t₂) of the study. Participants self-reported their offline social connectedness as the number of people in their support networks, and they reported their depressive symptoms using the Patient Health Questionnaire-8 both at baseline (t₁) and at 12-month follow-up (t₂). To ascertain the flow of causality between these variables, we employed a cross-lagged panel design, in which all variables were measured at t₁ and t₂.

Results

After controlling for the effect of offline support networks at t₁, web-based message consumption at t₁ decreased older adults’ depressive symptoms at t₂ (β=−.11; P=.02), but web-based message production at t₁ did not impact t₂ depressive symptoms (β=.12; P=.34). Web-based message consumption had a larger effect (β=−.11; P=.02) than offline support networks (β=−.08; P=.03) in reducing older adults’ depressive symptoms over time. Higher baseline depressive symptoms did not predict increased web-based message consumption (β=.12; P=.36) or production (β=.02; P=.43) over time.

Conclusions

The more messages older adults read on the web-based forum for the first 6 months of the study, the less depressed they felt at the 1-year follow-up, above and beyond the availability of offline support networks at baseline. This pinpoints the substantial potential of web-based communication to combat depressive symptoms in this vulnerable population.

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-015-0713-2

In Dialogue: How Writing to the Dead and the Living Can Increase Self-Awareness in Those Bereaved by Addiction

This article examines how writing can increase the self-awareness of a socially isolated and often stigmatized population: those bereaved by addiction. Writing about a traumatic event has been shown to increase self-awareness which can improve health and regulate negative behaviors. Using narrative analysis on the writing of individuals bereaved by addiction, this study found that participants were able to increase their self-awareness through writing to the dead, the living and themselves. Participants’ writing also demonstrated their attempts to make sense and make meaning out of their loss which are both strong predictors of positive health outcomes. All participants in this study demonstrated increased self-awareness as well as sense-making and/or meaning-making which can lead to improvements in behavior regulation, psychological health and physical heath. This suggests that writing may be a uniquely beneficial therapeutic intervention for those experiencing disenfranchised grief as a result of bereavement by addiction.

Written Emotional Disclosure Can Promote Athletes' Mental Health and Performance Readiness During the COVID-19 Pandemic

The widespread effects of the coronavirus disease 2019 (COVID-19) pandemic have negatively impacted upon many athletes’ mental health and increased reports of depression as well as symptoms of anxiety. Disruptions to training and competition schedules can induce athletes’ emotional distress, while concomitant government-imposed restrictions (e.g., social isolation, quarantines) reduce the availability of athletes’ social and emotional support. Written Emotional Disclosure (WED) has been used extensively in a variety of settings with diverse populations as a means to promote emotional processing. The expressive writing protocol has been used to a limited extent in the context of sport and predominantly in support of athletes’ emotional processing during injury rehabilitation. We propose that WED offers an evidence-based treatment that can promote athletes’ mental health and support their return to competition. Research exploring the efficacy of the expressive writing protocol highlights a number of theoretical models underpinning the positive effects of WED; we outline how each of these potential mechanisms can address the multidimensional complexity of the challenging circumstances arising from the COVID-19 pandemic (e.g., loss of earnings, returning to training and competition). Considerations and strategies for using WED to support athletes during the COVID-19 pandemic are presented.

Giving words to emotions: the use of linguistic analysis to explore the role of alexithymia in an expressive writing intervention

Expressive writing techniques are methods focusing on written emotional expression that require people to write about traumatic or difficult experiences, with the objective of promoting an elaboration of these events. The general aim of the study is to investigate the influence of alexithymia, a deficit in emotional regulation processes, on the effects of an expressive writing intervention, analyzing the writing protocols through the use of the Linguistic Inquiry and Word Count (LIWIC) and Referential Process (RP) linguistic measures via IDAAP software. Thirty-five women undergoing an assisted reproductive treatment participated in the study and filled out a sociodemographic questionnaire, the 20-item Toronto Alexithymia Scale. They also underwent three session of writing, following a request that they write about their emotions regarding their current situation. The women enrolled were divided into two groups: low alexithymia and high alexithymia, comprising individuals with a TAS-20 total score lower or higher than the mean, respectively. Analyses within the groups during the three writing sessions revealed that the women with low alexithymia reported a greater number of words expressing affectivity, sadness and future perspective, whereas no significances in the high alexithymia group emerged. Moreover, when analysing differences between the groups, high-alexithymia women reported lower scores in RP indexes and fewer words expressing sadness, future perspectives and we verbal. In conclusion, these preliminary findings may confirm the hypothesis that alexithymia affects the effectiveness of expressive writing through a difficulty in becoming involved in the writing process and a lack of symbolizing processes.

Talking about emotions: Effects of emotion-focused interviewing on children's physiological regulation of stress and discussion of the subjective elements of a stressful experience

This is the first study to examine the effect of questioning children about emotions and cognitions versus facts on children's stress reactivity and regulation, as well as children's abilities to discuss their subjective experiences, in the context of adult-child discussions about a stressful event. A total of 80 8- to 12-year-old children participated in a stressful laboratory task (i.e., Trier Social Stress Test). Following the task, half of the children were engaged in an emotion-focused conversation with an adult interviewer about the event, and half were engaged in a fact-focused conversation. Electrodermal and cardiac preejection activity and respiratory sinus arrhythmia were derived at baseline, during the laboratory stressor, and during the conversation to index stress reactivity and regulation. Children's narratives were coded for indicators of emotion processing (i.e., positive and negative emotion words, cognitive words [e.g., think, know]). Children's English language abilities, self-reported stress, and several parent-report measures (demographics, child life stress, and children's emotion regulation strategies) were also obtained. Results indicate that the emotion-focused interview facilitated children's discussions of their subjective experiences without increasing their stress reactivity and that children showed enhanced physiological stress regulation during the emotion-focused interview. This research will be of interest to those in the fields of child narratives, stress, and social context as well as to parents and practitioners interested in improving children's understanding, reporting, and recovery after stressful experiences.

Context- and Subgroup-Specific Language Changes in Individuals Who Develop PTSD After Trauma

Post-traumatic stress disorder (PTSD) is a very common condition with more than 3 million new cases per year in the US alone. The right diagnosis in a timely manner is key to ensuring a prompt treatment that could lead to a full recovery. Unfortunately, avoidance of trauma reminders, social stigma, self-presentation, and self-assessment biases often prevent individuals from seeking timely evaluation, leading to delays in treatment and suboptimal outcomes. Previous studies show that various mental health conditions are associated with distinct patterns of language use. Analyzing language use may also help to avoid response bias in self-reports. In this study, we analyze text data from online forum users, showing that language use differences between PTSD sufferers and controls. In all groups of PTSD sufferers, the usage of singular first-person pronouns was higher and that of plural first-person pronouns was lower than in control groups. However, the analysis of other word categories suggests that subgroups of people with the same mental health disorder (here PTSD) may have salient differences in their language use, particularly in word usage frequencies. Additionally, we show that word usage patterns may vary depending on the type of the text analyzed. Nevertheless, more studies will be needed to increase precision by further examine a variety of text types and different comorbidities. If properly developed, such tools may facilitate earlier PTSD diagnosis, leading to timely support and treatment, which are associated with better outcomes.

Memory, Neuroscience and Memory Enhancement

This paper advances a new and updated understanding of memory that should also change the coordinates of the memory enhancement debate. Instead of thinking of memory as a storehouse, we should think of memory from a narrative perspective. This view allows for a better understanding of the process in which we actually construct our memories by elaborating meaningful summaries, rather than adding discrete elements. I argue that this new way of thinking about memory makes most of the memory enhancement technologies we have or will have in the near future much less ethically problematic. The main idea is that (biological) memory interacts with memory enhancement in the creative and re-elaborative way it ordinarily does. To conclude, I discuss some cases to illustrate the previous points.

Recognizing hotspots in Brief Eclectic Psychotherapy for PTSD by text and audio mining

Background: Identifying and addressing hotspots is a key element of imaginal exposure in Brief Eclectic Psychotherapy for PTSD (BEPP). Research shows that treatment effectiveness is associated with focusing on these hotspots and that hotspot frequency and characteristics may serve as indicators for treatment success. Objective: This study aims to develop a model to automatically recognize hotspots based on text and speech features, which might be an efficient way to track patient progress and predict treatment efficacy. Method: A multimodal supervised classification model was developed based on analog tape recordings and transcripts of imaginal exposure sessions of 10 successful and 10 non-successful treatment completers. Data mining and machine learning techniques were used to extract and select text (e.g. words and word combinations) and speech (e.g. speech rate, pauses between words) features that distinguish between 'hotspot' (N = 37) and 'non-hotspot' (N = 45) phases during exposure sessions. Results: The developed model resulted in a high training performance (mean F ₁-score of 0.76) but a low testing performance (mean F ₁-score = 0.52). This shows that the selected text and speech features could clearly distinguish between hotspots and non-hotspots in the current data set, but will probably not recognize hotspots from new input data very well. Conclusions: In order to improve the recognition of new hotspots, the described methodology should be applied to a larger, higher quality (digitally recorded) data set. As such this study should be seen mainly as a proof of concept, demonstrating the possible application and contribution of automatic text and audio analysis to therapy process research in PTSD and mental health research in general.

Deconstructing Information Elaboration: The Critical Role of Framing and Initial Dialogue

Information elaboration is crucial for successfully responding to change, and teams inevitably frame changes to ground them. Yet, there is sparse knowledge around how framing affects information elaboration. In investigating the relationship that framing has with information elaboration, we show that framing starts a domino effect throughout the phases of information elaboration. Our experiment shows that opportunity framing motivates teams to engage with the change by asking questions about it, which increases the sharing and integrating of unique information, thereby improving decision performance. In contrast, threat framing is followed by avoiding the change through making status quo-directed statements and then discussing shared information, ultimately lowering decision performance. Our findings contribute to the information elaboration literature by helping explain differences in information elaboration’s effectiveness through uncovering interdependent behaviors. Next, we move information elaboration’s antecedents beyond static characteristics to include dynamic tactics.

Understanding Therapeutic Change Process Research Through Multilevel Modeling and Text Mining

Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied, and multi-layered processes? We advocate the use text mining and multi-level models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. We (re-)used the data from Lamers et al. (2015) because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analyzed through MLMs. We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-leveled TCPR outcomes (using a MLM). Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR.

Creative utterances about person-centered care among future health care professionals are related to reward dependence rather than to a creative personality profile

Background

Creativity can be defined as the creation of something that is novel, useful, and valuable for society (i.e., high-level creativity) and/or everyday life. In this context, people have implicit theories of creativity as being either non-malleable (i.e., a fixed creative mindset) or malleable (i.e., a growth creative mindset). Our aim was twofold: (1) to test an improved creative mindset priming paradigm (i.e., adding high-level/everyday creativity perspectives and using an organizational important task) by assessing if participants used different ways to answer to the prime and (2) to analyse the relationship between personality and creative utterances regarding an important topic in participants' future professions.

Method

Students (N = 73) from different health care professions were randomly assigned to the non-malleable or malleable creative mindset priming paradigm (i.e., fixed vs. growth) and then asked to write about (a) their own creativity, (b) person-centered care in their professions (i.e., unusual use test), and to (c) self-rate their personality (Temperament and Character Inventory). We used natural language processing methods (i.e., Latent Semantic Algorithm) to analyse participants' responses in the different conditions and also responses in relation to self-reported personality.

Results

The fixed versus growth condition was predicted (r = .55, p < 0.0001), following Bonferroni correction for multiple comparisons by participants' descriptions about creativity. Although the condition was not predicted (r = .07, p < 0.2755) by participants' utterances about person-centered care, a t-test suggested that participants used words that were semantically different depending on the condition they were randomly assigned to (t(2371) = 5.82, p = .0000). For instance, participants in the growth condition used verbs more frequently, while those in the fixed condition used the personal pronoun I more often. Finally, only the temperament trait of reward dependence (r = .32, p < 0.01) predicted the person-centered care utterances.

Conclusion

We argue that the paradigm successfully primed participants to write about creativity and person-centered care using narratives with different semantic content. However, individuals' ambition to be socially accepted, rather than creative personality traits, elicited the utterances about person-centered care. The creative mindset priming paradigm presented here along language processing methods might be useful for measuring creative potential at work. We suggest that if health care personnel's notions of the activities related to care are generated from their drive to be socially accepted and not from a truly creative profile, the activities might be self-serving and not person-centered.

Charting Cognitive Growth of Nursing Students Using Linguistic Software

BACKGROUND

Students' word choice when writing in a reflective journal may reveal their emotional development, sense of belonging, cognitive processing, and ability to appraise their own growth and understanding. New linguistic analysis software can scan and categorize these journals for the use of pronouns, positive and negative emotions, and cognitive keywords.

METHODS

A retrospective study design evaluated student journaling from a psychiatric clinical course. Journal entries from weeks 1 and 12 were compared by z-score analysis.

FINDINGS

Significant increases were found in the use of "we" (P = .001), positive emotions (P < .001), inclusion words (P < .001), and insight words (P = .004), whereas the use of cause and self-discrepancy words were not significantly different.

CONCLUSION

Identification of learning as expressed in words could have an impact on how student assignments are designed by including the use of the Linguistic Inquiry and Word Count software to assess changes in student cognition.

Investigating linguistic coherence relations in child sexual abuse: A comparison of PTSD and non-PTSD children

Background

Language is the most common way to communicate internal states and emotions into a narrative form. Studies on the use of language provide a useful understanding of how people process an event and interpret it.

Objective

The aim of this study was to investigate the effects of PTSD on the narrative coherence of children's reports of sexual abuse.

Participants and setting

Narrative coherence was analyzed within a group of 89 allegations of children (M = 10; range: 4–16), who were victims of sexual abuse. Thirty-seven children presented the symptoms for a diagnosis of PTSD.

Method

Linguistic Inquiry Word Count (LIWC) was employed and narrative coherence was analyzed through some linguistic markers (first-person singular pronouns, conjunctions, and cognitive words).

Results

Results illustrated the effects of PTSD on the narrative coherence, in terms of first-person singular pronouns, conjunctions, and cognitive processes. Indeed, compared with traumatic narratives of children without PTSD, traumatic narratives of children with PTSD contained a greater number of first-person singular pronouns (M_PTSD = 1.45 versus M_no-PTSD = 1.12) and a smaller number of conjunctions (M_PTSD = .37 versus M_non-PTSD = .67), cognitive (M_PTSD = 2.93 versus M_non-PTSD = 3.76) and insight words (M_PTSD = 2.29 versus M_non-PTSD = 3.09). Regression analyses were used to examine if age and PTSD were predictors of the narrative coherence, suggesting the effects of PTSD in predicting the use of the first-person singular pronouns and the conjunctions.

Conclusion

This study could underline the importance of considering the PTSD in legal testimony of children who have been sexually abused.

The Improvement Readiness scale of the SCORE survey: a metric to assess capacity for quality improvement in healthcare

BACKGROUND

Quality improvement efforts are inextricably linked to the readiness of healthcare workers to take them on. The current study aims to clarify the nature and measurement of Improvement Readiness (IR) by 1) examining the psychometric properties of a novel IR scale, 2) assessing relationships between IR and other safety culture domains 3) exploring whether IR differs by healthcare worker demographic factors, and 4) examining linguistic differences in word type use between high and low scoring IR work settings from their free text responses.

METHODS

Of 13,040 eligible healthcare workers across a large academic health system, 10,627 (response rate 81%) completed the 5-item IR scale, demographics, safety culture scales, and two open-ended questions. Psychometric analyses, correlations and ANOVAs tested the properties of IR. Linguistic Inquiry Word Count software assessed comments from open-ended questions.

RESULTS

The IR scale exhibited strong psychometric properties and a one factor model fit the data well (Cronbach's alpha = .93; RMSEA = .07; CFI = 99; TLI = .99). IR scores differed significantly by role, shift, shift length, and years in specialty. IR correlated significantly and in expected directions with safety culture scales. Linguistic analyses revealed that people in low versus high IR work settings used significantly more words in their responses, and specifically more past tense verbs (e.g., "ignored"), negative emotion words (e.g., "upset"), and first person singular ("I"). Workers from high IR work settings used significantly more positive emotions words (e.g., "grateful") and social words (e.g., "team").

CONCLUSION

The IR scale exhibits strong psychometric properties, is associated with better safety and teamwork climate, lower burnout, and predicts linguistic differences in high versus low IR groups.

Women's Word Use in Pregnancy: Associations With Maternal Characteristics, Prenatal Stress, and Neonatal Birth Outcome

Background: Experiencing high levels of stress during pregnancy can impair maternal well-being and fetal development. Consequently, unbiased assessment of maternal psychological state is crucial. Self-report measures are vulnerable to social desirability effects. Thus, implicit measures, such as word choice analysis, may offer an alternative.

Methods: In this longitudinal online-study, 427 pregnant women described their emotional experiences in writing and additionally responded to self-report questionnaires assessing symptoms of prenatal stress and depression. The written texts were analyzed with a computerized text analysis program. After birth, 253 women provided information on birth outcome.

Results: Word use differed significantly depending on maternal socioeconomic (e.g., marital status) and pregnancy-related characteristics (e.g., parity). Prenatal stress and depressive symptoms were associated with more frequent use of negative emotion words and words of anxiety, as well as with less first-person plural, but not singular pronoun use. Negative emotion and cognitive mechanism words predicted birth outcome, while self-report measures did not.

Conclusion: In addition to self-report measures, word choice may serve as a useful screening tool for symptoms of depression and stress in pregnant women. The findings on pronoun use may reflect women’s changing experience of self-identity during the transition to motherhood.

From I to We: Group formation and linguistic adaption in an online xenophobic forum

Much of identity formation processes nowadays takes place online, indicating that intergroup differentiation may be found in online communities. This paper focuses on identity formation processes in an open online xenophobic, anti-immigrant, discussion forum. Open discussion forums provide an excellent opportunity to investigate open interactions that may reveal how identity is formed and how individual users are influenced by other users. Using computational text analysis and Linguistic Inquiry Word Count (LIWC), our results show that new users change from an individual identification to a group identification over time as indicated by a decrease in the use of “I” and increase in the use of “we”. The analyses also show increased use of “they” indicating intergroup differentiation. Moreover, the linguistic style of new users became more similar to that of the overall forum over time. Further, the emotional content decreased over time. The results indicate that new users on a forum create a collective identity with the other users and adapt to them linguistically.

Am I who I say I am? Unobtrusive self-representation and personality recognition on Facebook

Across social media platforms users (sub)consciously represent themselves in a way which is appropriate for their intended audience. This has unknown impacts on studies with unobtrusive designs based on digital (social) platforms, and studies of contemporary social phenomena in online settings. A lack of appropriate methods to identify, control for, and mitigate the effects of self-representation, the propensity to express socially responding characteristics or self-censorship in digital settings, hinders the ability of researchers to confidently interpret and generalize their findings. This article proposes applying boosted regression modelling to fill this research gap. A case study of paid Amazon Mechanical Turk workers (n = 509) is presented where workers completed psychometric surveys and provided anonymized access to their Facebook timelines. Our research finds indicators of self-representation on Facebook, facilitating suggestions for its mitigation. We validate the use of LIWC for Facebook personality studies, as well as find discrepancies with extant literature about the use of LIWC-only approaches in unobtrusive designs. Using survey data and LIWC sentiment categories as predictors, the boosted regression model classified the Five Factor personality model with an average accuracy of 74.6%. The contribution of this work is an accurate prediction of psychometric information based on short, informal text.

The impact of perinatal loss in maternity units: A psycholinguistic analysis of health professionals' reactions

Perinatal loss has a strong emotional impact on health professionals working in maternity units. We aimed to study the impact of this experience on health professionals' language. We analyzed the answers of 162 health professionals (physicians and non-medical staff) who described their reactions to perinatal loss. A linguistic analysis was performed using the Linguistic Inquiry and Word Count software. Associations between language and burnout were studied. Words typical of a psychological shock reaction were used more by non-medical staff than by physicians. Participants who used pronouns, optimistic words, future tense verbs, and cognitive words registered lower levels of burnout. Clinical implications of the results are discussed.

Partner Pronoun Use, Communal Coping, and Abstinence during Couple-Focused Intervention for Problematic Alcohol Use

Communal coping-a process in which romantic partners view a problem as ours rather than yours or mine, and take collaborative action to address it -has emerged as an important predictor of health and treatment outcomes. In a study of partners' pronoun use prior to and during couple-focused alcohol interventions, we examined first-person plural (we-talk) and singular (I-talk) pronouns as linguistic markers of communal coping and behavioral predictors of treatment outcome. Thirty-three couples in which one partner abused alcohol were selected from a randomized control trial (N = 63) of couple-focused Cognitive-Behavioral or Family Systems Therapy if they had unambiguously successful or unsuccessful treatment outcomes (i.e., patient maintained abstinence for 30 days prior to treatment termination or had more than one heavy drinking day in the same period). Pronoun measures for each partner were obtained via computerized text analysis from transcripts of partners' speech, derived from a videotaped pretreatment interaction task and three subsequent therapy sessions. Spouse we-talk during the intervention (accounting for pretreatment we-talk), as an index of communal orientation, uniquely predicted successful treatment outcomes. In contrast, both patient and spouse I-talk during the intervention (accounting for pretreatment I-talk), as a marker of individualistic orientation, uniquely predicted unsuccessful outcomes, especially when distinguishing active and passive (I vs. me/my) pronoun forms. Results strengthen evidence for the prognostic significance of spouse behavior for patient health outcomes and for communal coping (indexed via pronoun use) as a potential mechanism of change in couple-focused interventions for health problems.

Helping Yourself by Offering Help: Mediators of Expressive Helping in Survivors of Hematopoietic Stem Cell Transplant

BACKGROUND

A randomized experiment by Rini et al. (Health Psychol. 33(12):1541-1551, 2014) demonstrated that expressive helping, which involves three expressive writing sessions regarding hematopoietic stem cell transplant, followed by one writing session directed toward helping other stem cell transplant recipients, reduced psychological distress and bothersome physical symptoms among stem cell transplant recipients with elevated survivorship problems, relative to a neutral writing control condition.

PURPOSE

The current study evaluated whether word use reflective of emotional expression, cognitive processing, and change in perspective mediates the effects of expressive helping.

METHOD

The essays of 67 stem cell transplant recipients with high survivorship problems were analyzed with Linguistic Inquiry and Word Count. Multiple mediation modeling was used to test the hypothesized mechanisms of expressive helping on distress and bothersome physical symptoms.

RESULTS

Relative to the control condition, expressive helping produced significant reductions in psychological distress and marginal reductions in physical symptom bother in the analyzed subset of participants from the parent study. Results indicated that positive emotion word use significantly mediated effects of expressive helping on reduced distress, but only for participants who used average (compared to above or below average) rates of negative emotion words. Cognitive processing and change in perspective did not significantly mediate benefits of expressive helping.

CONCLUSIONS

Expressive helping carried its positive effects on distress through participants' higher expression of positive emotions when coupled with moderate rates of negative emotions. Findings highlight the benefit of expressing both positive and negative emotions in stressful situations.

The acute mania of King George III: A computational linguistic analysis

We used a computational linguistic approach, exploiting machine learning techniques, to examine the letters written by King George III during mentally healthy and apparently mentally ill periods of his life. The aims of the study were: first, to establish the existence of alterations in the King's written language at the onset of his first manic episode; and secondly to identify salient sources of variation contributing to the changes. Effects on language were sought in two control conditions (politically stressful vs. politically tranquil periods and seasonal variation). We found clear differences in the letter corpus, across a range of different features, in association with the onset of mental derangement, which were driven by a combination of linguistic and information theory features that appeared to be specific to the contrast between acute mania and mental stability. The paucity of existing data relevant to changes in written language in the presence of acute mania suggests that lexical, syntactic and stylometric descriptions of written discourse produced by a cohort of patients with a diagnosis of acute mania will be necessary to support the diagnosis independently and to look for other periods of mental illness of the course of the King's life, and in other historically significant figures with similarly large archives of handwritten documents.

Linguistic Agency and Life-Span Longevity

OBJECTIVES

Agency has been conceptualized as a drive toward mastery, control, and effective self-management. Such an agentic approach to life and its challenges may be life-prolonging, a hypothesis not previously investigated.

METHOD

In four studies, individual differences in agency were assessed in terms of the frequency with which agency-related words (e.g., "achieve," "fix," and "control") were mentioned in archived interviews or speeches (N = 210).

RESULTS

Higher levels of linguistic agency predicted longer life-spans among prominent physicists (study 1: n = 60, β = .30, t = 2.30, p = .025), historians (study 2: n = 69, β = .29, t = 2.47, p = .016), psychologists (study 3: n = 45, β = .32, t = 2.35, p = .024), and American presidents (study 4: n = 36, β = .75, t = 2.74, p = .010) when adjusting for birth year. Considered from another angle, life-span longevity averaged 8 years longer at a high (+1 standard deviation) relative to low (-1 standard deviation) level of the linguistic agency continuum, a marked difference. Follow-up analyses indicated that these results could not be attributed to covarying levels of positive emotion, negative emotion, or social connection, as quantified in terms of other linguistic categories.

CONCLUSIONS

The investigation provides unique support for agentic perspectives on health, and several potential mechanisms are discussed.

Using New Technology to Assess the Academic Writing Styles of Male and Female Pairs and Individuals

Background:

Previous research suggests that there are advantages to writing in groups or in pairs compared with writing individually, and that men write differently from women. However, as far as we know, no one has yet used new technology to assess published academic articles written in these different modes.

Method:

We assembled 80 papers from recent issues of the Journal of Educational Psychology as follows: 21 authored by individual men, 21 by individual women, 19 by pairs of men, and 19 by pairs of women. We then used two computer-based measures to assess various textual features of the Abstracts, the Introductions, and the Discussion sections of these 80 papers.

Results:

Several differences were found between these various parts of the journal articles (e.g., the Discussions were more readable than the Introductions and these in turn were more readable than the Abstracts). However, there were few differences between the writing of pairs or individuals, or between that of men and women.

Conclusions:

There was no real evidence to support the notion that writing in pairs would lead to better quality articles or that there would be differences between the readability of papers produced by men and women. Such differences may occur, however, before peer review.

Automated Assessment of Patients' Self-Narratives for Posttraumatic Stress Disorder Screening Using Natural Language Processing and Text Mining

Patients' narratives about traumatic experiences and symptoms are useful in clinical screening and diagnostic procedures. In this study, we presented an automated assessment system to screen patients for posttraumatic stress disorder via a natural language processing and text-mining approach. Four machine-learning algorithms-including decision tree, naive Bayes, support vector machine, and an alternative classification approach called the product score model-were used in combination with n-gram representation models to identify patterns between verbal features in self-narratives and psychiatric diagnoses. With our sample, the product score model with unigrams attained the highest prediction accuracy when compared with practitioners' diagnoses. The addition of multigrams contributed most to balancing the metrics of sensitivity and specificity. This article also demonstrates that text mining is a promising approach for analyzing patients' self-expression behavior, thus helping clinicians identify potential patients from an early stage.