Friends of the Nonverbal Communication Blog, this week we present the paper “Nonverbal synchrony in subjects with hearing impairment and their significant others”, by Völter, C.; Oberländer, K.; Mertens, S. and Ramseyer, F. T. (2022), in which authors carry out a study to know which is the level of nonverbal synchrony between people with hearing problems and their partners, or, in general, their loved ones.

Hearing impairment is the third most common chronic disease and has numerous effects on physical, mental and social health, causing a decrease in quality of life in up to 49% of those affected.

Effective communication, which is crucial for social interaction, is very difficult for people with hearing impairment (hereafter referred to as PHI), and can lead to frustration and resentment, which in turn can affect the quality of social interaction.

The problems are numerous and include misunderstandings in communication in general and, more specifically, changes in the frequency and/or type of communication. Conversations are often hampered by loss of spontaneity and difficulty in sharing unexpected small observations in everyday interactions, which has a strong impact on marital relationships, for example. 

It seems that, regarding the communicative relationship between PHIs and their partners, there are three specific risk factors: first, relationship satisfaction; then, the age difference between the couples; and finally, the perception of typically hearing partners about the disability of the other

Because of this, research is trying to propose specific interventions to help PHIs and their significant others to implement more effective coping strategies in their relationships, since interpersonal synchrony is fundamental for human beings, among other things, to constitute social connections and feelings of understanding.

These processes are essential for our development in the social world; in fact, one of the benefits of nonverbal synchrony is that it works as a kind of “social glue” that strengthens the connection between people. And it is important to note that this nonverbal coordination generally occurs in the absence of conscious control. 

In the last decade, nonverbal synchrony has received increasing attention from different areas. For example, from psychotherapy. Nonverbal synchrony provides valuable information about the patient-therapist relationship and their engagement with the sessions. 

Authors mention that an objective method to measure synchrony is motion energy analysis (MEA). Through a certain software, the amounts of pixels changing in the frames are summed and simple approximations of the motion are extracted. 

Until now, the synchrony of nonverbal communication between PHIs and their loved ones has rarely been the focus of research, being related, moreover, to aural rehabilitation. 

One observation obtained a few years ago, in a 2005 study, indicated that if a person perceived their partner’s hearing loss to be low, the relationship was significantly better, with the opposite occurring if the person perceived the impairment to be greater.

In general terms, understanding the etiology of the problem and being able to express emotions and have some nonverbal synchrony seems to be essential for good interpersonal relationships. 

For this research, the authors gathered a total of 39 hearing impaired adults and their significant others. The couples were asked to talk, during 10 minutes and being recorded, about an imaginary party they were going to organize together. 

The results yielded interesting findings. For example, it appears that couples formed between a hearing impaired person and a person with typical hearing ability possess a nonverbal synchrony comparable to the nonverbal synchrony between two people without hearing impairment, and is higher than that generally reported in psychotherapy sessions.

For the data on healthy people and psychotherapy sessions, several studies noted in the original article, from 2011, 2014, and 2021, were taken as references.

The authors’ interpretation, considering this finding, is that many hearing-impaired people have been able to experience a withdrawal from certain social activities and therefore, their social efforts have been able to be devoted more to strengthening their close relationships. 

In addition, it is interesting to note that in heterosexual couples in which the hearing-impaired person is a man, the one who took the communicative leadership position was the female partner. This may reflect that the impact of hearing impairment is greater in these couples.

Another interesting fact is that in couples with a small age difference there is an even greater synchrony. 

Authors point out that more effort and resources are needed to investigate how the communication skills, both verbal and nonverbal, of hearing impaired people can be improved so that they can enjoy a quality of life similar to those with typical hearing ability.

If you want to know more about nonverbal behavior and how it affects personal relationships, visit our Master of Science in Nonverbal and Deceptive Behavior, which you can take in English or Spanish, with special grants for readers of the Nonverbal Communication Blog.

Friends of the Nonverbal Communication Blog, this week we present the paper “Evidence of Phone vs Video-Conferencing for Mental Health Treatments: A Review of the Literature”, by Chen, P. V.; Helm, A.; Caloudas, S. G.; Ecker, A.; Day, G.; Hogan, J. and Jan, L. (2022), in which authors carry out a meta-analysis in which they draw conclusions from previous literature on the positive or negative outcomes of online with video and telephone psychological therapy compared to traditional face-to-face therapy.

The ability to receive mental health care remotely, either by video and audio or by telephone only, has been available since about 1960. However, many therapists felt, even in those years, that this type of care was of lower quality than traditional care.

Precisely this traditional model was forced to change in the early 2020s. The Covid-19 pandemic imposed very drastic measures for the population, including confinement and social isolation. Thus, in-person healthcare was limited and video and telephone modalities were brought to the forefront as patients and therapists sought to continue therapy while adhering to safety and prevention measures. 

However, it is not clear whether, in fact, video and/or telephone care is better than face-to-face or not, or which of the two might be its more direct competition, because their applications have been so disparate. 

For example, from April through June 2020, of all mental health encounters conducted at Veterans facilities in the United States, 63% occurred by telephone, 21% by video, and 14% face-to-face. A survey of the use of telematics by health insurance beneficiaries found that 56% of visits were by telephone only, compared to 28% of visits by video and 16% that were a combination of telephone and video. 

The goal of the article we present this week was to provide a comparative review of the use of telephone and video to provide mental health treatment. 

Authors extracted a number of articles on “video telehealth,” including those published between 2002 and 2022, to get as current a picture as possible, and divided their findings according to different blocks of mental health conditions or problems.

When it comes to anxiety and depression, it appears that video telehealth services may be particularly valuable, as patients diagnosed with a mood disorder are more likely to attend video-conferencing appointments than patients with other diagnoses. 

In addition, both video and telephone have been shown to be effective in reducing symptoms related to mood disorders. Telephone therapy for depression is more effective than no treatment, or even more effective than treatment as usual; and treatments for anxiety conducted by telephone are at least moderately effective in reducing symptoms compared to no treatment or traditional treatment.

In patients with post-traumatic stress disorder, the effectiveness of video treatment is comparable to in-person care, and results in symptom improvement. For telephone treatments, patients also reported a decrease in symptoms.

It appears that patients, on the other hand, are less satisfied with therapists when it comes to telephone care and, in addition, treatments via video had higher dropout rates. 

For substance use treatments, there are no significant differences in effectiveness when patients receive video or telephone treatment compared to in-person care. Patients who received in-person or video group therapy had comparable positive rates on their urine screening tests, similar duration of abstinence, and similar amounts of time spent in intensive counseling.

Studies of remotely delivered smoking cessation treatments show that no differences in treatment effectiveness have been found between telephone therapy, video therapy, and face-to-face therapy in terms of abstinence rates, cigarettes per day, and quit attempts. Overall, smoking cessation therapies can be delivered very effectively by non-face-to-face means. 

For obsessive-compulsive disorder, both telephone and video are viable modalities of care for its treatment. In two controlled trials, we compared telephone and face-to-face treatment and found that, for both, symptom reduction persisted 6 months after treatment. In addition, those who received treatment for OCD by telephone reported high satisfaction with their treatment compared to in-person patients. 

Although more comparative studies are needed between video therapy and audio therapy, it can be concluded that both have a very similar percentage of effectiveness to face-to-face therapy. However, it is necessary to dedicate more efforts to study aspects such as nonverbal communication in non face-to-face therapy, for example, in order to establish solid relationships between patient and therapist.

If you want to know more about nonverbal behavior and how it affects personal relationships, visit our Master of Science in Nonverbal and Deceptive Behavior, which you can take in English or Spanish, with special grants for readers of the Nonverbal Communication Blog.

Friends of Nonverbal Communication Blog, this week we present the paper “Experiences of mimicry in eating disorders”, by Erwin, S. R.; Liu, P. J.; Nicholas, J.; Rivera-Cancel, A.; Leary, M.; Chartrand, T. L. and Zucker, N. L. (2022), in which authors carry out a study to know how mimicry and nonverbal imitation works in social relationships when it comes about people who suffer from eating disorders. 

In general, it has been shown that comparing oneself to others contributes to an increased likelihood of eating disorders. One example of this is in pro-anorexia online communities, where people share photos of the results of their dietary restrictions, as well as highly dangerous and health-damaging strategies designed to lose weight. 

Experts suggest that comparison with others may compromise the effectiveness, and possibly the safety, of inpatient treatment settings, and even go further and affect those who are not hospitalized, causing, for example, patients to learn new harmful behaviors. 

Despite compelling examples of explicit mimicry being problematic, mimicry has not been systematically studied with an eating disordered population.

One potentially fruitful area of research focuses on how people with a history of an eating disorder respond to being mimicked by others. For, while examples of social networks and contagion in a treatment setting describe potentially dangerous mimicry processes, there are others that have been associated with prosocial behaviors and increased affiliation among typically developing individuals.

Previous research on mimicry found that engaging in similar behavior creates feelings of empathy and relatedness among interactants. Other research found that when therapists mimicked the body position of their patients, the patients perceived a greater level of expressed empathy on their part.

Imitation processes often require both physical and emotional closeness, a certain degree of intimacy in relationships. However, people with anorexia and/or bulimia have been reported to experience interpersonal difficulties characterized by mistrust, negative interactions and conflicts with others. For people with restrictive eating behaviors, fear of intimacy may be characterized by avoidance of expressing feelings of personal importance to others. 

Since intimate interpersonal relationships necessarily involve some degree of dependence on another person, avoiding relationships makes these individuals feel more secure. However, it is also detrimental to them, since secure and close relationships promote recovery from eating disorders. Therefore, it is important to identify the barriers they create to developing these intimate relationships.

On the other hand, evidence of early disruptions in attachment may contribute to this reluctance toward intimacy. More specifically, insecure attachment with early caregivers. 

In summary, people with eating disorders possess a number of characteristics that make their interpersonal relationships different, more complex, and influenced by multicausal factors. 

The present study examines how adults with a history of an eating disorder react when a therapist subtly mimics them. The therapist subtly mirrored the participants’ postures, movements, and gestures. In addition, there was a control group, that is, a group of participants whom the therapist did not try to imitate. 

There was a final sample of 118 people, all of them women, with an average age of 21 years. 

It was found that, in all groups, the participants who were not imitated rated the therapist as nicer, and the interaction as smoother, than the participants who were imitated. 

There is a large body of research supporting that subtle mimicry increases comfort, however, it is possible that these prosocial influences have been downplayed due to certain interpersonal factors. 

Previous research has shown that, compared to healthy people, people with eating disorders are unconsciously more attentive to the bodies of others. It could be understood that the study participants may have been more sensitive to mimicry due to a hypervigilance inherent to the disorder.

Another explanation may be that, given the fears of intimacy and negative evaluation discussed above, it is possible that the experience of nonverbal mimicry is threatening due to possible rejection, contributing to increased scrutiny in interactions. 

Authors encourage further research on this topic, arguing that it is very important to continue to investigate how the verbal behavior or perception of verbal behavior of people with conduct disorders differs from the verbal behavior or perception of verbal behavior of healthy people to better understand their social and cognitive functioning.

If you want to know more about nonverbal behavior and how it affects personal relationships, visit our Master of Science in Nonverbal and Deceptive Behavior, which you can take in English or Spanish, with special grants for readers of the Nonverbal Communication Blog.

Friends of the Nonverbal Communication Blog, this week we present the paper “Communicatie deficits associated with maladaptive behavior in individuals with deafness and special needs”, by Fellinger, J.; Dall, M.; Weber, C. and Holzinger, D. (2022), in which the authors carry out a study to know whether a relationship between being deaf and having a maladaptive social behavior exists, considering quality communication deficits as another factor.

Prevalence rates of hearing loss range from 15-25% of the adult population. Hearing loss that begins before language acquisition can have a tremendous impact on communication and socioemotional and cognitive development.

The early years of life are critical for language and general development. If a child does not have sufficient access to spoken or signed language during this period, it can have lasting negative effects on his or her future ability to learn language, and this language deprivation can lead to social isolation, which in turn severely affects mental health throughout life. 

Approximately 33-50% of people with prelingual deafness or hearing difficulties in general have additional disabilities, for example, neurodevelopmental disorders such as autism spectrum disorders or attention deficit hyperactivity disorder, or other neurological disorders. 

This fact makes communication and mental health difficulties even more pronounced. The combination of deafness and intellectual disabilities is a double risk and has a much greater impact on people’s lives. 

In a Danish study, children with deafness and special needs were three times more likely to suffer from psychosocial problems compared to children with deafness but no additional needs. 

The emotional and behavioral problems of deaf children and how these relate to language are, in general, well documented in the literature, but it is true that these two elements associated with social communication and maladaptive behavior are not as popular, which is why the authors opted for the convergence of these issues. 

Communication, with its verbal and nonverbal elements, plays an essential role in our lives, as we have already pointed out on many occasions, but also in neurocognitive processes, including attention, learning, social norms…. 

In the literature, when we speak of maladaptive behavior, we refer to behavior that interferes with an individual’s daily life activities or with his/her ability to adapt and participate in environments. Using this definition, the authors conducted an analysis about the prevalence of maladaptive behavior and how it is associated with verbal and nonverbal language skills and social communication in adults with deafness and special needs. 

The sample consisted of 61 participants with deafness and intellectual disability and/or other neurodevelopmental disorders. All participants had in common that, before the age of 6 years, when they were enrolled in a school for children with deafness, they had had almost no access to sign language. They grew up without adequate access to language and with only minimal expressive language. In most families only a limited number of simple signs and gestures were used, leading to severe language deprivation during childhood. 

The findings showed that there was a prevalence rate of high maladaptive behavior of 41% and a particularly high score in 18% of the participants. This is quite a high rate, considering that the participants were living in an environment that had been adapted to their needs.

Language delays, especially in sign language, were found to be significantly more pronounced the more intense the patient’s neurological difficulty. 

Language and social communication skills were shown to explain 14% of the variance in the tendency to have more or less maladaptive behaviors, confirming the authors’ hypothesis that it has a fairly strong influence. 

The results emphasize the importance of early access to language, whatever the child’s circumstances, and the constant promotion of verbal and nonverbal communication skills, as those with better language and social communication skills demonstrated lower levels of maladaptive behavior. 

In addition, the findings highlight the need to foster the development of social communication in all individuals, regardless of cognitive functioning. 

If you want to know more about nonverbal behavior and how it affects personal relationships, visit our Master of Science in Nonverbal and Deceptive Behavior, which you can take in English or Spanish, with special grants for readers of the Nonverbal Communication Blog.

Friends of the Nonverbal Communication Blog, this week we present the paper “Conditions Influencing Effective Nurse Nonverbal Communication With Hospitalized Older Adults in Cameroon”, by Wanko-Keutchafo, E. L.; Kerr, J.; Baloyi, O. B. and Duma, S. E. (2022), in which authors carry out a study in Cameroonian hospitals to know which factors affect the quality of nonverbal communication between elder patients and nurses that are in charge of their care. 

Elder adults make up a very significant proportion of the population worldwide, and are often the forgotten ones.

These adults have reached the figure of more than 32 million people in sub-Saharan Africa in 2019 (the context of this article), and are projected to reach 101 million by 2050, which is an increase of 218%.

This rapid growth means that, over time, there will be a greater need for medical care for the elderly, and nurses are expected to interact with these patients more than with any other. 

However, patients have a wide range of personal experiences that influence their perceptions, which increase in diversity as they age. 

In addition, elder adults may experience auditory deficits, changes in attention and information encoding, which can restrict their interaction, participation and effective communication. All this indicates that good communication skills will be essential in nursing. 

As we have said on numerous occasions, communication is the core of human society and sustains community life. 

In healthcare settings, effective communication is the foundation of any relationship. It is important for understanding patients’ needs and supporting the improvement of their health and well-being. 

Communication, as we already know, has both verbal and nonverbal components and is therefore more complicated than the simple transmission of information. 

The nonverbal aspect refers to facial expressions, how we behave in general, the use of touch, space and distances, how we move our body, physical appearance, silences and the tone of our voice… among many other elements. 

The factors that influence communication between nurses and patients seem to be divided into those related to the nurse, the patient, the environment, the physical or the psychological aspects. 

Authors have identified some within these groups. For example, nurse-related factors could be job dissatisfaction, a high workload or insufficient time. Regarding the environment, we could point out the fact that it is a busy, hectic place. Within the physical factors we could mention the space in the rooms, the noise or the lack of privacy. And in the psychological factors, anxiety, level of self-esteem, disorders, and even religion. 

When communication is effective, patients feel taken care of, respected and more able to describe their concerns. 

Age discriminatory attitudes, prejudices and stereotypes based on age, such as condescending speech, are also worth investigating. 

In this article, authors aim to describe the conditions that influence nurses’ effective nonverbal communication with hospitalized elder adults in the Cameroonian context. 

The study was conducted in two public referral and teaching hospitals in Cameroon. Ten female nurses, four students, two managers and one nursing assistant participated, allowing their behavior in dealing with elderly patients to be observed. Data were collected between July 2018 and January 2020. 

The findings revealed that the most influential factors were those related to nurses. 

It appears that the most determinant ones are beliefs and prejudices, their personality traits, personal experiences, and their love and vocation for their work. 

On the other hand, it appears that religious beliefs facilitate positive verbal communication between nurses and patients; however, this is not always the case, as a 2019 study reported that some Muslim patients expected nurses to bow to them when caring for them and, if they did not, they were perceived as insolent. 

Nurses’ awareness of their nonverbal behavior is also very important, since the more they seem to be mindful of conveying positive feelings, the more effective they appear to be. This point is, of course, influenced by experience. 

It is suggested that, in order to increasingly improve nonverbal communication between nurses and patients, educational programs for health professionals should be created, promoting mainly empathy.

If you want to know more about nonverbal behavior and how it affects personal relationships, visit our Master of Science in Nonverbal and Deceptive Behavior, which you can take in English or Spanish, with special grants for readers of the Nonverbal Communication Blog.

Friends of the Nonverbal Communication Blog, this week we present the paper “‘You never get a second chance’: First impressions of Physicians depend on their Body Posture and Gender” by Grün, F. C.; Heibges, M.; Westfal, V. and Feufel, M. A. (2022), in which authors carry out a study to know whether open and/or closed postures influence the perception we have about doctors, as well as their gender. 

The way a patient perceives his or her physician influences a multitude of factors that determine the success of treatment, such as the information shared between the two, patient-physician communication, patient satisfaction, medication adherence and, ultimately, health outcomes. 

First impressions lay the foundation for successful patient-physician interactions, particularly when encounters are brief, which is often the case for many health care visits. 

Recently, empirical research has begun to ask how nonverbal behavior, related to body postures, can affect patients’ first impressions of physicians. 

A 2019 study, demonstrated that physicians who adopt high power postures, put another way, open postures (for instance, arms on hips), are more likely to be perceived as competent, than when they assume low power postures, that is, closed postures (arms crossed), however, it did not take gender into account. This same study also concluded that empathic ability was also related to perceived physician competence. 

The quality of the doctor-patient interaction is not only influenced by the communication of information about the patient’s health, but also by other elements, including the nonverbal one. 

The influence of physicians’ physical appearance has recently been studied in relation to their clothing, the ethnic group to which they belong or their gender, but the authors focus in this case on postures and, moreover, on these related to gender.

In 2002, a study reported that nodding the head, leaning forward, and uncrossed legs and arms lead to greater patient satisfaction. 

With respect to the clinical setting, there is also research showing that physician-patient interaction is influenced by gender, and patients appreciate behavior that fits stereotypes, such as women who speak in a soft voice. 

Other studies show conflicting results on gender regarding the latter idea. One meta-analysis showed that patients generally prefer to interact with male physicians, but there is other research indicating that gender does not exist, and others saying that women prefer to be seen by female gynecologists. 

In a nutshell, the inconsistent findings of the effects of gender on physicians’ perceptions call for further research on the topic. 

In the research at hand, authors focused on open postures and closed postures, and introduced gender as an additional variable, to study patients’ perceptions of physicians.

They gathered a total of 200 North American adults and conducted an online survey. The survey material consisted of photographs of doctors in open and closed postures, so that there were male doctors with open and closed postures, and the same for female doctors. In the online survey, participants were asked to rate their perceptions of these physicians. 

The results obtained showed that male physicians tend to be perceived as more professionally competent when they assume open body postures and, in addition, seem to encourage patients to take an active role in the patient-physician interaction.

On the other hand, female physicians who assumed open postures were perceived as more professionally competent than those with closed postures, but no more so than male physicians. And, interestingly, female physicians were rated more positively in social competencies when they had closed postures. 

Plus, male physicians in open postures and showing empathy tended to be perceived as warm, as well as competent. 

In other words, it seems that women tend to have high scores in competence when they show open postures, but low scores in warmth; this would not be the case with male physicians, who would have high scores in both. 

Body postures influence patients’ perceptions. Therefore, in addition to training the verbal aspects of interaction, medical professionals should be aware of the nonverbal dimensions and incorporate them into their day-to-day work, in order to have greater control of their patients’ perceptions of them.  

If you want to know more about nonverbal behavior and how it affects personal relationships, visit our Master of Science in Nonverbal and Deceptive Behavior, which you can take in English or Spanish, with special grants for readers of the Nonverbal Communication Blog.

Friends of the Nonverbal Communication Blog, this week we present the paper “Gender Biases in Estimation of Others’ Pain” by Zang, L.; Reynolds Losin, E. A.; Ashar, Y. K.; Koban, L. and Wager, T. D. (2021), where the authors carry out two experiments to know if women feel or express more pain than men, or if it happens the other way round. 

Accurately estimating the pain of others based on nonverbal signals is an essential aspect of interpersonal communication, since it is the basis of empathy and care.

Acknowledging the pain of others is an increasingly valuable interpersonal skill, both for doctors and for the rest of the population.

Although pain is usually assessed through self-reports, recognition of facial expressions of pain is a very important part of the assessment.

Because expressions of pain are communicative behaviors, observers’ interpretations of those expressions are a crucial aspect of pain communication. These interpretations are affected not only by the characteristics of the expressions of pain, but also by the observer’s knowledge and biases about pain and the characteristics of those who suffer from it.

For example, several studies have shown that psychological treatment is more likely to be recommended for women suffering any kind of pain than for men, who are prescribed painkillers. Therefore, female patients take longer to receive analgesic medication. However, it is important to note that there are other studies of gender bias in pain management that show the opposite pattern, or no significant gender difference.

Despite clinical evidence of underestimation and undertreatment of pain in female patients, laboratory results on gender bias have been inconsistent and, in fact, some studies have found that women felt more pain than men, having note their facial expressions.

That is, it seems that a large part of the results in the evaluation of pain is decided by facial expressions. Therefore, controlling the objective measures of facial expressiveness in general, and of pain in particular, is an important step in stopping the bias in the perceiver.

In this context, there are also gender stereotypes related to pain, for example, that women complain more than men and do not accurately report their pain, or that men are more sensible and when they complain about their pain, it is real. These beliefs would affect pain assessment and treatment.

To delve into the subject, authors conducted two experiments. First, they compared differences in pain estimation in men and women, controlling for the same level of facial expressiveness and also controlling for patients’ self-reported pain. This is necessary because the amount of pain patients experience is highly variable, also because the facial response to pain is one of the most salient cues we use to estimate pain, and lastly, because the expressiveness of patients can affect observer estimates through empathy.

For experiment 1, 50 volunteers participated and had to watch a series of videos of faces of people experiencing pain. Each video was coded through the FACS system, and the action units AU4 (lowering of the eyebrows), AU6 and 7 (contraction of the eyelids), AU9 and 10 (contraction of the elevator) and AU43 (closure of the eyes) were especially relevant. These action units are representative of the emotion of pain.

In addition, the videos included a self-report from the patients where they rated their own pain.

The objective of this experiment was to test whether the sex of the patients affects the estimation of pain according to the observers. The hypothesis was that if the intensity of facial expressions was not controlled, female patients would be perceived as being in more pain than male patients. If, on the other hand, there were similar levels of expression and self-reported pain, it would be the male patients who would be perceived as having more pain.

The results did not support the hypotheses. Male and female patients were not perceived to have different degrees of pain before controlling pain, facial expressiveness, and patient self-reported pain. However, female patients were perceived to have less pain than male patients when facial expressions and self-reports were controlled.

The second experiment was very similar, except that opinion questionnaires about pain treatment and gender stereotypes were added.

In general, women’s pain was underestimated relative to self-reported pain, while men’s was overestimated. In addition, female patients, according to observers, would benefit more from psychotherapy than male patients.

The underestimation of pain and psychologization in the treatment of women’s pain could have very negative side effects on their health. Therefore, the existence of these stereotypes must be taken into account and act accordingly, so that both men and women receive the treatment they need and their health is not harmed.

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Friends of the Nonverbal Communication Blog, this week we present the paper “Communication training is inadequate: the role of deception, non-verbal communication and cultural proficiency” by Baugh, A. D.; Vanderbilt, A. A. and Baugh, R. F. (2020), in which authors explain why they consider is necessary to improve the communicative training in the context of medicine. 

This week’s paper starts from the next question: are we training our doctors well, so that communication is effective with all types of patients?

Health systems in all societies have an interest in improving the ability of their physicians to provide competent care to all users of the system, regardless of their culture.

The United Nations has recognized that the inequalities faced by marginalized populations must be addressed, and also has placed the issue on its agenda.

More than 20% of displaced or marginalized people say they have given up seeking medical care at all, due to difficulties they found along the way and previous bad experiences too, demonstrating the importance of culturally sensitive care. In addition, they identified racism as one of the main causes of dissatisfaction.

What the authors argue, considering all these ideas, is that communication failures underlie these problems, and are rooted in the changing and heterogeneous demographics of today’s culture, but also attitudes of clinicians. Moreover, they consider that effective intercultural communication stems from an awareness of cultural differences and a genuine desire to communicate actively and correctly.

For this, it is important to bear in mind that socialization during childhood imparts values ​​and social tendencies that take root in us and guide our behavior in life, despite education, subsequent experiences, etc.

Medical students often lack intercultural exposure, due to the tendency toward residential, economic, and cultural self-segregation. In the absence of this, the tendency to privilege one’s own predominates and a negative effect on intercultural attitudes is presaged when exposed to diversity. And rising inequality will only make matters worse.

Communication, a fundamental pillar of human social interaction, and therefore also for the practice of medicine, requires the alignment and synchronization of the speaker and the listener.

Effective communication between two people requires the overlapping of verbal and non-verbal cues, which can sometimes be culturally specific.

Healthcare must aspire to something bigger: the creation of a shared reality between doctor and patient.

Cultural influences arise as a result of many factors: ethnic origin, religion, age, socioeconomic status, or educational level among others.

Both the aspiration of achieving a shared reality, as well as the complexities inherent in the practice of medicine and cultural influences, make relying solely on verbal or non-verbal signals an unsuccessful strategy, because both are necessary.

For example, due to most nonverbal communication being unconscious, signals that may not be appropriate can be used by default, consequently frustrating attempts to improve communication.

There is also the point that damage to doctor-patient relationships is also related to the patient’s ability to perceive dishonest communication.

Incongruous non-verbal behavior or communication is what underlies most lie detection. For example, there are detectable differences based on the activation or not of certain muscles of the face to know if a smile is fake or genuine (the so-called “Duchenne smile”).

Patients notice physicians’ nonverbal inconsistencies and may understand them as signs of dishonesty.

In addition, medical encounters represent tense or risky situations, which make the detection of insincerity more likely.

Students have been found to acquire cultural fluency more slowly when done in small doses, for example, in medical encounters; while the opposite happens if they spend time immersed in a different culture. Furthermore, the greater and more extensive the previous exposure and interaction with another culture, the less unconscious biases there will be.

There are some schools that offer medical language courses, recognizing the relationship between language and culture, however, they have limited accessibility and it would be very positive to facilitate it more.

Medical schools should be trained to redesign communication training so that students are more aware of these weaknesses and how to change them.

If you want to know more about nonverbal behavior and how it influences our personal relationships, visit our Nonverbal Communication Certificate, a 100% online program certificated by the Heritage University (Washington) with special discounts for readers of the Nonverbal Communication Blog. 

Friends of the Nonverbal Communication Club, this week we present the paper “The Influence of Face Gaze by Physicians on Patient Trust: an Observational Study” by Jongerius, C.; Twisk, J. W. R.; Romijn, J. A.; Callemein, T.; Goedemé, T.; Smets, E. M. A. and Hillen, M. A. (2021), in which authors wonder whether the fact that the doctor looks at his/her patient affects positively or negatively to their relationship and trust.

Gaze is a very important element in nonverbal communication. Between other things, it is useful to transmit information about how we feel, if we are paying attention to what people are saying, and even we use it to direct a conversation.

If we consider it is so significant in relationship with others, it would also be relevant at the doctor’s, because that is a social meeting too.

For instance, it is known that during medical consultations, patients follow the physician’s gaze towards the computer screen. Plus, the physician’s gaze has also been related to better patients’ medication adherence and compromise.

The opposite has been related to a reduction of trust of patients in their physicians.

Why is important to study this topic?

Mainly, because we are using technology to an increasing extent to change our presential medical citations to remote meetings, just as we do with our friends or family. And if technological methods reduce eye contact between physician and patient, it may eventually harm patient’s trust in their physician.

One more question appears. In the past few years an increase of mental diseases has been observed, such as depression or anxiety. That is why authors want to give a brief insight of how face gaze between physician and patient could affect to people who suffer from social anxiety, which is the third most common mental disorder.

In order to study face gaze by physician on patient effects, authors made an experiment in which 16 doctors meet a hundred patients. These physicians wore glasses with eye-tracking technology.

After the consultation, patients made a series of questionnaires so authors could measure their trust in the physicians and the level of empathy perceived. They also answered a test to know if they suffered from social anxiety or not. Besides, before and after the consultation they were asked about their distress, to check if it had gone better or worse after the meeting with the doctor.

Results were surprisingly the opposite to the expected.

According to the experiment, more face gaze is associated with lower trust from patient to the physician.

Furthermore, no relation was found between physician face gaze and patient’s perception of physician empathy or patient’s distress.

It seems that social anxiety it is not a sufficiently relevant factor to shed significative information to the experiment, but authors point out that patients did not obtain high results in the anxiety test, so that may be an explanation. Further investigations should be made to study this aspect.

These results are shocking for the authors, and so they are for most of us. In popular beliefs it’s common the idea that when a doctor looks at his/her patient’s face, the bond between them is stronger and their relationship, better.

This was confirmed by previous research. However, these studies assessed face gaze using less objective methodologies, such as observer-based coding of video recordings.

One of the hypotheses that authors throw to explain these results is the so-called “eye contact effect”.

This means that perceived gaze affects neurobehavioral responses and cognitive processing. These responses to gaze would include higher bodily self-awareness and a decreased capability to perform cognitive tasks. Namely, the feeling of being observed could lead to decreased trust in the physician because the patient feels overly observed by him/her.

A couple of limitations are observed in the study, as the previously mentioned which was related to the anxiety. Another would be the possibility of a Hawthorne effect, meaning that the results may have been biased because physicians were aware of being observed. It must be mentioned that authors did not measure the face gaze of the patient towards the physician, because they did not want to burden patients. However, this should be studied in further investigations because the level of face gaze in a conversation depends on all people involved in the interaction.

These experiment’s results are against the society’s general belief, and scientific community’s in particular. It was believed that face gaze from physician to patient was, without doubts, beneficial for the latter and for improving their relationship and the trust between both.

Nevertheless, authors point out the need to delve into this question, making research that correct these mentioned limitations, so conclusions could be used to make better relations between physicians and patients.

NonVerbal Communication Blog