Friends of the Nonverbal Communication Blog, this week we present the paper “Nonverbal Synchrony: An Indicator of Clinical Communication Quality in Racially-Concordant and Racially- Discordant Oncology Interactions”, by Hamel, L. M.; Moulder, R.; Ramseyer, F. T.; Penner, L. A.; Albrecht, T. L.; Boker, S. and Eggly, S. (2022), in which authors use two previous studies to know how nonverbal synchrony affects the communicative process of the interactions between doctors and patients when their races match and when they do not match.

Communication, both verbal and nonverbal, is the key to social interactions in all areas, including healthcare.

Good, high-quality patient-physician communication is associated, as we have noted in previous articles, with good adherence to treatment. Conversely, poor communication can lead to poorer treatment outcomes, with consequences such as discontinuity of care, patient dissatisfaction, and higher costs overall.

Unfortunately, it appears that the quality of clinical care is also influenced by patient race. Black patients, for example, would experience poorer quality communication more frequently compared to white patients.

For oncology cases, previous research indicates that physicians tend to be less patient-centered, verbally more dominant, more confrontational, and also give less information during interactions with black patients.

Research has consistently demonstrated the relationship between verbal and nonverbal doctor-patient communication and patient health outcomes, considering elements such as trust, satisfaction, understanding, symptom resolution….

For example, it has been shown that, when it comes to focusing on the patient, having interactions with him/her, developing an empathic relationship and being aware of any psychological problems the patient may have, eye contact is a great ally.

Another example of the effect of nonverbal communication is that the authors’ team observed that, in an oncology setting, if patients and physicians smile and show “open to interaction postures”, the results of the interaction will be more positive.

In this week’s study, authors wanted to investigate the dynamic, interdependent, and unconscious nature of nonverbal interpersonal communication during oncology interactions with black patients in racially discordant contexts and, on the other hand, with white patients in racially concordant contexts.

And how did they do this? They used software that was able to measure the synchrony of patient-physician interactions based on the movement coordination. It is understood that the greater the synchrony, the greater the likelihood that communication is occurring effectively and to the benefit of both parties.

People synchronize more with those with whom they have existing positive relationships, or with those with whom they want to develop them. Higher levels of nonverbal synchrony result in more subsequent positive affect and sympathy.

The analysis in this article was conducted using data from two recent studies. The first was conducted between 2002 and 2006 and the second between 2012 and 2014. Both studied different aspects and influences of nonverbal communication in oncology patients and included video data.

The total number of patients analyzed reached more than 220 people. Numerous research studies have shown that unconscious processes affect the outcome of human interactions. Authors’ findings suggest that, among black patients and nonblack doctors, unconscious processes were operating to overcome possible cultural and racial barriers and, thus, help create greater nonverbal synchrony. These motivations may have been absent in racially concordant interactions between black physicians and black patients.

There is evidence that people with higher levels of implicit racial bias may work harder to control it during interracial interactions.

On the other hand, it appears that black patients who had experienced higher levels of prior discrimination were more verbally active when communicating with their white or nonblack physicians, which may suggest that black patients may use verbal and nonverbal strategies, consciously and unconsciously, to be more in control of the medical interaction.

Ideally, racial discordance or concordance would not affect the quality of communication in oncology interactions. The reality is, however, quite different. The authors concluded that there are differences in nonverbal communication that are almost certainly beyond conscious control.

An important idea to keep in mind for future studies is that one should study whether the differences found in nonverbal synchrony in racially discordant and concordant interactions replicate in other types of medical interactions. If they do, then why these differences in Healthcare occur and how to combat them should be investigated. 

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 “The Impact of Poor Nonverbal Social Perception on Functional Capacity in Schizophrenia”, by Chapellier, V.; Palivdou, A.; Maderthaner, L.; von Känel, S. and Walther, S. (2022), in which authors carry out a study with people with schizophrenia to know if their ability to recognize nonverbal cues is the same as that of people who do not live with the disease.

Schizophrenia is a severe psychiatric disorder, affecting almost 1% of the world’s population. It is characterized by delusions, hallucinations and, in general, negative symptoms that impair social cognition. 

Generally, by social cognition we mean the psychological processes that allow us to decode the behaviors and intentions of others. Moreover, its impairment is not only frequent in patients with schizophrenia, but also in patients with psychosis. 

Social cognitive deficits are assumed to be a stable trait that precedes and thus helps predict the onset of schizophrenia. And furthermore, it informs on the relapse frequency of patients. 

Therefore, these deficiencies play a key role, not only in the development of the disorder but also in the functional outcome of patients. 

Nonverbal social perception, which is the ability to decode relevant, nonverbal interpersonal cues, appears to be impaired in patients with schizophrenia, according to several studies from some years ago (reference to these can be found in the original article). 

The correct interpretation of, for example, facial expressions and body movements, greatly limits the communication of patients with schizophrenia: they have a greater tendency to perceive ambiguous gestures and direct gaze as self-referential or even threatening. 

Despite attempts to understand these social cognitive deficits in people with schizophrenia, the role of nonverbal social perception remains poorly understood. 

A 2002 study mentions that impaired nonverbal social perception is related to symptoms of disorganization, which, in turn, could be associated with schizophrenia.

In addition, deficits in nonverbal social perception have been associated in some studies with poor functional outcome, and this in turn is related to poor adaptive skills relevant in the real world for people’s daily functioning. 

The aim of this study was to determine whether patients with schizophrenia are more successful performing nonverbal cue recognition tasks, in addition to briefly exploring the above ideas. 

To do so, they gathered 41 clinical patients suffering from schizophrenia and 30 people without the disease to act as a control group. Data were collected between December 2019 and June 2021. 

Nonverbal social perception was assessed using sound videos and psychologically valid scales with subscales to obtain information about accuracy in interpreting facial expressions, emotional prosody, and body movements. 

Authors obtained data that allowed them to confirm that patients with schizophrenia do, indeed, have worse accuracy in nonverbal social perception compared to the control group. 

Most interestingly, their performance worsens markedly when it comes to recognizing prosodic cues. Regarding other channels of nonverbal expression, the differences were not very marked. 

Moreover, as authors expected, impaired nonverbal social perception was associated with limited functional ability. This has repercussions in, for example, poor self-care skills, few activities in general or impaired work skills. 

Thus, the difficulty in decoding nonverbal cues in patients with schizophrenia is key to their ability to function normally in daily life. 

Authors propose that future studies should attempt to determine if there is any type of intervention that will alive these nonverbal perception deficits. This is tremendously important for improving the social and community functioning of people living with schizophrenia, as well as helping them to have an overall higher quality of life, similar to those who are fortunate enough not to have schizophrenia. 

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.

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