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. 

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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 “Atypical behaviors found in some mental health conditions negatively affect judgements of deception and credibility” by Lim, A.; Young, R. L. and Brewer, N. (2022), in which authors carry out a study to examine some visible behaviors that we associate with an unbelievable speech, but also, are behaviors that people with some mental conditions can present. 

There is a general belief that what people say does not matter as much as their behavior when they say it, since it could indicate guilt, deception, regret…, etc.

In a 2006 study, 58 participants were asked when they knew someone was lying. The most common answers were: when there is an aversion to the gaze, incoherence, exaggerated body movements, certain facial expressions…

Only one of the elements was related to the content of the message: the inconsistency. Which leads us to think that we focus much more on non-verbal elements than on verbal ones, an idea consistent with numerous previous studies on the subject.

While the use of unreliable cues in lie detection is concerning in itself, it is likely to be problematic for people who have a disability or mental health condition as well.

For example, some people with social anxiety and social communication disorders have difficulty maintaining eye contact, which, rather than being a guilt avoidance mechanism, is more related to fear of social interaction.

On the other hand, repetitive body movements may be behaviors of people with neurodevelopmental disorders or autism spectrum disorders.

However, to an observer who doesn’t know much about the subject, these behaviors can be misinterpreted as signs of nervousness or guilt.

Another indicator of trustworthiness is emotional expressions. For example, there are studies that show that, in a trial, both victims and defendants are perceived as more credible when they show negative emotions (such as crying) rather than neutral (flat affect) or positive emotions (smiles).

Despite the fact that many studies have pointed out that it is necessary to pay attention to verbal signals especially, the stereotype that the most important are the non-verbal ones is very widespread, even for professionals such as police or judges.

This can be explained by attribution theory, which is based on the premise that individuals inherently seek to understand and explain observed behaviors, thus attributing a cause to the behavior.

In this study, authors examine the effect of four cues commonly associated with lying: gaze aversion, repetitive body movements, monologues, and flat affect. These behaviors are selected because they are associated with lying and also because they often appear in people with mental health problems.

It was hypothesized that individuals displaying these behaviors would be perceived as more liars and less credible.

The total sample was a total of 392 people of legal age, gathered through online tools.

They were shown a video of a game, in which one person had to choose whether or not to steal a small amount of money and then convince another person that they had or had not. If they got away with it, they got $50; if not, only 10$. The people in these videos were professional actors with a standardized script.

Results revealed significant effects of repetitive body movements and monologues on perceived deception, and significant effects of flat affect on credibility. It is important, as it could have important practical indications for people who often show these behaviors, for example, people with schizophrenia or mood disorders, people with neurodevelopmental disorders, autism spectrum, among others.

However, contrary to expectations, and also contrary to previous studies, gaze aversion did not have a significant effect on judgments of deception or credibility. It is possible that this happened because in this study this trait was studied individually, while in most studies it is interpreted within a context or accompanied by other behaviors that can give strength to the “lie effect”.

One limitation of the study is that it was not conducted with people with mental health conditions, so authors recommend the direct participation of these populations.

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