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Soma CS, Knox D, Greer T, Gunnerson K, Young A, Narayanan S. It's not what you said, it's how you said it: An analysis of therapist vocal features during psychotherapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023; 23:258-269. [PMID: 36873916 PMCID: PMC9979575 DOI: 10.1002/capr.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 11/07/2022]
Abstract
Psychotherapy is a conversation, whereby, at its foundation, many interventions are derived from the therapist talking. Research suggests that the voice can convey a variety of emotional and social information, and individuals may change their voice based on the context and content of the conversation (e.g., talking to a baby or delivering difficult news to patients with cancer). As such, therapists may adjust aspects of their voice throughout a therapy session depending on if they are beginning a therapy session and checking in with a client, conducting more therapeutic "work," or ending the session. In this study, we modeled three vocal features-pitch, energy, and rate-with linear and quadratic multilevel models to understand how therapists' vocal features change throughout a therapy session. We hypothesized that all three vocal features would be best fit with a quadratic function - starting high and more congruent with a conversational voice, decreasing during the middle portions of therapy where more therapeutic interventions were being administered, and increasing again at the end of the session. Results indicated a quadratic model for all three vocal features was superior in fitting the data, as compared to a linear model, suggesting that therapists begin and end therapy using a different style of voice than in the middle of a session.
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Affiliation(s)
- Christina S Soma
- Department of Educational Psychology, University of Utah, Salt Lake City, (UT) USA
| | - Dillon Knox
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, (CA,) USA
| | - Timothy Greer
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
| | - Keith Gunnerson
- Department of Educational Psychology, University of Utah, Salt Lake City, (UT) USA
| | - Alexander Young
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
| | - Shrikanth Narayanan
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
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Perceiving Assertiveness and Anger from Gesturing Speed in Different Contexts. JOURNAL OF NONVERBAL BEHAVIOR 2022. [DOI: 10.1007/s10919-022-00418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reh S, Van Quaquebeke N, Giessner SR. The aura of charisma: A review on the embodiment perspective as signaling. LEADERSHIP QUARTERLY 2017. [DOI: 10.1016/j.leaqua.2017.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Szameitat DP, Darwin CJ, Wildgruber D, Alter K, Szameitat AJ. Acoustic correlates of emotional dimensions in laughter: Arousal, dominance, and valence. Cogn Emot 2011; 25:599-611. [DOI: 10.1080/02699931.2010.508624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nicolai J, Demmel R, Farsch K. Effects of mode of presentation on ratings of empathic communication in medical interviews. PATIENT EDUCATION AND COUNSELING 2010; 80:76-79. [PMID: 19945815 DOI: 10.1016/j.pec.2009.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 10/21/2009] [Accepted: 10/24/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To test the impact of nonverbal behaviour on the assessment of a clinician's level of empathic communication. METHODS One hundred volunteers were asked to assess a clinician's level of empathic communication using the Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM). Participants were randomly assigned to three groups differing with regard to the level of nonverbal information made available to them. Participants either watched a simulated medical interview, listened to an audio-only version of this interview, or read a transcribed version of the interview. RESULTS Compared to watching a video and listening to an audiotape, respectively, reading a transcribed version of the interview produced lower empathy ratings and interrater reliabilities. CONCLUSIONS The findings suggest that assessments of a clinician's level of empathic communication may differ according to the level of nonverbal information made available to the raters. PRACTICE IMPLICATIONS Focusing on the verbal level of communication alone ignores the fact that empathy can be expressed through nonverbal means. Hence, nonverbal channels need to be taken into account in addition to the verbal channel when conducting research on empathic communication in health care.
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Affiliation(s)
- Jennifer Nicolai
- Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany.
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Street RL, Gordon H, Haidet P. Physicians' communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor? Soc Sci Med 2007; 65:586-98. [PMID: 17462801 PMCID: PMC2811428 DOI: 10.1016/j.socscimed.2007.03.036] [Citation(s) in RCA: 350] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Indexed: 11/18/2022]
Abstract
Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N=29) and patients (N=207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patient-centered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, TAMU 4234, College Station, TX 77843-4234, USA.
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Ishikawa H, Hashimoto H, Kinoshita M, Fujimori S, Shimizu T, Yano E. Evaluating medical students' non-verbal communication during the objective structured clinical examination. MEDICAL EDUCATION 2006; 40:1180-7. [PMID: 17118111 DOI: 10.1111/j.1365-2929.2006.02628.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Non-verbal communication (NVC) in medical encounters is an important method of exchanging information on emotional status and contextualising the meaning of verbal communication. This study aimed to assess the impact of medical students' NVC on interview evaluations by standardised patients (SPs). METHODS A total of 89 medical interviews in an objective structured clinical examination (OSCE) for post-clerkship medical students were analysed. All interviews were videotaped and evaluated on 10 non-verbal behaviour items. In addition, the quality of the interview content was rated by medical faculty on 5 items and the interview was rated by SPs on 5 items. The relationships between student NVC and SP evaluation were examined by multivariate regression analyses controlling for the quality of the interview content. RESULTS Standardised patients were likely to give higher ratings when students faced them directly, used facilitative nodding when listening to their talk, looked at them equally when talking and listening, and spoke at a similar speed and voice volume to them. These effects of NVC remained significant after controlling for the quality of the interview content. CONCLUSIONS This study provided evidence of specific non-verbal behaviours of doctors that may have additional impacts on the patient's perception of his or her visit, independently of the interview content. Education in basic NVC should be incorporated into medical education alongside verbal communication.
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Affiliation(s)
- Hirono Ishikawa
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
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Hall JA, Coats EJ, LeBeau LS. Nonverbal Behavior and the Vertical Dimension of Social Relations: A Meta-Analysis. Psychol Bull 2005; 131:898-924. [PMID: 16351328 DOI: 10.1037/0033-2909.131.6.898] [Citation(s) in RCA: 316] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The vertical dimension of interpersonal relations (relating to dominance, power, and status) was examined in association with nonverbal behaviors that included facial behavior, gaze, interpersonal distance, body movement, touch, vocal behaviors, posed encoding skill, and others. Results were separately summarized for people's beliefs (perceptions) about the relation of verticality to nonverbal behavior and for actual relations between verticality and nonverbal behavior. Beliefs/perceptions were stronger and much more prevalent than were actual verticality effects. Perceived and actual relations were positively correlated across behaviors. Heterogeneity was great, suggesting that verticality is not a psychologically uniform construct in regard to nonverbal behavior. Finally, comparison of the verticality effects to those that have been documented for gender in relation to nonverbal behavior revealed only a limited degree of parallelism.
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Affiliation(s)
- Judith A Hall
- Department of Psychology, Northeastern University, Boston, MA 02115, USA.
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Roter DL, Hall JA. Physician Gender and Patient-Centered Communication: A Critical Review of Empirical Research. Annu Rev Public Health 2004; 25:497-519. [PMID: 15015932 DOI: 10.1146/annurev.publhealth.25.101802.123134] [Citation(s) in RCA: 350] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Physician gender has stimulated a good deal of interest as a possible source of variation in the interpersonal aspects of medical practice, with speculation that female physicians are more patient-centered in their communication with patients. Our objective is to synthesize the results of two meta-analytic reviews the effects of physician gender on communication in medical visits within a communication framework that reflects patient-centeredness and the functions of the medical visit. We performed online database searches of English-language abstracts for the years 1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and BIOETHICS), and a hand search was conducted of reprint files and the reference sections of review articles and other publications. Studies using a communication data source such as audiotape, videotape, or direct observation were identified through bibliographic and computerized searches. Medical visits with female physicians were, on average, two minutes (10%) longer than those of male physicians. During this time, female physicians engaged in significantly more communication that can be considered patient-centered. They engaged in more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk. Moreover, the patients of female physicians spoke more overall, disclosed more biomedical and psychosocial information, and made more positive statements to their physicians than did the patients of male physicians. Obstetrics and gynecology may present a pattern different from that of primary care: Male physicians demonstrated higher levels of emotionally focused talk than their female colleagues. Female primary care physicians and their patients engaged in more communication that can be considered patient-centered and had longer visits than did their male colleagues. Limited studies exist outside of primary care, and gender-related practice patterns might differ in some subspecialties from those evident in primary care.
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Affiliation(s)
- Debra L Roter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Clark PA. Medical practices' sensitivity to patients' needs. Opportunities and practices for improvement. J Ambul Care Manage 2003; 26:110-23. [PMID: 12698926 DOI: 10.1097/00004479-200304000-00004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article presents the results of a national study of medical practices' patient satisfaction using data collected from January to December 2001 with Press Ganey Associates' Medical Practice Survey (n = 503,407). The question, "Our sensitivity to your needs" (r = 0.85), most highly correlated with overall patient satisfaction. Patients' age, sex, or first visit were not predictors of sensitivity to patients' needs. Responses highly correlated with sensitivity to patients' needs: (1) concern for patients' privacy, (2) cheerfulness of practice, (3) care received during visit, and (4) likelihood to recommend practice. Patient perception and satisfaction with medical practices' sensitivity to patient needs and recommended practices for improvement are discussed.
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Affiliation(s)
- Paul Alexander Clark
- Department of Research Operations and Services, Press Ganey Associates, Inc., South Bend, Ind., USA
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Friedrichsen MJ, Strang PM, Carlsson ME. Cancer patients' interpretations of verbal expressions when given information about ending cancer treatment. Palliat Med 2002; 16:323-30. [PMID: 12132545 DOI: 10.1191/0269216302pm543oa] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cancer patients' interpretations of the meaning of words used when given bad news are not well studied in medical settings. The aim of this study was to ascertain what significance verbal expressions had for cancer patients when they were given information about ending active tumour treatment, and what message they felt they received. METHODS Tape-recorded semi-structured interviews were performed and analysed using a qualitative phenomenographical approach. RESULTS Thirty patients with incurable cancer admitted to hospital-based home care unit in Sweden participated. Three main categories about the significance of words emerged: 1) words could indicate indirect warnings as being forewarnings, evasive or ambiguous; 2) words could also be perceived as emotionally trying, as threats or abandoning; 3) other words were fortifying and strengthened the patient in this situation. The overall message given during the information could be interpreted differently: either focused on treatment, on quality of life, or on threat and death. CONCLUSION The understanding of the significance of words to tailor the information to patients helps the physician to use forewarnings and fortifying words and to identify and avoid the use of threatening words.
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