Choosing a physician depends on how you want to feel: the role of ideal affect in health-related decision making

Social capital and health beliefs: Exploring the effect of bridging and bonding social capital on health locus of control among women in Dhaka

This cross-sectional study examined if social capital affects women's health attributions. The study used the Internet Social Capital Scale (ISCS) and Multidimensional Health Locus of Control (MHLC) Scale to measure Social Capital and Health Locus of Control. A predefined 38-item questionnaire was used to survey 485 purposively selected women. A bidirectional reciprocal structural equation model was used to measure the covariance between Social Capital and Health Locus of Control. We hypothesized that women with strong social capital, particularly those rich in bridging ties, would exhibit a greater sense of agency and empowerment over their health, attributing their health outcomes less to internal factors like fate and more to external influences like powerful others and broader social support. However, we found that when women have higher social capital, their external health locus of control increases. Bridging and bonding social capital lower women's internal health control, but bridging social capital leads to higher attributes to powerful others. Likewise, we expected women with more social capital would exhibit a lower perception of uncontrollability over their health, but is not the case. The findings underscore the necessity for women to have more social capital.

Negative consequences of self-presentation on disclosure of health information: A catch-22 for Black patients?

RATIONALE

Most patients assume that it is adaptive to present oneself in a positive light when interacting with medical professionals. Here in two studies focused on Black patients we ask: might this desire to present oneself well inhibit the disclosure of health-relevant information when patients are concerned about negative and stereotypic evaluations by their health care providers?

OBJECTIVE

Specifically, we explore three important questions: First, whether self-presentational efforts (e.g., working hard to sound knowledgeable or "smart") are negatively associated with disclosure of health information (e.g., not taking certain medications); Second, whether patient-provider racial congruence (e.g. Black patients interacting with a Black vs. a White doctor) moderates that relationship; and third, more broadly, what factors promote or inhibit disclosure of health information for Black patients in medical interactions.

METHODS

These questions were investigated using mixed methodology (survey, experimental, qualitative) studies on CloudResearch and Prolific.

RESULTS

We found a potential catch-22: participants who spend more effort self-presenting tend to be less comfortable disclosing health information to their healthcare providers. Moreover, Study 1 (N = 321) indicated that the negative relationship between self-presentation and disclosure was significant in Black-incongruent (i.e., Black patient and White provider) and White-congruent (i.e., White patient and White provider) medical interactions. Study 2 (N = 361) did not find a significant moderation by race of the provider but instead suggested that the relationship between self-presentation and disclosure was moderated by expectations of unfair treatment. Exploratory qualitative analyses suggested that some Black participants face a dilemma when deciding whether to disclose information to their healthcare providers. They weigh the kind of information they will share, and how sharing some information might lead to embarrassment and judgment.

CONCLUSION

Mitigating the potentially counteractive effects of self-presentation on disclosure and working to foster contexts that encourage honest disclosure of health information may help to reduce health care inequalities.

Momentary Emotion Goals and Spontaneous Emotion Regulation in Daily Life: An Ecological Momentary Assessment Study of Desire for High Versus Low Arousal Positive Emotion

Recent research has highlighted that emotion regulation strategy use varies both between and within people, and specific individual and contextual differences shape strategy use. Further, use of specific emotion regulation strategies relates to a wide array of differential outcomes, including mental health and behavior. Emotion goals (desire for a given emotion state) are thought to play a particularly important role in shaping people’s use of emotion regulation strategies; yet, surprisingly little is known about whether and how momentary emotion goals predict spontaneous strategy use in daily life. In the present investigation, we examined whether ideal desire for high versus low arousal positive affect was associated with subsequent use of specific emotion regulation strategies. Undergraduate participants (final N = 101) completed ecological momentary assessments (final ks = 1,932 for contemporaneous analyses, 1,386 for time-lagged analyses) of their momentary experienced affect, momentary desire for high versus low arousal positive affect, and emotion regulation. Desire for higher arousal predicted greater use of three disengagement strategies: distraction, expressive suppression, and experiential suppression. None of these strategies, though, were associated with sustained enhancement of high arousal (or low arousal) positive affect. These findings point to a possible disconnect between the strategies that people tend to use when they want to feel more arousal and the affective outcomes associated with use of those strategies.

Seeing the Whole Picture? Avoided Negative Affect and Processing of Others' Suffering

Noticing someone's pain is the first step to a compassionate response. While past research suggests that the degree to which people want to avoid feeling negative ("avoided negative affect"; ANA) shapes how people respond to someone's suffering, the present research investigates whether ANA also predicts how people process others' suffering. In two studies, using complex photographs containing negative aspects (i.e., suffering), we found that the higher people's ANA, the fewer details of negative aspects they correctly recognized, and the fewer negative words they used in their image descriptions. However, when asked to process negative content, the higher people's ANA, the more negatively they rated that content. In Study 3, we report cultural differences in people's sensitivity to notice suffering in an ambiguous image. ANA mediated these cultural differences. Implications for research on compassion are discussed.

Multivariate associations of ideal affect with clinical symptoms

Prior research has indicated that ideal affect (i.e., the affective states that people value and would ideally like to experience) may be relevant to mental health outcomes. Studies to date, however, have not used comprehensive multivariate models that account for covariation among facets of ideal affect and incorporate multiple clinical outcomes. In the present studies, we used structural equation modeling to examine the multivariate effects of ideal affect on symptoms of depression, anxiety, and alcohol abuse in 2 moderately large samples of undergraduates (N = 293 and N = 146). Exploratory results of Study 1 indicated that valuation of high arousal positive affective states was significantly associated with lower depression symptoms but higher anxiety and alcohol abuse symptoms and that valuation of high arousal negative states was specifically associated with greater anxiety symptoms. These results were shown to be structurally invariant across samples and ethnicities in Study 2, which also found that ideal-actual affect discrepancies were significantly associated with symptoms of depression and anxiety. These findings support and extend the hypothesis that ideal affect is implicated in clinical outcomes by highlighting the importance of jointly considering multiple facets of ideal and actual affect as they relate to a range of clinical syndromes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Positive Affect and Health: What Do We Know and Where Next Should We Go?

Positive affect (PA) is associated with better health across a wide range of physical health outcomes. This review reflects on why the study of PA is an essential component of our understanding of physical health and expands on pathways that connect these two variables. To encourage forward movement in this burgeoning research area, measurement and design issues in the study of PA and health are discussed, as are the connections between PA and a range of different health outcomes. Plausible biological, social, and behavioral pathways that allow for positive feelings to get under the skin and influence physical wellness are detailed and framed in the context of several theoretical models. Finally, new directions for the field and important methodological and interpretative considerations that are essential to moving this important research area forward are explored.

When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction

Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of competence, or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of warmth, or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.

Moving Beyond a One-Size-Fits-All View of Positive Affect in Health Research

Although the literature that connects positive affect (PA) to health has exploded over the last 20 years, the approach to studying this topic has remained simplistic. Specifically, researchers overwhelmingly rely on the principle that all PA is healthful, all of the time. Here, we review recent studies indicating that a more nuanced approach is valuable. In particular, we demonstrate that a more thoughtful approach to factors such as arousal, culture, timing, and measurement type results in a more complex picture of when PA is helpful and when it is not. Taking these issues into account also has implications for the types of mechanisms underlying these associations, as well as how other moderators might operate. Thus, we argue that considering these gradations will allow researchers to develop successful and theoretically based health interventions, untangle mixed findings, and enable a deeper understanding of the connection between PA and health.

Neurocultural evidence that ideal affect match promotes giving

Why do people give to strangers? We propose that people trust and give more to those whose emotional expressions match how they ideally want to feel ("ideal affect match"). European Americans and Koreans played multiple trials of the Dictator Game with recipients who varied in emotional expression (excited, calm), race (White, Asian) and sex (male, female). Consistent with their culture's valued affect, European Americans trusted and gave more to excited than calm recipients, whereas Koreans trusted and gave more to calm than excited recipients. These findings held regardless of recipient race and sex. We then used fMRI to probe potential affective and mentalizing mechanisms. Increased activity in the nucleus accumbens (associated with reward anticipation) predicted giving, as did decreased activity in the right temporo-parietal junction (rTPJ; associated with reduced belief prediction error). Ideal affect match decreased rTPJ activity, suggesting that people may trust and give more to strangers whom they perceive to share their affective values.

Resonance and dissonance asymmetry in effective physician-patient relationships

This paper examines the proposed asymmetry that should occur between resonance and dissonance in physician-patient relationships in favour of resonance to facilitate an effective relationship. Resonance is represented by the positive emotional attractor, which comprises patients' conscious preferred future or ideal self, and dissonance is expressed by the negative emotional attractor and consists of the gaps between patients' ideal and real self or their fears, problems, and shortfalls. Intentional change theory is reviewed to optimise the physician-patient relationship. Concepts from complexity theory and recent research on emotions are used to explain positive and negative emotional attractors. The role of resonance and dissonance in physician-patient relationships is discussed along with how behaviour can be changed with positive and negative emotional attractors. This paper focuses on the quality and effectiveness of physician-patient relationships for physicians who create high versus low positive emotional attractor/negative emotional attractor ratios. Two theoretical propositions are offered and the research and practice implications are explained.

Asian Americans respond less favorably to excitement (vs. calm)-focused physicians compared to European Americans

OBJECTIVES

Despite being considered a "model minority," Asian Americans report worse health care encounters than do European Americans. This may be due to affective mismatches between Asian American patients and their European American physicians. We predicted that because Asian Americans value excitement (vs. calm) less than European Americans, they will respond less favorably to excitement-focused (vs. calm) physicians.

METHOD

In Study 1, 198 European American, Chinese American, and Hong Kong Chinese community adults read a medical scenario and indicated their preference for an excitement-focused versus calm-focused physician. In Study 2, 81 European American and Asian American community college students listened to recommendations made by an excitement-focused or calm-focused physician in a video, and later attempted to recall the recommendations. In Study 3, 101 European American and Asian American middle-aged and older adults had multiple online encounters with an excitement-focused or calm-focused physician and then evaluated their physicians' trustworthiness, competence, and knowledge.

RESULTS

As predicted, Hong Kong Chinese preferred excitement-focused physicians less than European Americans, with Chinese Americans falling in the middle (Study 1). Similarly, Asian Americans remembered health information delivered by an excitement-focused physician less well than did European Americans (Study 2). Finally, Asian Americans evaluated an excitement-focused physician less positively than did European Americans (Study 3).

CONCLUSIONS

These findings suggest that while physicians who promote and emphasize excitement states may be effective with European Americans, they may be less so with Asian Americans and other ethnic minorities who value different affective states. (PsycINFO Database Record

American = Independent?

U.S. American cultures and psyches reflect and promote independence. Devos and Banaji (2005) asked, does American equal White? This article asks, does American equal independent? The answer is that when compared to people in East Asian or South Asian contexts, people in American contexts tend to show an independent psychological signature—a sense of self as individual, separate, influencing others and the world, free from influence, and equal to, if not better than, others (Markus & Conner, 2013). Independence is a reasonable description of the selves of people in the White, middle-class American mainstream. Yet it is a less good characterization of the selves of the majority of Americans who are working-class and/or people of color. A cultural psychological approach reveals that much of North American psychology is still grounded in an independent model of the self and, as such, neglects social contexts and the psychologies of a majority of Americans. Given the prominence of independence in American ideas and institutions, the interdependent tendencies that arise from intersections of national culture with social class, race, and ethnicity go unrecognized and are often misunderstood and stigmatized. This unseen clash of independence and interdependence is a significant factor in many challenges, including those of education, employment, health, immigration, criminal justice, and political polarization.

Ideal affect in daily life: implications for affective experience, health, and social behavior

Over the last decade, researchers have increasingly demonstrated that ideal affect-the affective states that people value and ideally want to feel-shapes different aspects of daily life. Here I briefly review Affect Valuation Theory (AVT), which integrates ideal affect into existing models of affect and emotion by identifying the causes and consequences of variation in ideal affect. I then describe recent research that applies AVT to the valuation of negative states as well as more complex states, examines how ideal affect shapes momentary affective experience, suggests that ideal affect has both direct and indirect effects on health, and illustrates that people's ideal affect shapes how they judge and respond to others. Finally, I discuss the implications of cultural and individual differences in ideal affect for clinical, educational, work, and leisure settings.

Valuing calm enhances enjoyment of calming (vs. exciting) amusement park rides and exercise

Do people derive more enjoyment from activities that match how they ideally want to feel (their "ideal affect")? Affect valuation theory (AVT) predicts that they do; however, no study has directly examined whether this is the case. Therefore, the authors conducted 4 studies that examined whether valuing calm and other low arousal positive states (LAP) increased enjoyment of calming (vs. exciting) activities. In Study 1, the more participants valued LAP, the more enjoyment they recalled during calming (vs. exciting) episodes from their lives. In Studies 2-3, the more participants valued LAP, the more enjoyment they experienced during calming (vs. exciting) amusement park rides, both in the United States and Hong Kong. To assess causality, in Study 4, participants were randomly assigned to either a "value LAP" or control condition and then engaged in either low or high intensity exercise. Participants in the value LAP condition who engaged in low intensity exercise reported greater enjoyment than those who engaged in high intensity exercise; these differences did not emerge in the control condition. People's trait levels of experienced LAP ("actual LAP") were not related to their enjoyment of calming (vs. exciting) activities. Together, these findings provide evidence that people derive more enjoyment from activities that match their ideal affect. The authors discuss the implications of these findings for AVT as well as interventions aimed at enhancing well-being. (PsycINFO Database Record

Neural evidence for cultural differences in the valuation of positive facial expressions

European Americans value excitement more and calm less than Chinese. Within cultures, European Americans value excited and calm states similarly, whereas Chinese value calm more than excited states. To examine how these cultural differences influence people's immediate responses to excited vs calm facial expressions, we combined a facial rating task with functional magnetic resonance imaging. During scanning, European American (n = 19) and Chinese (n = 19) females viewed and rated faces that varied by expression (excited, calm), ethnicity (White, Asian) and gender (male, female). As predicted, European Americans showed greater activity in circuits associated with affect and reward (bilateral ventral striatum, left caudate) while viewing excited vs calm expressions than did Chinese. Within cultures, European Americans responded to excited vs calm expressions similarly, whereas Chinese showed greater activity in these circuits in response to calm vs excited expressions regardless of targets' ethnicity or gender. Across cultural groups, greater ventral striatal activity while viewing excited vs. calm expressions predicted greater preference for excited vs calm expressions months later. These findings provide neural evidence that people find viewing the specific positive facial expressions valued by their cultures to be rewarding and relevant.

The cultural construction of emotions

A large body of anthropological and psychological research on emotions has yielded significant evidence that emotional experience is culturally constructed: people more commonly experience those emotions that help them to be a good and typical person in their culture. Moreover, experiencing these culturally normative emotions is associated with greater well-being. In this review, we summarize recent research showing how emotions are actively constructed to meet the demands of the respective cultural environment; we discuss collective as well as individual processes of construction. By focusing on cultural construction of emotion, we shift the focus toward how people from different cultures 'do' emotions and away from which emotions they 'have'.

The “Empty Vessel” Physician

Although much research examines how physicians perceive their patients, here we study how patients perceive physicians. We propose patients consider their physicians like personally emotionless “empty vessels”: The higher is individuals’ need for care, the less they value physicians’ traits related to their personal lives (e.g., self-focused emotions), but the more they value physicians’ traits related to patients (e.g., patient-focused emotions). In an initial study, participants recalled fewer personal facts (e.g., marital status) about physicians who seemed more important to their health. In subsequent experiments, participants in higher need for care believed physicians have less personal emotions. Although higher need individuals, such as patients in a clinic, perceived their physicians to be personally emotionless, they wanted the clinic to hire physicians who displayed patient-focused emotion. We discuss implications of perceiving physicians as empty vessels for health care.

Wanting to maximize the positive and minimize the negative: implications for mixed affective experience in American and Chinese contexts

Previous studies have demonstrated that European Americans have fewer mixed affective experiences (i.e., are less likely to experience the bad with the good) compared with Chinese. In this article, we argue that these cultural differences are due to "ideal affect," or how people ideally want to feel. Specifically, we predict that people from individualistic cultures want to maximize positive and minimize negative affect more than people from collectivistic cultures, and as a result, they are less likely to actually experience mixed emotions (reflected by a more negative within-person correlation between actual positive and negative affect). We find support for this prediction in 2 experience sampling studies conducted in the United States and China (Studies 1 and 2). In addition, we demonstrate that ideal affect is a distinct construct from dialectical view of the self, which has also been related to mixed affective experience (Study 3). Finally, in Study 4, we demonstrate that experimentally manipulating the desire to maximize the positive and minimize the negative alters participants' actual experience of mixed emotions during a pleasant (but not unpleasant or combined pleasant and unpleasant) TV clip in the United States and Hong Kong. Together, these findings suggest that across cultures, how people want to feel shapes how they actually feel, particularly people's experiences of mixed affect.

Patients respond more positively to physicians who focus on their ideal affect

Previous findings suggest that patients choose physicians whose affective focus matches how they ideally want to feel (Sims et al., 2014). For instance, the more people wanted to feel excitement, the more likely they were to hypothetically choose a new physician who promoted excitement. What remains unknown is whether this match shapes how patients actually respond to physicians after being assigned to them (i.e., whether they adhere to physicians' recommendations more and evaluate physicians more positively). To this end, community adults reported their global ideal affect and actual affect (how they ideally want to feel and actually feel during a typical week, respectively), and were randomly assigned to receive health recommendations from either a physician who expressed and promoted high arousal positive states (HAP) (e.g., excitement), or one who expressed and promoted low arousal positive states (LAP) (e.g., calm). For the next 5 days, participants reported their daily adherence to the recommendations and their daily ideal and actual affect. At the end of the week, participants evaluated their physician. As predicted, the more participants wanted to feel HAP, the more they adhered to the "HAP-focused" physician's recommendations, and the more participants wanted to feel LAP, the more they adhered to the "LAP-focused" physician's recommendations. Participants also evaluated their physician more positively when his affective focus matched their ideal affect. Neither global nor daily actual affect systematically predicted how patients responded to their physicians. These findings suggest that patients respond better to physicians whose affective focus matches their ideal affect.