How to alleviate the agony of providing negative feedback: Emotion regulation strategies affect hormonal stress responses to a managerial task.

Providing negative feedback can be demanding, as it typically requires dealing with multiple negative emotions. The first aim of this study was to transfer this work-related task to a new laboratory protocol and to investigate short-term hormonal changes among feedback providers. The second aim was to test if such hormonal stress responses can be attenuated through a priori instructions on how to regulate emotions. Each of 150 participants (51% women) provided eight saliva samples before, during, and after anticipating and conducting a negative feedback conversation with a professional actor who displayed negative emotional reactions. Participants were divided into four conditions regarding the way they were instructed to regulate their emotions: expressive suppression (keeping a neutral expression); cognitive reappraisal (staying task-oriented and emotionally distanced); affect utilization (moving towards and using emotions); or control condition. By means of three-phase spline growth models, latent growth factors during baseline, stress response, and recovery were specified. Providing negative feedback was followed by significant temporary testosterone decreases as well as cortisol increases. Testosterone (but not cortisol) responses were attenuated when feedback providers had been instructed to either follow a cognitive reappraisal or affect utilization strategy. This study provides evidence that a typical managerial task, that is, having to provide negative feedback, is a testosterone- and cortisol-relevant experience. Down-regulation of an individual's emotional involvement through reappraisal, as well as the newly introduced technique of moving towards and making use of the interaction partner's emotions (affect utilization), revealed consequences in terms of attenuating the testosterone response to stress.

[Series: Communication in the dental practice. Dealing with conflict and intimidation in the dental practice]. / Serie: Communicatie in de tandarts­praktijk. Omgaan met conflicten en intimidatie in de tandartspraktijk.

In the dental practice, several situations that might lead to conflict are imaginable. How a dentist deals with a conflict depends in part on the importance he places on the content of the conflict in relation to the importance of the relationship with the patient. This article briefly describes 5 conflict management styles. On the basis of case histories, suggestions are made for handling situations when a conflict leads to aggression, you are facing sexual intimidation or a conflict develops with a demanding patient. Finally, some advice is given on how to deal with errors/complications in treatment and dealing with criticism.

Transcutaneous vagus nerve stimulation (tVNS) enhances conflict-triggered adjustment of cognitive control.

Response conflicts play a prominent role in the flexible adaptation of behavior as they represent context-signals that indicate the necessity for the recruitment of cognitive control. Previous studies have highlighted the functional roles of the affectively aversive and arousing quality of the conflict signal in triggering the adaptation process. To further test this potential link with arousal, participants performed a response conflict task in two separate sessions with either transcutaneous vagus nerve stimulation (tVNS), which is assumed to activate the locus coeruleus-noradrenaline (LC-NE) system, or with neutral sham stimulation. In both sessions the N2 and P3 event-related potentials (ERP) were assessed. In line with previous findings, conflict interference, the N2 and P3 amplitude were reduced after conflict. Most importantly, this adaptation to conflict was enhanced under tVNS compared to sham stimulation for conflict interference and the N2 amplitude. No effect of tVNS on the P3 component was found. These findings suggest that tVNS increases behavioral and electrophysiological markers of adaptation to conflict. Results are discussed in the context of the potentially underlying LC-NE and other neuromodulatory (e.g., GABA) systems. The present findings add important pieces to the understanding of the neurophysiological mechanisms of conflict-triggered adjustment of cognitive control.

Affective and physiological response to a novel parent-adolescent conflict stressor.

Few laboratory paradigms exist that expose adolescents to conflict that might commonly be experienced in parent-adolescent relationships. Given the continued importance of parent-adolescent relationships on adolescent development, as well as the changing expectations in these relationships, we examined the effect of a novel parent-adolescent conflict paradigm on physiological and affective response in a sample of 52 adolescents. The parent-adolescent conflict stressor (PACS) involved adolescent participants (50% girls; M = 14.75, SD = 0.88) watching a 12-minute scripted video that asked youth to imagine that they were the teenager in the video, which consisted of parent and adolescent actors having discussions about conflict in their relationship and solving this conflict in either a positive, typical, or hostile manner. Cortisol, alpha amylase, and self-report of negative and positive affect were collected at baseline, following the video, and during a recovery period. Heart rate also was taken continuously while adolescents watched the videos. Hierarchical linear modeling (HLM) analyses indicated significant linear change in alpha amylase and linear and quadratic change in negative affect to the PACS. There also was a significant linear and quadratic change in heart rate during the portion of the video where teens and parents discussed issues of personal responsibility. The PACS marks a preliminary but important first step in developing a parent-adolescent conflict paradigm that can be used across studies to understand the impact of parent-adolescent conflict on affective and physiological markers associated with stress response.

Sex differences in testosterone reactivity during marital conflict.

When attempting to resolve relationship problems, individuals in close relationships sometimes challenge their partners with statements that oppose their partners' point of view. Such oppositional behaviors may undermine those partners' relational value and threaten their status within the relationship. We examined whether perceptions of opposition from a partner during a series of problem-solving interactions were associated with reactivity in testosterone levels and whether those associations were different for men and women. Fifty newlywed couples discussed four marital problems. Each member of the couple reported how much oppositional behavior they perceived from their partner during the discussions. Pre- and post-discussion saliva samples were assayed for testosterone. For men, but not for women, perceptions of oppositional behavior were associated with heightened testosterone reactivity, and this result replicated across three different measures of testosterone reactivity. Findings were specific to men's perceptions of oppositional behavior, and held controlling for objective measures of oppositional behavior coded from videos of the conversations. Results highlight the benefits of considering pair-bonded relationships as a novel context for investigating associations involving hormones and behavior. Findings also raise the possibility that sex differentiated hormonal reactions to opposition partly explain why conflict among heterosexual partners can be so divisive.

Associations Between Marital Conflict and Adolescent Conflict Appraisals, Stress Physiology, and Mental Health.

The goal of the current study was to examine conflict appraisals and diurnal cortisol production as mediators of the robust association between marital conflict and adolescent adjustment problems. Parents reported their marital conflict and were observed engaging in a marital conflict discussion; they also reported adolescent internalizing and externalizing behaviors. Adolescents (n = 105, 52% female, 10-17 years of age) appraised their parents' marital conflict and reported their internalizing and externalizing behaviors. After the laboratory visit, adolescents provided four saliva samples on each of 2 consecutive days to assess diurnal cortisol production. More-negative marital conflict predicted more self-blame for parental conflict, which in turn predicted less robust decreases in cortisol across the day. Further, this flattened cortisol production pattern mediated the relationship between greater self-blame for parental conflict and adolescents' elevated internalizing behaviors. Feeling responsible for parental conflict appears to be particularly damaging in terms of physiological regulation and adjustment, and may therefore be a particularly useful intervention target.

Mindfulness during romantic conflict moderates the impact of negative partner behaviors on cortisol responses.

This study was designed to test whether romantic partners' mindfulness-present moment, nonjudgmental awareness-during a conflict discussion could buffer the effects of negative partner behaviors on neuroendocrine stress responses. Heterosexual couples (n=88 dyads) provided 5 saliva samples for cortisol assay during a laboratory session involving a conflict discussion task. Conflict behaviors were coded by outside observers using the System for Coding Interactions in Dyads, and partners rated their mindfulness during the task using the Toronto Mindfulness Scale. Interactions tested using multilevel modeling revealed that participants with higher levels of mindfulness during the conflict showed either quicker cortisol recovery or an absence of slowed recovery in the presence of more negative partner behaviors. Whereas the attitudinal component of mindfulness (curiosity) moderated effects of negative partner engagement in the conflict (i.e., attempts to control, coerciveness, negativity and conflict), the attentional component of mindfulness (decentering) moderated the effect of partner disengagement (i.e., withdrawal). These findings lend support to the idea that mindfulness during a stressful interaction can mitigate the physiological impacts of negative behaviors.

How do tutors intervene when conflicts on knowledge arise in tutorial groups?

Recent research on problem-based learning (PBL) has shown that students need support when dealing with conflicting ideas in PBL-tutorial discussions. In the present study, we examined tutor facilitation during tutorial discussions, and particularly how the facilitation helped students to collaboratively resolve conflicts on knowledge. The study involved four PBL-tutorial sessions that included altogether 33 first-year medical and dental students. The sessions were videotaped and analysed using qualitative interaction analysis. Our aim was to find out how the tutor interventions encouraged students to elaborate on conflicting ideas, and how the interventions differed between conflict and non-conflict situations. We also examined how the tutors intervened during conflicts about factual or conceptual knowledge. The tutorial discussions included 92 tutor intervention episodes and 43 conflict episodes. The tutors intervened during 24 of the conflict episodes and resolved 13 of these episodes. Generally, the tutors often intervened by confirming what the students had said or by giving explanations, but they rarely asked questions that would stimulate the elaboration of knowledge. During conflicts on knowledge the tutors gave more explanations, but did little to encourage the students to deal with conflicting ideas. The tutors more often resolved conflicts on factual knowledge than conceptual knowledge. The findings suggest that tutor training should focus on promoting tutors' understanding on when to give direct explanations, and when and how to encourage students to collaboratively elaborate on conflicting ideas.

Signaling context modulates social function of silent bared-teeth displays in rhesus macaques (Macaca mulatta).

The signaling context has been found to change the meaning of the silent bared-teeth display (SBT) in pigtail macaques (Macaca nemestrina) such that the SBT in apparently peaceful contexts communicates subordination, a long-term pattern of behavior, whereas in conflict contexts it communicates immediate submission (PNAS, 104: 1581-1586). However, the context dependent nature of the SBT has not yet been explored in other species. We investigated SBT usage with respect to grooming, severe aggression, and signaler-receiver sex, rank difference, and body size in seven captive groups of rhesus macaques. Peaceful SBTs were given most often to male receivers by male and female signalers whereas conflict SBTs were given to both male and female receivers primarily by female signalers. Male signalers rarely gave SBTs (peaceful or conflict) to female receivers. Unlike pigtail macaques, peaceful SBTs in rhesus were often accompanied by withdrawal behavior (referred to as peaceful SBT-leave), which influenced grooming, but not aggression, at the dyadic level. Severe aggression was less frequent among dyads using peaceful SBTs (regardless of withdrawal behavior) than those using conflict SBTs. In contrast, grooming was more frequent among dyads using peaceful SBT-stay signals than those using peaceful SBT-leave signals or conflict SBTs. In total, our results indicate that peaceful SBTs are a functionally different signal from conflict SBTs in rhesus macaques.

How we view complainants; an ethical dilemma?

UNLABELLED: All too often, those patients who complain are thought to be unreasonable. Healthcare professionals often feel that patients do not have an understanding of the pressures and hardships that they struggle with on a day-to-day basis. When a patient complains, it is seen by the professional complained about as a wholly negative event, leading to loss of confidence and leaving that professional feeling demoralized. Often complaints are due to a breakdown in communication. Sometimes a patient is unhappy with a treatment charge or simply there is a perception that he/she has been poorly treated. The General Dental Council and Primary Care Trusts (and now their successors) take a dim view of dental practitioners who deal with complaints poorly. This article sets out to offer a different perspective on complaints, so that the complaint system can be used to build trust between dental professionals and patients, instead of instilling demoralization and fear of litigation into those on the receiving end of a complaint. CLINICAL RELEVANCE: This article is relevant to all dental professionals as complaints are an inevitability of practice.

Salivary nerve growth factor reactivity to acute psychosocial stress: a new frontier for stress research.

OBJECTIVE: Neurotrophins such as nerve growth factor (NGF) may represent a stress-responsive system complementing the better known neuroendocrine (hypothalamic-pituitary-adrenal axis) and autonomic nervous system, but there is little evidence for NGF response to acute stress in humans because noninvasive measures have not been available. We investigated salivary NGF (sNGF) in 40 healthy young adults confronting a romantic conflict stressor. METHODS: Five saliva samples-two collected before and three after the conflict-were assayed for sNGF, cortisol (hypothalamic-pituitary-adrenal marker), and α-amylase (sAA; ANS marker). In addition, a control group (n = 20) gave saliva samples at the same time intervals to determine whether sNGF changes were specific to the conflict stressor. RESULTS: sNGF showed significant reactivity from entry to the first poststress sample among study participants (ß = .13, p = .001), with nonsignificant change across poststress samples. Control participants showed no change in sNGF across the same period. Within-person changes in sNGF were generally aligned with both cortisol (ß = .17, p = .003) and sAA (ß = .17, p = .021) responses. Preconflict negative emotion predicted lower sNGF reactivity (ß = -.08, p = .009) and less alignment with sAA (ß = -.09, p = .040), whereas positive emotion predicted less alignment with cortisol (ß = -.10, p = .019). CONCLUSIONS: This study is the first to document sNGF as a marker that responds to stress in humans.

Dealing with conflicts on knowledge in tutorial groups.

The aim of our study was to gain understanding of different types of conflicts on knowledge in the discussions of problem-based learning tutorial groups, and how such conflicts are dealt with. We examined first-year medical and dental students' (N = 33) conflicts on knowledge in four videotaped reporting phase tutorials. A coding scheme was created for analysing verbatim transcripts of 43 conflict episodes in order to find out whether the conflict episodes were about factual or conceptual knowledge and how the students elaborated the knowledge. Conflict episodes were relatively rare (taking up 7.6 % of the time) in the videotaped groups. Conflict episodes were more frequently about factual knowledge (58 %) than conceptual knowledge (42 %), but conflicts on conceptual knowledge lasted longer and were more often elaborated. Elaboration was, however, more frequently done individually than collaboratively. Conflict episodes were generally fairly short (mean duration 28 s). This was due to a lack of thorough argumentation and collaborative elaboration of conflicting ideas. The results suggest that students' skills to bring out differences in each other's conceptual thinking, the depth of argumentation and the use of questions that elicit elaboration need to be improved. Tutors' skills to facilitate the collaborative resolving of conflicts on knowledge call for further study.

Mothers' perceptions of their child's enrollment in a randomized clinical trial: poor understanding, vulnerability and contradictory feelings.

BACKGROUND: Little is known about the views of mothers when their children are invited to participate in randomized clinical trials (RCTs) investigating medicines and/or invasive procedures. Our goal was to understand mothers' perceptions of the processes of informed consent and randomization in a RCT that divided uncooperative children into three intervention groups (physical restraint, sedation, and general anesthesia) for dental rehabilitation. METHODS: This is a qualitative study based on semi-structured interviews with mothers accompanying children under 3 years old presenting severe early childhood caries. Their responses were analyzed using content analysis. RESULTS: We identified one major theme from 15 mothers' responses - "Understanding of, attitudes toward, and feelings about consenting to participate in a RCT involving advanced behavior guidance techniques and about randomization" - that was derived from the following subcategories: confusion in defining techniques, questions after signing the consent form, lack of knowledge about the techniques, acceptance or questioning of the drawing, sharing responsibility with the child during the drawing, and feelings of faith in God, fear, powerlessness to choose, and relief from or an increase in pressure. CONCLUSIONS: Despite mothers' misunderstanding, vulnerability, and contradictory feelings, they were willing to overlook their thoughts in order to complete their children's dental treatment.

Women in orthodontics and work-family balance: challenges and strategies.

The number of women entering the orthodontic profession over the past few decades has increased dramatically. A review of the literature revealed the lack of research on achieving a work-family balance among female dentists and dental specialists. Work-family balance has been researched more extensively in the field of medicine; however, despite some critical differences, parallels between these 2 professions exist. This study identified issues that Canadian female orthodontists face and strategies they use to achieve a work-family balance. A phenomenological qualitative study was used to analyze the results of semi-structured telephone interviews of a purposive sample of 13 Canadian female orthodontists. The results strongly support the role-conflict theory about the competing pressures of maternal and professional roles. Female orthodontists described their challenges and strategies to minimize role conflict in their attempt to achieve a work-family balance. The women defined balance as having success and satisfaction in both their family life and professional life. They identified specific challenges of achieving a work-family balance that are unique to orthodontic practice and strategies for adapting to their maternal and professional roles. Achieving a work-family balance is of paramount importance to female orthodontists, and the results of this study may be applied to other specialties in dentistry.

A novel interference behaviour: invasive wasps remove ants from resources and drop them from a height.

This study reports a novel form of interference behaviour between the invasive wasp Vespula vulgaris and the New Zealand native ant Prolasius advenus. By videotaping interactions at bait stations, we found that wasps commonly remove ant competitors from food resources by picking up the workers in their mandibles, flying backward and dropping them unharmed some distance from the food. Both the frequency and the efficiency of the wasp behaviour significantly increased with the abundance of ant competitors. Ant removals were the most common interference events initiated by wasps when ants were numerous, while intraspecific conflicts among wasps were prominent when few ants were present. The 'ant-dropping' behaviour emphasizes how asymmetry in body sizes between competitors can lead to a pronounced form of interference, related to asymmetric locomotion modes.

Conflicting representations of pain: a qualitative analysis of health care professionals' discourse.

INTRODUCTION: Studies regarding health care professionals' representations of pain indicate that doctors and nurses tend to concentrate on the organic origin of pain, and to view pain as subordinate to diagnosis and treatment of the disease; they also tend to underestimate the psychological and psychosocial components of pain, which means that they generally view the patient's subjective experience as secondary. This leads to an underestimation of pain. OBJECTIVE: The objective of this study was to analyze the representations of pain held by doctors, head nurses, and nurses in two Italian hospitals, focusing on how these representations are shaped according to the local culture in which they are constructed and negotiated. METHODS: Our study is based on a socio-constructionist approach, drawing on semi-structured, in-depth interviews with 26 health care professionals. RESULTS: The results show similarities and differences in how health care professionals construct their representations of pain. Three main issues emerged. First, the contents of these representations are strictly related to participants' job position and professional training; second, the representation of pain is significantly influenced by the values and meanings associated with the different professions; and third, there are two conflicting representations of pain, focusing on the objectivity vs the subjectivity of pain, respectively. CONCLUSIONS: To promote significant change regarding pain management within hospital organizations, it is essential to construct shared representations of the problem and its implications, particularly as regards relations with the patient. This change should take place at the educational as well as the socio-organizational level, and it should take into account ideas and proposals from the subjects involved.

Relation of intimate partner violence to salivary cortisol among couples expecting a first child.

Despite advances in understanding the role that several physiological systems play in the occurrence of general violence, little progress has been made toward understanding biological correlates of intimate partner violence (IPV). We explored involvement of one physiological system, the hypothalamic-pituitary-adrenal (HPA) axis. Among 137 heterosexual couples expecting a first child, baseline level of HPA activity-assessed via salivary cortisol collected before a couple conflict discussion-was linked to both men's and women's violence perpetration. HPA reactivity to the conflict bout did not show an independent association with IPV. However, persisting elevation in men's, and down-regulation in women's, HPA activity during a further recovery period was linked to men's violence perpetration.

Assessing change in the family impact of caries in young children after treatment under general anaesthesia.

OBJECTIVE: To examine the properties, validity and responsiveness of the Family Impact Scale in a consecutive clinical sample of patients undergoing dental treatment under general anaesthesia. MATERIALS AND METHODS: A consecutive clinical sample of parents/caregivers of children receiving dental treatment under general anaesthesia provided data using the Family Impact Scale (FIS) component of the COHQOL(©) Questionnaire. The first questionnaire was completed before treatment, the follow-up questionnaire 1-4 weeks afterward. Treatment-associated changes in the FIS and its components were determined by comparing baseline and follow-up data. RESULTS: Baseline and follow-up data were obtained for 202 and 130 participants, respectively (64.4% follow-up). All FIS items showed large relative decreases in prevalence, the greatest seen in those relating to having sleep disrupted, blaming others, being upset, the child requiring more attention, financial difficulties and having to take time off work. Factor analysis largely confirmed the underlying factor structure, with three sub-scales (parental/family, parental emotions and family conflict) identified. The parental/family and parental emotions sub-scales showed the greatest treatment-associated improvement, with large effect sizes. There was a moderate improvement in scores on the family conflict sub-scale. The overall FIS showed a large improvement. CONCLUSION: Treating children with severe caries under general anaesthesia results in OHRQoL improvements for the family. Severe dental caries is not merely a restorative and preventive challenge for those who treat children; it has far-reaching effects on those who share the household and care for the affected child.