A case study of vocal features associated with galvanic skin response to stressors in a clinical interaction.

OBJECTIVE: We investigated vocal characteristics associated with physiologically determined stressful episodes by means of post-hoc acoustic analyses of speech recorded in a clinical setting. Our research addressed the understudied question of which vocal features may serve as cues naturally occurring stress and is the first to explore this issue in a pitch accent language. METHODS: The vocal profile of a single female patient interacting with a physician was analyzed with standard speech analysis software for acoustic indicators of stress-related arousal determined by galvanic skin response measurements. RESULTS: Vocal jitter, representing an aspect of voice quality perceived as hoarseness, appeared to increase during and immediately after skin conductance response intervals. Skin conductance levels during the response intervals were negatively correlated with acoustic features used to approximate the perception of voice unsteadiness (slope and standard deviation of fundamental frequency). CONCLUSION: An acoustic analysis of vocal properties of speech uttered during independently detected skin conductance response intervals revealed individual patterns for some acoustic features linked to stress in earlier studies. PRACTICE IMPLICATIONS: Non-invasive methods of arousal detection in physician-patient communication based on acoustic analyses of vocal profiles may, in combination with other analyses, help identify stressful events and thus improve the process of medical information gathering and decision-making.

Electrodermal activity in response to empathic statements in clinical interviews with fibromyalgia patients.

OBJECTIVE: To study patients' electrodermal response (1) to an interviewer's empathic statements vs. inattention to emotional concerns and (2) to the emotional content in clinical interviews. METHODS: Patients with fibromyalgia (n=48) were given a clinical interview in a randomized 2×2 design, in which interviewer empathic or inattentive behavior (scenario A) and the emotional or neutral content of the interview (scenario B) were manipulated. Electrodermal activity (EDA) was measured during the interview. The patients' affective state (PANAS) and patient satisfaction were also assessed. RESULTS: In scenario A a significant main effect of empathy was found, indicating an increased tonic EDA (skin conduction level, SCL) during the empathy condition (p<.05). In scenario B there was a main effect of empathy (p<.01) and a significant empathy×content interaction effect (p<.01). There was a strong positive association between empathy and patient satisfaction (p<.0001). CONCLUSIONS: Empathic statements by the interviewer were associated with increased SCL in patients, most so in interviews with emotional content. PRACTICE IMPLICATIONS: Psychophysiological variables such as EDA may be applied in clinical communication research on emotional communication, but the limitations of such measures should also be recognized.

Is pain patients' psychophysiological arousal while watching their videotaped medical interview similar to their arousal during participation in this medical interview?

Showing videos of medical consultation as a proxy for participation is being increasingly applied in research in order to let patients (re-)experience social interaction in medical settings. If subjects do indeed experience the interaction process when watching this on video, then they should show similar patterns in physiological arousal as when actually participating. We assessed whether watching one's own interaction in a medical setting on video lead to the same skin conductance activity (SC) as when participating in that interaction. Fifteen women with fibromyalgia participated in a medical interview and, after a break, watched the video of this interview. Skin conductance activity was measured throughout the medical interview and, again, while the participants watched their own video. Coherence in SC between these two conditions was assessed. In eleven subjects (73%) a significant positive coherence between the two measurements was found, indicating that watching your own videotaped consultations evokes comparable psychophysiological arousal in most but not all participants. This physiological coherence might be an indication that people are capable of re-experiencing their interaction process by watching replays of these situations, although further research is needed. The positive coherence also supports skin conductance as a reliable moment-to-moment measure for physiological arousal throughout the doctor-patient interaction process. The next step should be linking the changes in physiological arousal to what exactly is happening at that moment in the interaction between doctor and patient. This could provide support for the validity of experimental designs in which standardized videotaped medical visits are shown to patients. More research is needed on predictors of (non-)coherence in certain subjects.