Expectations about pain and analgesic treatment are shaped by medical providers’ facial appearances: Evidence from five online clinical simulation experiments

Necka, Elizabeth A.; Amir, Carolyn; Dildine, Troy C.; Atlas, Lauren Y.

doi:10.1016/j.socscimed.2021.114091

Cited by 11 publications

(8 citation statements)

References 72 publications

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“…Furthermore, studies of emotion recognition indicate that basic emotions are recognized more accurately when assessed by perceivers that share an identity with the target (e.g., same race; Elfenbein & Ambady, 2002), often referred to as an in-group advantage, and perceivers tend to misattribute outgroup faces with stereotyped emotions (e.g., seeing anger in neutral Black faces ;Hugenberg & Bodenhausen, 2003) and are less confident and slower to rate outgroup faces (Beaupre & Hess, 2006). Previous studies also indicate that patients who feel similar to their providers experience greater pain relief and lower expectations of pain in patients in simulated (Losin et al, 2017;Necka et al, 2021) and real clinical environments (Nazione et al, 2019;Street et al, 2008). However, we do not know how similarity impacts pain assessments from the perceiver's position.…”

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confidence: 78%

How Pain-Related Facial Expressions Are Evaluated in Relation to Gender, Race, and Emotion

et al. 2023

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Inequities in pain assessment are well-documented; however, the psychological mechanisms underlying such biases are poorly understood. We investigated potential perceptual biases in the judgments of faces displaying pain-related movements. Across five online studies, 956 adult participants viewed images of computer-generated faces (“targets”) that varied in features related to race (Black and White) and gender (women and men). Target identity was manipulated across participants, and each target had equivalent facial movements that displayed varying intensities of movement in facial action-units related to pain (Studies 1–4) or pain and emotion (Study 5). On each trial, participants provided categorical judgments as to whether a target was in pain (Studies 1–4) or which expression the target displayed (Study 5) and then rated the perceived intensity of the expression. Meta-analyses of Studies 1–4 revealed that movement intensity was positively associated with both categorizing a trial as painful and perceived pain intensity. Target race and gender did not consistently affect pain-related judgments, contrary to well-documented clinical inequities. In Study 5, in which pain was equally likely relative to other emotions, pain was the least frequently selected emotion (5%). Our results suggest that perceivers can utilize facial movements to evaluate pain in other individuals, but perceiving pain may depend on contextual factors. Furthermore, assessments of computer-generated, pain-related facial movements online do not replicate sociocultural biases observed in the clinic. These findings provide a foundation for future studies comparing CGI and real images of pain and emphasize the need for further work on the relationship between pain and emotion.

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confidence: 78%

How Pain-Related Facial Expressions Are Evaluated in Relation to Gender, Race, and Emotion

et al. 2023

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“…Therefore, a longer gaze, more smiling, more positive and expressive body movements and gestures, and a more positive tone of voice will make the individual appear more positive and expressive. In most of previous studies, static photographs of caregiver's facial expressions are used to test the perceived impressions (Kraft-Todd et al, 2017;Necka et al, 2021); however, in this study, dynamic NBs of caregivers in three dimensions of facial expressions, body movements, and tone of voice are tested, with the results showing that higher display of such NBs, regardless of the type, contributes to the impression of overall positivity.…”

Section: E Ects Of Nbs On the Impressions Of Dominance Overall Positi...mentioning

confidence: 96%

Systematic manipulation of experimenters' non-verbal behaviors for the investigation of pain reports and placebo effects

Daniali,

Ruben,

Flaten

2023

Front. Psychol.

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ObjectiveNon-verbal behaviors (NBs) of caregivers affect pain reports and placebo effects. However, little experimental research has systematically examined the caregivers' NBs. This study protocol and preparatory study report a systematic manipulation of experimenters' NBs to investigate pain report and placebo effects.MethodsWe propose an experiment in which videotaped experimenters (VEs) conduct a pain stimulation and a placebo treatment study. The VEs express one positively enhanced NB and keep the other NBs neutral. Participants will be randomized to either the positive facial expressions (+FE), tone of voice (+TV), body movement (+BM), or neutral NBs (i.e., neutral condition; NC) of the VEs. As a preparatory study for proof of concept, two groups of NB coders from Norway and the USA separately rated the degree of NBs (eye contact, body postures and movements, and tone of voice), and impressions of dominance and being in charge, positivity, and expressivity from each NB video. The NB videos had construct validity and reliability. The +BM and +FE were rated as more dominant and in charge than the +TV and the NC. The +FE and +BM were rated as the most positive and expressive NBs, respectively.Expected results+FE will have the largest placebo effects on pain and stress levels. However, transmitting the NBs to patients by VEs is challenging. Moreover, controlling for the effects of research assistants present in the testing room is challenging.DiscussionWe propose that caregivers' NBs affect pain reports and placebo effects. Moreover, different NBs elicit different impressions, and a better understanding of the role of caregiver NBs requires more rigorous investigations. Lastly, aiming to investigate the caregiver NBs, the varying degrees of micro-NBs and their effects on the formation of impressions should be considered.

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“…Substantial psychological and neural overlap between physical pain and social distress has led to a great deal of interest in the concept of "social pain," which has been addressed in previous reviews (Eisenberger 2015;Iannetti et al 2013;Mogil 2015). In addition, recent studies indicate that expectations may vary depending on features of the provider (Howe et al 2017;Necka et al 2021), and that the patient-provider interaction can impact pain relief (Anderson et al 2020;Kaptchuk et al 2008;Losin et al 2017). We should continue to pursue work on not only the mechanisms by which instructions shape pain, placebo, and responses to treatment, but also how the person delivering instructions impacts responses.…”

Section: Patient-provider Interactions and Socially Mediated Expectat...mentioning

confidence: 97%

How instructions, learning, and expectations shape pain and clinical outcomes

Atlas¹

2022

Preprint

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Treatment outcomes are strongly influenced by expectations, as evidenced by the placebo effect. Placebo effects are strongest in pain, indicating that psychosocial factors directly influence pain. In this review, I focus on the neural and psychological mechanisms by which instructions, learning, and expectations shape subjective pain. I address new experimental designs that help researchers tease apart the impact of these distinct processes and evaluate the evidence regarding the neural mechanisms by which higher order factors shape subjective pain. Studies reveal that expectations modulate pain through parallel circuits that include both pain-specific and domain general circuits, such as those involved in affect and learning. I then review how expectations, learning, and verbal instructions impact clinical outcomes, including placebo analgesia and responses to pharmacological treatments, and discuss implications for future work.

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Expectations about pain and analgesic treatment are shaped by medical providers’ facial appearances: Evidence from five online clinical simulation experiments

Cited by 11 publications

References 72 publications

How Pain-Related Facial Expressions Are Evaluated in Relation to Gender, Race, and Emotion

How Pain-Related Facial Expressions Are Evaluated in Relation to Gender, Race, and Emotion

Systematic manipulation of experimenters' non-verbal behaviors for the investigation of pain reports and placebo effects

How instructions, learning, and expectations shape pain and clinical outcomes

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