Empathic Conversation Research Articles

Challenges and Opportunities for Psychological Research in the Majority World

How can psychology transform itself into an inclusive science that engages with the rich cultural diversity of humanity? How can we strive towards a broader and deeper understanding of human behavior that is both generalizable across populations and attentive to its diversity? To address these major questions of our field, relying on scholars from different world regions, we outline first the opportunities associated with conducting psychological research in these and other majority world regions, highlighting international collaborations. Cross-cutting research themes in psychological research in the majority world are presented along with the urgent need to adopt a more critical lens to research and knowledge production within psychology. Indigenization, critical, transformative and liberatory approaches to understanding psychological phenomena framed within the decolonial imperative are presented as future options for a more diverse and equitable psychological science. Next, we address challenges, including limited institutional research infrastructure, limited national investment in research, political and social challenges these regions face, and the impact of imported (rather than locally produced) psychological knowledge. We conclude by offering recommendations to enable psychological science to be more representative of the world’s population. Our aim is to facilitate a broader, better-informed, and more empathic conversation among psychological scientists worldwide about ways to make psychological science more representative, culturally informed and inclusive.

Changes in stress, burnout, and resilience associated with an 8-week intervention with relational agent “Woebot”

BackgroundResearch investigating the potential for digital mental health interventions with integrated relational agents to improve mental health outcomes is in its infancy. By delivering evidence-based mental health interventions through tailored, empathic conversations, relational agents have the potential to help individuals manage their stress and mood, and increase positive mental health. AimsThe aims of this study were twofold: 1) to assess whether a smartphone app delivering mental health support through a relational agent, Woebot, is associated with changes in stress, burnout, and resilience over 8 weeks, and 2) to identify demographic and clinical factors associated with changes in these outcomes. MethodThis exploratory, non-randomized, single-armed, open-labeled trial was conducted from May to July 2022. A total of 256 adults (mean age 39 ± 13.35; 72 % females) recruited through social media advertising enrolled in the study. Participants completed an 8-week intervention period during which they were invited to use a smartphone app called Woebot-LIFE that delivers cognitive behavioral therapy through a relational agent called “Woebot”. Participant-reported measures of stress, burnout, and resilience were collected at Baseline, and Week 8. Changes in these outcomes during the study period were assessed. Bivariate and stepwise multiple regression modeling was used to identify sociodemographic and clinical factors associated with observed changes over the 8-week study period. ResultsExposure to Woebot-LIFE was associated with significant reductions in perceived stress and burnout and significantly increased resilience over the 8-week study period. A greater reduction in stress was observed among those with clinically elevated mood symptoms (i.e., Patient Health Questionnaire-8 or Generalized Anxiety Disorder 7-item scores ≥10) at baseline compared to those without; however, the differences in the improvements in resilience scores and burnout between the two groups were not statistically significant. Although a difference in the magnitude of change in stress was observed for participants with and without clinically elevated mood symptoms at baseline, significant improvements in stress, burnout, and resilience over the 8-week study period were observed for both groups. Bivariate analyses showed that race, insurance type, and baseline level of resilience were associated with changes in each of the outcomes, though baseline resilience was the only factor that remained significantly associated with changes in the outcomes in the stepwise multiple regression analyses. ConclusionResults of this single-arm, exploratory study suggest that conversational agent-guided mental health interventions such as Woebot-LIFE may be associated with reduced stress and burnout and increased resilience in both clinical and non-clinical populations.

Human–AI collaboration enables more empathic conversations in text-based peer-to-peer mental health support

Advances in artificial intelligence (AI) are enabling systems that augment and collaborate with humans to perform simple, mechanistic tasks such as scheduling meetings and grammar-checking text. However, such human–AI collaboration poses challenges for more complex tasks, such as carrying out empathic conversations, due to the difficulties that AI systems face in navigating complex human emotions and the open-ended nature of these tasks. Here we focus on peer-to-peer mental health support, a setting in which empathy is critical for success, and examine how AI can collaborate with humans to facilitate peer empathy during textual, online supportive conversations. We develop HAILEY, an AI-in-the-loop agent that provides just-in-time feedback to help participants who provide support (peer supporters) respond more empathically to those seeking help (support seekers). We evaluate HAILEY in a non-clinical randomized controlled trial with real-world peer supporters on TalkLife (N = 300), a large online peer-to-peer support platform. We show that our human–AI collaboration approach leads to a 19.6% increase in conversational empathy between peers overall. Furthermore, we find a larger, 38.9% increase in empathy within the subsample of peer supporters who self-identify as experiencing difficulty providing support. We systematically analyse the human–AI collaboration patterns and find that peer supporters are able to use the AI feedback both directly and indirectly without becoming overly reliant on AI while reporting improved self-efficacy post-feedback. Our findings demonstrate the potential of feedback-driven, AI-in-the-loop writing systems to empower humans in open-ended, social and high-stakes tasks such as empathic conversations. AI language modelling and generation approaches have developed fast in the last decade, opening promising new directions in human–AI collaboration. An AI-in-the loop conversational system called HAILEY is developed to empower peer supporters in providing empathic responses to mental health support seekers.

Improving multimodal fusion with Main Modal Transformer for emotion recognition in conversation

Emotion recognition in conversation (ERC) is essential for developing empathic conversation systems. In conversation, emotions can exist in multiple modalities, i.e., audio, text, and visual. Due to the inherent characteristics of each modality, it is not easy for the model to use all modalities effectively when fusing modal information. However, existing approaches consider the same representation ability of each modality, resulting in unsatisfactory fusion across modalities. Therefore, we consider different modalities with different representation abilities, propose the concept of the main modal, i.e., the modal with stronger representation ability after feature extraction, and then propose the method of Main Modal Transformer (MMTr) to improve the effect of multimodal fusion. The method preserves the integrity of the main modal features and enhances the representation of weak modalities by using multihead attention to learn the information interactions between modalities. In addition, we designed a new emotional cue extractor that extracts emotional cues from two levels (the speaker’s self-context and the contextual context in conversation) to enrich the conversation information obtained by each modal. Extensive experiments on two benchmark datasets validate the effectiveness and superiority of our model.

The perception of empathy.

In the present article, we aim to identify, analyse and correlate the variables underlying the perception of empathy based on the evaluations made by the role play participants of their own interactions. The subjects, whose L1 was either Catalan or English, held a conversation dealing with a trouble that aimed to elicit an empathic response. Each participant assessed the effects that those dyad dialogues had on them by completing a questionnaire in which different elements were included depending on whether they were the empathy receiver or the empath provider. Although partially grounded on conversational aspects, the analysis of the items favours a more psychology-oriented approach since they involve subjective cognitive and emotional factors. The results show the positive effects of empathy-related verbal strategies on the empathy receiver and the central importance of understanding and appraisal in the construction of empathy. The results also point to the mutual influence of interactional participants on each other. By identifying the significant correlations established between the variables considered, we hope to contribute to the understanding of the impact of empathic conversations on the participants.

Transitions at the End of Life

Transitions at the End of Life Abstract. Transitions in places of care are often associated with a high symptom burden, a constantly growing care network and / or frequent changes between ambulatory and inpatient care. Interface problems occur at the organizational, communication, information, and knowledge levels, as well as in the networking of care facilities and services. Indications of care deficits at the end of life and the extent to which unsuccessful symptom relief or frequent changes between ambulatory and inpatient care can be cushioned are discussed on the basis of study results. At the end of life, open empathic conversations, symptom relief, psycho-social support, and, if necessary, the addressing of spiritual questions with needs-based availability of facilities and services are important cornerstones for the dying and the bereaved. An overview of the various kinds of hospice and palliative care services in the ambulatory and inpatient sector, including those for the bereaved, will also be presented.

Effectiveness of embodied conversational agents for managing academic stress at an Indian University (ARU) during COVID‐19

AbstractStress has become one of the major reasons for many mental health related issues among students of all age groups, which has resulted in devastating personal losses including suicide. Societal and familial pressure to succeed is high, particularly in developing countries where education is highly valued as a key enabler. As part of stress management during the COVID‐19 pandemic, demand for online intelligent virtual advisors has risen and, consequently, the need for personalised explanation that is culturally sensitive to the user's context is essential to improve the user's understanding of and trust in the recommendations provided by the virtual advisor. This paper presents the mAnaging stRess at University embodied conversational agent (ECA) that has been adapted for Indian university students from an explainable agent that was found to help Western students reduce their stress by providing study tips with explanations based on the student's beliefs and/or goals. We conducted a research study with sixty students which measured the impact of providing three different patterns of tailored explanations (belief‐based, goal‐based, and belief and goal‐based explanation) on the students' intentions to change the recommended behaviours and the relationship built with the ECA. The experimental results indicate that there was stress reduction across all student groups provided with different types of explanations. Further, the students showed trust and a good working alliance with the conversational agent, along with an intention to change behaviour across all types of explanations. However, it was observed that the user context played an important role in behaviour change intention and hence explanations could be tailored further, making them culturally more relevant to Indian students. Practitioner notesWhat is already known about this topic Embodied conversational agents (ECAs) have been mostly developed, applied and shown to be effective in developed countries. Hence, their design and development are mostly guided by the intended user's needs and preferences. In a Western context, ECAs have been found to be beneficial for reducing study stress in university students. There is a pertinent need for use of low cost, effective technology that can aid academic stress reduction in higher educational institutions in developing countries owing to their high youth populations, lack of adequate mental healthcare facilities and associated social stigma. What this paper adds The adaptation and use of ECAs to reduce study stress in higher education students in a developing country is evaluated. The ECA technology is adapted for an Indian context in terms of its physical appearance, colour, speech dialect and dialog content so that it is culturally more aligned to the target population. The ECA engages in an empathic conversation tailored for the Indian students and their COVID‐19 context providing them with explanation‐backed behaviour recommendations that take their beliefs and goals into account. The ECA provides three types of explanation: belief‐only; goal‐only; and both belief and goal. Results of a study carried out in an Indian university with 61 students, randomly assigned to one of the explanation types, to capture their demographics, study stress statistics, behaviour change intentions and trust/working alliance with the conversational agent. The major findings include stress reduction across all explanation groups, development of a positive relationship between the ECA and the students regardless of its explanation pattern, and changes in behaviour intentions across all types of explanations for all recommended behaviours. However, differences in change intentions for certain behaviours indicate further tailoring of explanations is required based on the user context. Implications for practice and/or policy The ECA technology has shown promise in terms of stress reduction amongst Indian students. Higher Education Institutions in developing countries could utilise low‐cost and widely accessible ECAs to overcome lack of access to human‐based support and reluctance to use available services due to stigmatized attitudes to mental health issues. This technology can be further improved and deployed into a larger number of Indian educational institutions leading to a widespread impact on overall student health and wellbeing. Digital technologies to support mental health have become more prominent during the COVID‐19 pandemic, at least in Western countries. The ECA technology evaluated in our study demonstrates its viability and potential value for use in developing countries, with appropriate tailoring.

Telephone-based communication training in the era of COVID-19.

Introduction: In the wake of the COVID-19 pandemic, alternatives to established and proven formats had to be found in university teaching within a very short time. In the case of the SkillsLab at the Dorothea Erxleben Lernzentrum Halle (Saale) at the Martin Luther University Halle (Saale)-Wittenberg, this meant in relation to the communication courses that a considerable proportion of the simulation participants of advanced age or with pre-existing conditions were suddenly no longer available for conversation simulations in teaching.Project description: In the course of the seminar “Conversation with relatives – dealing with relatives” in the 8th semester, the conversation simulation was therefore adapted at short notice and converted into a telephone conversation. Thus, the simulation subjects were able to participate remotely and the students had the opportunity to test their doctor-patient conversation skills with regard to telephone calls in a safe environment. Results: The focus on nonverbal techniques and the departure from the usual face-to-face setting was perceived by students and simulation subjects alike as a positive stimulus and particularly challenging. The lack of visual impressions had made empathic conversation more difficult. Discussion and Conclusions: The positive experiences from this project should be used to expand the communication curriculum in the future to include telephone-based conversations with simulation subjects. Ideally, it would then be possible for the simulation persons to be present in the future after the conversation for feedback mediation and group discussion.

Impact of surgical complications on the operating surgeon, Biggs et al

I felt one coming. Disbelief, guilt, self-doubt, shame and sadness were my companions. Amidst the turmoil, I tried to cope according to expectations: repeated updates with the intensive care unit specialist, lengthy empathic conversations with the wife and the rest of the family, a phone call to the general practitioner. Nothing I did would bring my patient back to life. Nothing helped me to understand why he aspirated, developed acute respiratory distress syndrome and died. Maybe I jinxed it. Studies have shown that nearly 80% of healthcare personnel are emotionally affected by a near miss or adverse event at least once in their career [1, 2]. Regardless of a complaint or lawsuit, doctors show a higher prevalence of mental health sequelae compared to nurses [3]. The most common symptom is hypervigilance, which lasts longer than 6 months in 28% of doctors after a patient safety incident [4] Biggs et al. [5] conducted an online survey using the Twitter feed of the European Society of Coloproctology, the Association of Coloproctology of Great Britain and Ireland and the Association of Surgeons of Great Britain and Ireland. A total of 94% of 82 respondents reported personal involvement in a serious surgical complication in the previous 5 years. A negative impact on personal/family life was noted by 55% and over 25% reported a negative impact on interactions with colleagues. Stress was coped with through discussion with colleagues, ensuring optimal management of the complication, and involvement with patients and relatives. Alarmingly, 54% reported that the support provided by the institutions was felt to be inadequate, and 10% reported that no support was available. Perceived managerial support and information about rights have shown positive associations with reduced defensive practices and well-being in a previous study [6] Our profession is unique due to the direct effects of clinical and technical decisions on patients' outcomes. In the case of adverse outcomes, the mental pressure can be hard to endure. In recent years, a surge of young doctor suicides emerged in the UK and in Australia. Biggs et al. have shown that collegial support is essential for coping with stress. Sharing experiences with the new generation of doctors and surgeons and teaching about developing resilience should be part of a just and ‘blame free’ culture. I would like to encourage you to share the article by Biggs et al. with your clinical lead and clinical service manager to support the participation of your institution in peer support programmes. For all we know, each one of us may be the next second victim.

Generating Emotional Controllable Response Based on Multi-Task and Dual Attention Framework

Building an empathic conversation agent in open-domain is a key step towards affective computing and intelligent interactions. However, most current methods either focus on the consistency of content or the controllability of emotion and handling both factors are not yet properly solved. In this paper, we propose the multi-task and dual attentions (MTDA) framework for generating an emotional response. The MTDA framework decomposes the input utterance into the content layer and emotional layer, and then encodes and decodes them separately, which makes this end-to-end model more interpretable and controllable. A multi-task learning based encoder is employed in the MTDA framework, which can obtain the representation of the content and the emotion through unsupervised learning and supervised learning. A dual attention mechanism is adopted for decoding, which ensures that specific emotional responses are coherent with the content and the emotion of the input. We also combine the MTDA framework with state of the art generative models to train emotional generation systems. Extensive experiments show that our model can not only adapt to different target emotion goals but also generate coherent and informative responses.

Heart health whispering: A randomized, controlled pilot study to promote nursing student perspective-taking on carers\u2019 health risk behaviors

BackgroundLifestyle counseling is described as a “major breakthrough” in the control of chronic diseases. Counseling can be challenging to nurses due their lack of motivation to counsel, hesitancy to appear non-judgmental, lack of empathy, and lack of time. Nurses voice their need for more training in counseling communication skills. Our main objective was to engage in ongoing development and testing of a promising Heart Health Whispering perspective-taking intervention on nursing students’ clinical empathy, perceptual understanding, and client readiness to alter health risk behaviors.MethodsIn this randomized controlled pilot study, the full intervention (perspective-taking instructions, practice, and video-feedback) and partial intervention (video-feedback only) comprised 24 and 18 nursing students, respectively. Quantitative data were collected with a 10-item pre- and post-intervention clinical empathy tool, a one-item ‘readiness to change’ health risk behavior tool plus similarity ratings on students’ empathic accuracy were calculated. Data were analyzed using Independent Samples t Tests and mixed model ANCOVA models. Students’ and actors’ evaluative responses toward the intervention phases were collected by handwritten notes, and analyzed using content analysis and constant comparison techniques.ResultsThe main finding was that students in the full intervention group reported greater clinical empathy in the post versus baseline condition. Students underestimated their clinical empathy in comparison to carers’ reports in the post-condition. In both intervention groups, carers reported more readiness to change in the post-condition. Carers identified favorable and unfavorable perceptions and outcomes of approaches taken by students. Students desired immediate and direct feedback after the video-dialogue and -tagging exercise.ConclusionsHeart Health Whispering is a promising intervention to help educators in basic and continuing education to bolster nurse confidence in empathic conversations on health risk behaviors. This intervention incorporates commonly used strategies to teach empathic communication along with a novel video-analysis application of a perspective-taking task. Student and carer actor comments highlighted the value in opportunities for students to engage in self-evaluation and practicing the empathic process of taking the client’s perspective on health risk behaviors.

Shared decision making in patients with diabetes mellitus

Patients with diabetes mellitus often have several medical problems and carry a burden imposed by their illness and treatment. Health care often ignores the values, preferences and context of patients, leading to treatments that do not fit into patients’ overwhelmed lives. Shared Decision Making (SDM) emerges as a way to answer the question: “What’s best for the patient?”. SDM promotes an empathic conversation between patients and clinicians that integrates the best evidence available with their values, preferences and context. We discuss three SDM approaches for patients with diabetes: one focused on sharing information, another on making choices, and a third one on helping patients and clinicians to talk about how to address the problems of living with diabetes and its comorbidities. Despite the benefits demonstrated in studies conducted in the U.S. and Europe, the implementation of SDM continues to be a challenge. In Latin America, healthcare and socio-economic conditions render the implementation of SDM more challenging. Research aimed to respond to this challenge is necessary. Meanwhile, clinicians can practice SDM by sharing evidence-based information, giving voice to patients’ values and preferences in making choices, and creating empathic conversations aimed at decisions aligned with patients’ context, dreams, goals, and life expectations.

Short-Term Effects of the Empathic Talk: The Role of Perceived Empathy, Interpersonal Dispositions, and Vagal Tone on Experiencing Depth.

The present study examines the immediate impact of empathic attitudes on the receiver, by comparing an empathic conversation (EC) with a neutral one (NC) on experiencing depth (EXP), perceived empathy and vagal tone. We also evaluate if empathy effects depend on personality dispositions relevant to interpersonal functioning. An experimental, counterbalanced, within-subject design was implemented wherein participants (n = 27, age M = 22.6, SD = 4.0, 52% females) talked about a personal, meaningful topic for 20 minutes under both the EC and NC conditions. At the group level, main results indicated that the EC was more effective than the NC in promoting increases in EXP over time (F(1, 25) = 21.04, p < .001, η p 2 = .457) and perceived empathy in women (F(1, 25) = 9.42, p = .005, η p 2 = .264). At the individual level, the NC particularly precluded EXP gains in people expressing a better interpersonal functioning (βs < -.46, ps < .05 for attachment security and empathy and β = .38, p < .05 for aggression), and who also inhibited their vagal tone throughout this very condition (β = .40, p = .024). We conclude that the empathic context has an immediate positive impact on healthy psychological variables, whereas a more impersonal setting would drive people away from this positive effect. Those results are discussed in the light of the role of interpersonal proximity (being empathic to another's experience and the lack of this attitude) in psychotherapy and healthy functioning.

Shared decision-making in the care of individuals with diabetes.

People with diabetes often live with other chronic conditions and lead complicated lives. Determining what is the best management decision for a patient requires consideration of each individual's personal, social and biomedical context, what he or she values, the reasons he or she has to value the available options, and the relative contribution of each option in terms of benefits, harms, costs and inconveniences. Empathic conversations between patients and clinicians to diagnose the patient situation that necessitates action and the range of evidence-based actions that best address the situation, so-called shared decision-making, are essential to the personalized care of people with diabetes.The aim of the present review was to present key elements of shared decision-making and propose three different approaches for its application. The first approach focuses on transferring information to patients so that they can make decisions. The second approach, choice, focuses on cultivating the individual's ability to give voice to which choice is best for them. The third approach, conversation, establishes an empathic conversational environment through which the individual with diabetes and their clinician think and talk through how to address the problems of living with diabetes and related illnesses. These approaches are manifest in the design of evidence-based decision aids created to support shared decision-making. In randomized trials, decision aids can efficiently improve patient's knowledge, satisfaction, risk awareness, decisional conflict and involvement. Further research, however, is needed to better understand when and how to promote the empathic conversations, patient, clinician and service and policy contexts necessary to routinely implement shared decision-making in different at scale healthcare systems. In the interim, sufficient evidence and tools exist for persons with diabetes and their clinicians to gain expertise in making decisions together.

Decision conflicts with relatives in the intensive care unit

If medicine is coming close to its limits conflicts sometimes occur. Most conflicts in the intensive care unit (ICU) involve the medical team and patients' relatives. In particular decisions about withholding and withdrawing life-sustaining therapy lead to conflicts. Decisions about limiting life-sustaining treatment are burdened by conflicts and put an enormous strain particularly on relatives. Illustration of currently available studies and existing recommendations on how to manage potentially conflict-laden decision-finding discussions on the ICU are presented. This article is based on a selective literature research in the PubMed database. Studies have been carried out to evaluate posttraumatic stress disorders in relatives who were involved in life-limiting treatment decisions. Conflicts on the ICU put an emotional strain on relatives. Evidence-based recommendations are available regarding physicians' attitudes during discussions about therapy decisions, communication style and other contextual factors. Study results show that the emotional stress level relatives have to endure can be reduced if conversations between patients' families and the clinical personnel were conducted according to these recommendations. The involvement of a clinical ethics committee can prevent conflicts and has been shown to have no impact on the mortality rate but does decrease the time life-sustaining measures were unsuccessfully pursued. To prevent conflicts between the medical personnel and patients' relatives on the ICU, a timely, congruent and empathic conversation style in an appropriate, quiet environment is essential. Consultation with clinical ethics committees is recommended to de-escalate disputes.

Addressing Vaccine Hesitancy With Values.

As a scientist with epidemiologic training, it has long been clear to me that the benefits of vaccines outweigh the risks, both on the individual and on the societal level. Both of my children are fully immunized on the standard schedule. Many of my friends’ children are not. When my 8-year-old was a toddler, I once noted that he was the only child in a playgroup who had received all of his vaccines on time. I felt connected in this group for other reasons; for example, I got helpful advice from other mothers about gently weaning a child at an age when most children have already stopped breastfeeding. Vaccines can be a difficult topic in such circles. When asked, I recommend that my friends and family talk to their child’s doctor or other health care provider about their questions. However, as a parent and a scientist in the field of medical decision-making, I offer my perspective on what I understand about the risks and benefits of different vaccines, the limits of my understanding, and why my husband and I had our children vaccinated without hesitation. Specifically, I talk about my family’s values and how those values have helped determine our decisions to immunize our children. I compare the best estimates of the small risks of vaccines against estimated risks of exposure to a vaccine-preventable disease in an increasingly global world, and the likelihood of complications should such a disease strike an unvaccinated child. I explain how I am willing to accept the very small risks of vaccines because I could never live with myself if my children … Address correspondence to Holly O. Witteman, PhD, Pavillon Ferdinand-Vandry, Local 2881-F, Universite Laval, Quebec City (QC), Canada G1V 0A6. E-mail: holly.witteman{at}fmed.ulaval.ca

Patterns of empathy as embodied practice in clinical conversation-a musical dimension.

Cognitive linguistics and conversation analysis (a) converge in the analysis of category bound activities and (b) in viewing thinking and talking as embodied activities. The first aim of this paper is to outline these powerful theories as useful tools for the analysis of enacting empathy. The second aim is to outline these theories as useful tools for the analysis of how empathy is co-enacted in clinical conversation documented in transcripts. Cognitive Linguistics and Conversation Analysis converge in detecting patterns of I-You-relationships with roots in early preverbal embodied protoconversation continuing to more symbolic conversational level. The paper proposes to describe this continuity of empathic conversation in musical metaphors like balance, rhythm and resonance. In a first section transcripts from therapeutic sessions are presented. In a second section linguistic and other research data are presented in order to bring empirical data to this new conception of how empathy can be understood, how it is done and how two participants cooperate to enact empathy. Ideas for further research are outlined.

Child–mother and child–father play interaction patterns with preschoolers

The study focused on qualitative and quantitative differences between maternal and paternal play interaction behaviours with their preschool children. Home observations of 18 child–mother and child–father play interactions were qualitatively analysed to derive interaction themes. In addition, the quality of child–mother and child–father interactions was assessed through emotional availability (EA) coding system. The qualitative analyses indicated that during play interactions with their preschool children, mothers tend to structure, guide, teach, and engage in empathic conversations, whereas fathers tend to engage in physical play, behave like age-mates, follow the child's lead, and challenge children. Despite these qualitative differences, child–mother dyads did not differ significantly from child–father dyads on five out of six EA dimensions. The discussion includes methodological implications of the findings derived through this mixed-methods study.

Psychiatrists Using Motivational Interviewing Say It’s Valuable Treatment Addition

The more people talk about changing their behavior, the more likely they are to actually do so, say therapists who use the technique of motivational interviewing.

If I Paint a Rosy Picture, Will You Promise Not to Cry?

These are powerful words, and it is impressive how very much we want to say them. The patient is in distress. The physician’s voice is calm, reassuring. “You’re going to be OK. I’m a doctor. I know.” If only our words could make it so. I was listening to this conversation between a patient and a physician who had never met him before and who had no idea why the patient was in the hospital. We were doing some quality improvement work and had stopped to talk to a patient about his experience. The patient had a gauze dressing wrapped around his head and could not remember how long he had been in the hospital. He said he was tired. He very much wanted to go home. Could we tell him when he could leave? Could we tell him whether he was going to be OK? Maybe being an oncologist leads me to expect the worst, but I thought that the memory loss and bandage were not necessarily good signs about his prognosis. I pulled his nurse aside and asked what the diagnosis was. He had pancreatic cancer and had just had a brain metastasis resected. Maybe he was not going to be OK. The urge to reassure can get us into trouble. It is a major impediment to caring for our patients empathically, although it seems like such a caring and benign impulse. Soothe people, make them less upset, show them great confidence to maintain their hope and peace of mind. But reassurance can also be a gesture to minimize their concerns, to snuff out their expressions of suffering so that we don’t have to deal with it, an exit strategy from a more difficult, truthful, and empathic conversation. As a fellow, I saw a staff oncologist tell a patient with metastatic cancer that had partially responded to chemotherapy that she was in remission. “You’ve had a great response to treatment,” he said. “Am I in remission?” she asked. “Yes,” she was told. But she was not in remission, as she saw for herself when I showed her the scans later on. And although I value and admire my surgical colleagues, what medical oncologist has not silently cursed a surgeon for telling a patient “I got it all,” leaving us to explain the mystery of the recurrence. I imagine it feels good to utter these words. They are very reassuring. Another version of, “You’re going to be OK. I’m a doctor. I know.” But the surgeon often is not there to answer the patient’s complaint: “But he said he got it all. What happened?” Of course, there have been times when I could not resist the temptation to prematurely or inappropriately reassure patients myself. The pitfalls of reassurance became clear to me only after fellowship training, when I attended the OncoTalk Teach program and also went through training by the American Academy of Communication in Healthcare to learn how to teach communication skills. Don’t respond to emotional distress by reassuring the patient, they said. Instead, empathize. Explore the patient’s experience. Listen more and talk less. Show our patients that we have some grasp of what they are going through. Acknowledge their emotions. Provide emotional support. Partner with them. Stay in the emotional rather than the cognitive realm until strong emotions have calmed down. When the news is bad, find a way to let patients know that you understand that their illness is terrible for them. The episode with the patient with pancreatic cancer made me wonder anew why we are so quick to reassure when it can so obviously lead us astray. Some of the answers seem clear. It is uncomfortable to be in the presence of distress, to face bad outcomes, to watch someone be upset. In oncology, our bad outcomes are profoundly bad. It is easier to reassure the patient with false hope or a change of subject. “Your cancer has spread to your liver and your brain, but I’m very excited about a new drug that’s in clinical trials, and I think we should try it. We’ve seen exciting results in mice.” We reassure because we want people to feel better, but perhaps we are also saying, “It makes me uncomfortable when you get upset, so please don’t get upset.” Or, “If I tell you that I got it all, will you promise to calm down?” Oftentimes patients collude with us. Newsweek ran an article about patients with cancer who loved their oncologists, and it described multiple cases of patients with advanced tumors who had beaten the odds against them after their physicians had refused to discuss their prognosis. Everyone loves a happy JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 30 NUMBER 27 SEPTEMBER 2