Towards More Accurate Recognition of Patient Emotion Cues: Meta-Analysis of Training Literature and Development of an Assessment Tool and Multi-Component Intervention for Clinicians

OF DISSERTATION Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology in the Graduate School of Arts and Sciences of Northeastern University, May, 2011 3 Abstract The ability to make accurate perceptions of others is a valuable skill related to a variety of positive intraand interpersonal attributes (Hall, Andrzejewski, & Yopchick, 2009). For healthcare providers in particular, accurate perception of patients, particularly accurate recognition of patient emotions, is an ability associated with better patient care, and more satisfied and adherent patients (Hall, Roter, Blanch, & Frankel, 2009). A critical component of quality in empathic provider-patient communication is the provider‟s ability to recognize the emotional needs of the patient. Despite the importance of this skill for effective communication, research on clinically relevant assessment tools and training programs for emotion cue recognition ability is extremely limited. This dissertation examines the effectiveness of training to improve person perception accuracy, with a particular focus on improving healthcare providers‟ ability to accurately recognize their patients‟ emotion cues. To summarize the existing literature and assess the combined effect of training on person perception accuracy, a meta-analysis was conducted of the existing literature on person perception training interventions in healthy adult populations. Moderators of training effectiveness were also examined. Overall, training interventions were shown to significantly increase person perception accuracy in nonclinical adult populations who had received the training, as compared to those who had not. Feedback and practice were more effective approaches than instruction alone; however, a combination of approaches was the most effective training intervention. No study included in the meta-analysis experimentally assessed the impact of a training intervention to improve basic emotion cue recognition ability in healthy adult populations. 4 With the goal of improving emotion cue recognition in healthcare providers, this dissertation also presents an experimental investigation of the effectiveness of a comprehensive training intervention and its individual components to increase emotion cue recognition ability. The comprehensive training included raising awareness about the importance of emotion cues in healthcare interactions, providing instruction for how to increase emotion cue recognition accuracy, and practicing emotion recognition while receiving feedback. Undergraduate participants role-playing medical students were randomly assigned to receive the comprehensive training condition, a control group with none of these training components, or one of four training conditions where participants received either consciousness-raising, instruction, practice alone, or practice with feedback. Emotion cue recognition ability following training was compared across conditions. Participants were significantly more accurate on a standardized test of emotion cue recognition in the comprehensive condition, when they practiced, and when they practiced and were given feedback about the correct answer, as compared to those participants in the control condition. The impact of training condition on participant mood and reactions to the training are also discussed. Results suggest that a 30-minute emotion recognition training intervention could significantly improve emotion recognition accuracy. In addition to testing the effects of training, this dissertation presents validation studies of the Patient Emotion Cue Test (PECT), as a novel assessment of emotion recognition ability, developed for healthcare providers (Blanch-Hartigan, 2011). The PECT consists of video clips depicting emotion cues of an actress portraying a patient with content derived from real patient interactions. Unlike other measures of emotion recognition ability, the PECT clips are specific to a healthcare context, vary in the intensity of both verbal and nonverbal cues, and cover five emotion categories and neutral affect. In three validation studies, the PECT demonstrated 5 sufficient reliability, normally distributed accuracy scores, significantly better than chance responding, and no ceiling effect. Construct validity was established through significant correlations with established measures of emotion recognition. The PECT was used as the primary assessment tool for the training intervention. Results of the meta-analysis and training intervention study suggest that training and assessing emotion cue recognition accuracy in healthcare providers is possible. The results can be used to guide development and implementation of future programs and research aimed at increasing providers‟ emotion recognition. 6 Acknowledgments First and foremost, I would like to thank an amazing woman and advisor, Dr. Judith A. Hall. In these past five years, you‟ve been a mentor, a teacher, a therapist, and a surrogate mother to me. I am constantly amazed by your brilliance and productivity. In addition to all the research lessons, you‟ve provided me with an example of how to be a strong and confident woman. I hope we continue to be friends and collaborators for years to come. Thank you from the bottom of my heart for everything. I want to thank my wonderful lab mates: Sue Andrzejewski, Sarah Gunnery, and Mollie Ruben for your professional advice and sometimes not-so-professional camaraderie. If Judy has been a surrogate mother, you‟ve all been amazing surrogate sistersyes, even the middle one! Thank you for all the support and laughter. I would also like to thank Maureen Gillespie and Maria Carrillo for five years of friendship. I feel so fortunate to have gone through this crazy graduate school process from the start to finish with two of the most beautiful and brilliant women I know. To Jolie Baumann, Leah Dickens, Krista Hill, Allison Seitchik, and Jennelle Yopchick, you are all the reason that graduate school was such a wonderful experience. The countless hours of “productive procrastination” up and down the second floor hallway are what I will remember most. I am so grateful for the memories and lifelong friendships I have made with you at Northeastern and I cannot wait to see where life takes us all! I would like to thank my committee members, Joanne Miller and David DeSteno for their extremely helpful comments and suggestions throughout this process. I would also like to thank the undergraduate research assistants who have contributed to different aspects of this research over the years. 7 In my life outside graduate school, I am unbelievably blessed by wonderful family and friends. I am so thankful for all of you. The deepest of thanks goes to my parents, Gary and Linda Blanch. Thank you for teaching me the value of education and always encouraging me to pursue whatever path I chose. This degree and all the years leading up to it would not have been possible without your constant love and support. You are truly amazing people, who I look up to both as parents and as friends. I love you so much. To my incredible sisters, Sara and Leanna, you are both extraordinary individuals, who I feel fortunate just to be friends with, let alone share this incredible bond of sisterhood. I am so proud of the beautiful women you have become and I am thankful for all your laughter and love. Our closeness means the world to me. Over these past five years, I have also gained the love and support of my “new” family. Dennis, Leanne, and Brian Hartigan, thank you for being the best in-laws anyone could ask for. I have been honored to join your family. I am so thankful for the hours you‟ve spent working on the house, watching Bond, and the countless dinners that have made life so much easier during this process. And finally, I dedicate this dissertation to my wonderful and supportive husband. Mike, thank you for always encouraging me to fulfill this dream. I know how much you have given of yourself to support me through this process and I could not have done it without you. Each year of graduate school is marked by the wonderful milestones in our life together: our first house, Bond, our engagement, and our beautiful wedding. Now we can look forward to this new phase in our lives. You are the best part of my every day and I love you with all my heart. Thank you. 8 Table of