# Motivation and emotion/Book/2016/Blushing and emotion

* Multimedia presentation (3 min)

## Overview

* Case Study
* Blushing is nearly a daily occurrence for Enid. If she’s in the long coffee line to get her morning coffee and realises she doesn’t have her purse with her, she blushes. When she gives a presentation in her tutorial class, even when her tutorial class members are very familiar to her and she feels confident on the topic, she blushes and stumbles over her words. When she speaks with a lecturer about an assignment, even if she has given the topic considerable thought, she blushes. Blushing for her has become something she expects in social and professional interactions. The hot sensation makes her turn bright red across her face, down her neck and even spreads down along her shoulders. It is something she absolutely dreads.
Blushing is an involuntary indicator for emotional expressiveness (Boone & Buck, 2003). It happens when the amygdala is stimulated and adrenaline is released into the blood stream, dilating the blood vessels and allowing the blood to flow more easily[factual?]. Being able to accurately communicate feeling states, expressing emotions, is helpful in revealing desires and intentions and allows an individual to make good heuristic decisions on whether to participate in a situation or not (Boone & Buck, 2003).
People also blush when the motives for their actions are exposed. An example provided by Crozier (2001) is a mother's ability to cause her child to blush by complaining that they only visit her when they want something from her. The child might blush because this is actually the reason that the child is visiting. However, sometimes the seemingly exact situation will not elicit a blush especially if the child holds no shame in approaching the mother to ask for something. A task for future research is to track down why it is that sometimes an event triggers a blush but other times it does not.
This chapter explores the theory and research of blushing and provides examples of some psychological disorders that often interact with blushing occurrences. Information is also provided that investigates the physiological and psychological arguments about blushing. This chapter considers wgere blushing originates, what exacerbates the condition and the consequences of regular and chronic blushing such as the distress it may cause and the interaction between blushing and social anxiety. Treatment options are also provided and include psychological treatment, medications and surgery.

## Bewildered by blushing

[Provide more detail]

### Signs of blushing

Table 1. Signs of Blushing[factual?]
Physical indicators of blushing
| Sign | Signal |
| Reddening of skin | Visible on face, throat and décolletage |
| Feeling hot | Blushers report increases in body temperatures |
| Heart rate rising | Monitored heart rates uncovers an increase in heart rate |
| Increased blood flow | Face, throat and décolletage |

### Theory

Darwin (1872) stated that ‘blushing is the most peculiar and the most human of all expressions’. Darwin believed ‘shyness, shame, and modesty; the essential element in all being self-attention’ is prompted by ‘the thinking what others think of us, which excites a blush (Darwin, 1872 pp.310–327).
Originally blushing did not receive much attention in psychological research as it was assumed it only represented embarrassment and was a signal of an apology or appeasement. However, blushing has been further explored and found to be associated with other expressions of emotion. The blush has also been explored as a signal[explain?] (Crozier, 2001).
Arnold Lazarus has been instrumental in the development of the way psychologists may manage social anxiety. Lazarus' [what?] theory states that as people have lots of different and very specific problems to be able to treat the individual, many treatment strategies are required be implemented to instigate a more favourable change (Lazarus, 1975)[Rewrite to improve clarity]. The individual [what?] components noted are Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal Relationships, and Drugs/Biology (BASIC ID).
Appraisal theory of emotions as developed by Magda Blondiau Arnold (1903-2002) moved theories of emotion away from the James-Lange Theory where an individual evaluates and translates a physiological reaction to a stimulus, such as a rapid heart rate during a social interaction, into an emotion towards a more cognitive approach to evaluating and knowing about emotions.
More recently Other more recent developments to cognitive appraisal theory have been contributed by Rosman (2001), Lazarus (1991) and Scherer (2001).
Component of 5 dimensions of appraisal when stimulus is encountered:
* Motivational State (appetitive, aversive);
* Situational state (motive consistence, motive inconsistent);
* Probability (certain, uncertain and unknown);
* Power (strong or weak);
* Agency (self caused, other caused and circumstance caused).
Following appraisal upon the 5 components an emotional response is then generated.
Research
It has been thought that perhaps people who have a blushing phobia overestimate the undesirable communicative effects of blushing, that more importance is placed upon a blush as demonstrating a social transgression[factual?]. Research does not support this notion of inflated negative communication effects of the blush (de Jong & Peters, 2005). Where most research is now aimed is towards the interactions of the blush and instances of social anxiety, chronic blushing and also, to a smaller effect, rosacea.

### Chronic blushing (pathological blushing)

It is common for most of us to experience blushing when we feel emotions, for example if we are anxious or embarrassed. Some people experience stronger, more frequent blushing episodes This can be characterised by blushing as a response to minor events and even for no apparent reason. This can negatively interfere with how the person affected interacts both professionally and socially.[factual?]
In treating a fear of blushing, social phobia and anxiety is predominantly targeted. Most people with chronic blushing report a fear of entering into social situations because of the fear they associate with the blushing event[factual?]. This fear can often lead to them avoiding social interactions with anyone unfamiliar to themselves or to avoid social interactions all together[factual?]. In an experiment with participants who presented with a fear of blushing either exposure in vivo or a task concentration training was implemented to test the effect redirecting attention would have. The participants[grammar?] outcomes were measured and followed up over the course of 1 year, the treatments were found to improve the overall complaint of fear and further to this the task concentration training effected more cognitive change (Mulkens, Bögels, de Jong & Louwers, 2001). Physiological response to stimulus showed no change.
It is interesting to note that researchers are implementing behavioural change treatments along with measuring physiological response for people who report with a fear of blushing[factual?]. There is actually little evidence that the treatments implemented reduce the physiological side of blushing however it has been reported frequently that teaching the blusher to manage their own anxiety through cognitive and/or behavioural strategies, the anxiety surrounding blushing is successfully reduced[factual?].

### Social Anxiety Disorder (SAD) and social anxiety

It is thought that the expectation that a blush will occur is enough to induce a person to feel socially anxious. Researchers investigated the effects of vasodilator niacin, a medication known to cause blushing a few minutes after it is taken, compared with a control group. Participants then watched a video of themselves singing a nursery rhyme song, expecting that this would elicit an emotional response. The preliminary findings are that even knowing that a blush will result from ingesting the vasodilator niacin (and increased blood flow ability) does not necessarily increase a perception of blushing or embarrassment levels experienced (Drummond & Lazaroo, 2012).
Research investigating whether people with a Social Anxiety Disorder (SAD), show an increased prevalence of blushing when compared to a typically functioning person have been inconclusive (Voncken & Bogels, 2009). The researchers measured this by recording physiological responses such as cheek and forehead blood flow, cheek temperature, and skin conductance while participants are involved in a social interaction task. Typically blushing behaviour is also observed and noted. Comparisons were drawn between a control group and groups of SAD blushers and SAD non-blushers. In comparison to a control group it was found that SAD blushers do not show an increase of blushing compared to the control group. Interestingly, it was also found that SAD non-blushers actually had a smaller cheek blood flow compared to the control and the SAD blushers, however there was no difference found between the groups for skin conductance (Voncken & Bogels, 2009).
There is no psychiatric classification specified for a fear of blushing in front of other people, however it is evident that such a condition exists, usually alongside social anxiety disorder[factual?]. To gain further evidence researchers are actively exploring the specificity of fear of blushing within the population of people who present with SAD. There is strong evidence to suggest that following successful treatment of blushing some suffers were completely alleviated of their social anxiety (Pelissolo, Moukheiber, Lobjoie, Valla & Lambrey, 2012). This suggests that fear of blushing may indeed require being a specific sub-category of SAD and to be treated as a specific condition rather than a generalised condition of social anxiety. This research is part of the growing interest around the fear of blushing and redefining how treatment can target this very specific population.

### Rosacea in blushing sufferers

Rosacea, a dermatological disorder, is indicated by extremely sensitive skin that results in facial flushing. It is believed to be initiated or exacerbated by intense, frequent blushing (Drummond & Su, 2012). There are also a number of environmental factors that are said to impact rosacea such as temperature extremes, heat from sunlight and moving from a hot to a cold environment. There are also psychological factors which are said to impact the instances of flushing such as anxiety or stress. Drinks, such as alcohol and caffeine, foods (particularly spicy foods) can contribute to blushing. Despite rosacea sufferers reporting more instances of blushing research shows that blushing level and frequency is not dissimilar to the control group but it did find there was an impact on social anxiety and the stress that this caused in the impact the blushing events had (Drummond & Su, 2012).

## Is blushing physical, psychological or both?

There is controversy, dependent upon the perspective taken, on what initiates typical blushing and chronic blushing.

### Physiological response: What happens in the body?

Vasodilation occurs when the blood vessels widen and expand (dilate), thereby decreasing blood pressure. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. The visibility of this process is thought to be linked to the characteristics of the facial skin. For excessive blushers more capillary loops are found per unit area[factual?], additionally there are more blood vessels than other skin areas. The blood vessels in the cheeks are wider in diameter in addition to being nearer to the surface, all factors leading to more visibility of blushing on the face in comparison to other skin surfaces of the body[factual?].
* However, vasodilation does not cause someone to blush and even when the physiological response occurs it does not mean that someone will blush. To further investigate causes psychological factors surrounding the blushing[grammar?].

### Psychological response: What happens to your mind?

Severe blushing is a common complaint in people who have a social phobia[factual?]. Social phobia is a type of anxiety disorder that includes an extreme and persistent anxiety in social and performance situations. When researching people who were diagnosed with social phobia compared with a control group research has found that people with social phobia report more instances of blushing than those in a control group[factual?]. The physiological response was also measured and did not indicate any difference in blushing events between the groups[factual?]. Research into blushing is complex and consideration needs to be given to measures that include self-report and physiological evidence, however these measures do not always align (Gerlach, Gruber, Wilhelm, & Roth, 2001).

## Chronic blushing (pathological blushing)

[Provide more detail]

## Consequences: What are the short and long term effects of blushing on emotion?

Some people can find blushing extremely distressing. Oftentimes this distress can lead to a person feeling anxious and depressed whenever they encounter an event that the individual perceives will result in blushing. When a chronic blusher seeks help a cognitive-behavioral approach is often utilised to assist the individual in developing the skills to help them manage the anxious and depressed feelings they have developed. Left untreated, anxiety and depression can lead to significant difficulties in living and participating in a typical life (Dijk, Buwalda, & de Jong, 2012).

## Treatment options: Can you control blushing?

There are a range of treatment options available to limit and manage blushing. Options include psychological treatment options, medications and surgery.

### Psychological treatment options

Involuntary blushing is common to people who have a social phobia. In most cases, these disorders respond well to treatment[factual?]. Practitioners may utilise cognitive behaviour therapy (CBT) which teaches techniques in breathing and other methods that are used in confronting fears that can co-exist with blushing.

### Medications to help treat facial blushing

* Beta-blockers to manage symptoms of anxiety[factual?]
* Clonidine changes the body’s response to naturally occurring chemicals, such as noradrenaline, that control the dilation and constriction of blood vessels[factual?]
* Botox injections into the skin of the face will temporarily paralyse the nerves in the skin that cause blushing. Effects may last up to six months[factual?].

### Surgery for severe blushing

Endoscopic thoracic sympathectomy (ETS) is an operation to cure severe facial blushing. The operation is performed under general anaesthesia. It is a treatment of last resort when all other options have been exhausted. The cure rate for facial blushing is around 90 per cent[factual?].
However, it is important to note that there are possible complications of the ETS operation, with risks including[factual?]:
* Risks of surgery – including allergic reaction to the anaesthetic, haemorrhage and infection
* Droop to the eyelid caused by nerve damage (Horner’s syndrome)
* Compensatory sweating, which means other areas of the body such as the legs and chest sweat heavily instead
* Chronically dry hands.

## Quiz

Time to test your knowledge about blushing:

## Conclusion

So what are the emotional causes and consequences of blushing? There appears to be a very strong relationship between how people interpret and deal with the information that is gathered following a physiological response, initiated by an internal or external stimulus[Rewrite to improve clarity]. There is little evidence to indicate that cognitive behavioural therapy decreases blushing extent and frequency, however it is successful in treating the anxiety often associated with chronic blushing.