An Investigation of Patients' and Doctors' Autonomic Nervous System Responses Throughout News-Focused Medical Consultations.

Although it is clear that people experience physiological arousal in anticipation of news-focused medical consultations, our knowledge of people's experiences during and throughout these consultations is scarce. We examine interbeat interval responses (IBI) of patients and doctors during real-life medical consultations to understand how the experiences of both parties change throughout these encounters and whether they differ from each other. We also examine how the type of news delivered affects responses. We measured the IBI responses of patients and their oncologists throughout 102 consultations in which providers delivered news (classified as good, bad, or status quo) to patients about a recent computerized tomography scan. We observed two distinct phases of consultations: an initial "news" delivery phase and a subsequent "information" phase. During the news phase, on average, patients' IBI responses rapidly increased-indicating less autonomic arousal over time - whereas doctors' responses did not change over time. In contrast, throughout the information phase, on average, both patients' and doctors' responses remained steady. During the information phase, responses differed based on news type: on average, status quo consultations involved an increase in autonomic arousal, whereas good and bad news consultations involved no changes. Lastly, we observed significant variability in patients' responses during both phases. In sum, on average, patients (but not doctors) experience decreases in autonomic arousal while news is being delivered, suggesting that anticipatory distress regarding these consultations wanes quickly. However, our results also indicate that patients' experiences vary from one another, and future research should focus on factors explaining this variability.

Oxytocin increases physiological linkage during group therapy for methamphetamine use disorder: a randomized clinical trial.

Patients and psychotherapists often exhibit behavioral, psychological, and physiological similarity. Here, we test whether oxytocin-a neuropeptide that can enhance expressivity and social perception-influences time-lagged "linkage" of autonomic nervous system responses among participants and facilitators during group therapy. Physiological linkage estimates (n = 949) were created from ten cohorts, each with two facilitators (n = 5) and four to six participants (n = 48), over six weekly sessions of group therapy for methamphetamine use disorder. All participants of a cohort received oxytocin or placebo intranasally in a randomized double-blind procedure before each session. Cardiac interbeat intervals (IBI) were measured continuously during sessions to estimate physiological linkage, operationalized as one cohort-mate's IBI reactivity during one minute predicting another cohort-mate's IBI reactivity during the following minute. In oxytocin cohorts, participants and facilitators experienced significant physiological linkage to their cohort-mates (i.e., their physiological responses were predicted by the prior responses of their cohort-mates) and significantly more linkage than people in placebo cohorts. Both effects occurred during the first and second sessions but not later sessions. Results suggest that oxytocin may enhance psychosocial processes often associated with linkage-such as social engagement-in groups and highlight oxytocin's potential to improve group cohesion during group therapy.Clinical Trials Registration: NCT02881177, First published on 26/08/2016.

Physiological linkage during interactions between doctors and cancer patients.

INTRODUCTION: Doctors and patients influence each other when interacting and, as a result, can become similar to each other in affect and behavior. In the current work, we examine whether they also become similar to each other on a moment-to-moment basis in their physiological responses. Specifically, we examine physiological linkage-how much a doctor's (or patient's) physiological response predicts a patient's (or doctor's) response at a subsequent time interval-and whether this changes over the course of doctor-patient relationships (measured as the number of consultations held for each unique doctor-patient dyad). METHODS: We collected interbeat interval responses (IBI) continuously during consultations between oncologists and patients undergoing cancer treatment (N = 102 unique doctor-patient interactions) at a hospital in Austria. RESULTS: Physiological linkage varied by an interaction between role (doctor vs. patient) and relationship length (in a non-linear, quadratic pattern). Patients showed significant positive linkage to their doctors (i.e., doctors' physiological responses positively, significantly predicted patients' responses) in relationships that spanned three to eight consultations together. Patients were not linked to their doctors in shorter or longer relationships. Doctors were never significantly linked to their patients, meaning that patients' physiological responses never predicted doctors' responses. CONCLUSION: These results reveal that, by influencing patients' physiological responses on a moment-to-moment basis, doctors may have even more influence over patients' physiology than previously known.

Self-disclosure is associated with adrenocortical attunement between new acquaintances.

Adrenocortical attunement-similarity in hypothalamic-pituitary-adrenal (HPA) axis activity-has been well-documented in close relationships (e.g., between romantic partners, parents and children, and close friends). However, little is known about adrenocortical attunement during early relationship formation. In the current study, we examine dyadic adrenocortical attunement during a guided conversation in which two new acquaintances (N = 140 people, 70 dyads), who were university students or adults in the community, answered questions about themselves. Dyads were randomly assigned to answer questions designed to elicit dyad members to reveal a high or low amount of personal information (i.e., to self-disclose at high or low levels). We collected saliva samples (assayed for cortisol) before and after the conversation, and we coded behavioral self-disclosure-the extent to which people revealed their thoughts, feelings, and facts about themselves-during the conversation. As expected, dyads who were assigned to ask and answer high self-disclosure questions disclosed more than those assigned to ask and answer low self-disclosure questions. In addition, greater self-disclosure during the conversation was associated with greater similarity in cortisol change-that is, dyad members who revealed more about themselves experienced more similar cortisol changes in response to their conversation. This work reveals one social process through which adrenocortical attunement occurs during early relationship formation, and, in doing so, describes how our physiological functioning is linked to those around us-even people we have just met.

Physiological linkage among successful high-status women in international teams.

In contemporary society, decisions are often made by teams whose members represent different nationalities and genders. In the current work, participants from 55 countries formed groups of 3 to 4 people to select one of the 5 firms in a mock firm search. In all groups, one woman was randomly assigned to have higher status than her groupmates; she was also surreptitiously instructed to persuade her group to select one (randomly assigned) firm. We measured cardiac interbeat intervals for participants throughout the decision-making process to assess physiological linkage-the degree to which a 'sender's' physiological response predicts a 'receiver's' physiological response at a subsequent time interval. On average, high-status women were successful at persuasion. The physiological responses of successful high-status women were also predicted by the responses of their female groupmates: stronger linkage to female group members during the task was associated with success at persuading the group. Successful high-status women were also perceived as more persuasive than others in the group. This work shows that the link between status and successful persuasion generalizes to women among heterogeneous international teams. It also suggests that attention to others-often associated with physiological linkage-may be useful in persuading others during decision-making.

Controlling the uncontrolled: Are there incidental experimenter effects on physiologic responding?

The degree to which experimenters shape participant behavior has long been of interest in experimental social science research. Here, we extend this question to the domain of peripheral psychophysiology, where experimenters often have direct, physical contact with participants, yet researchers do not consistently test for their influence. We describe analytic tools for examining experimenter effects in peripheral physiology. Using these tools, we investigate nine data sets totaling 1,341 participants and 160 experimenters across different roles (e.g., lead research assistants, evaluators, confederates) to demonstrate how researchers can test for experimenter effects in participant autonomic nervous system activity during baseline recordings and reactivity to study tasks. Our results showed (a) little to no significant variance in participants' physiological reactivity due to their experimenters, and (b) little to no evidence that three characteristics of experimenters that are well known to shape interpersonal interactions-status (using five studies with 682 total participants), gender (using two studies with 359 total participants), and race (in two studies with 554 total participants)-influenced participants' physiology. We highlight several reasons that experimenter effects in physiological data are still cause for concern, including the fact that experimenters in these studies were already restricted on a number of characteristics (e.g., age, education). We present recommendations for examining and reducing experimenter effects in physiological data and discuss implications for replication.

Income Inequality, HIV Stigma, and Preventing HIV Disease Progression in Rural Communities.

Antiretroviral therapies (ART) suppress HIV replication, thereby preventing HIV disease progression and potentially preventing HIV transmission. However, there remain significant health disparities among people living with HIV, particularly for women living in impoverished rural areas. A significant contributing factor to HIV-related disparities is a stigma. And yet, the relative contributions of stigma, gender, socio-economics, and geography in relation to health outcomes are understudied. We examined the associations of internalized stigma and enacted stigma with community-level income inequality and HIV viral suppression-the hallmark of successful ART-among 124 men and 74 women receiving care from a publicly funded HIV clinic serving rural areas with high-HIV prevalence in the southeastern US. Participants provided informed consent, completed computerized interviews, and provided access to their medical records. Gini index was collected at the census tract level to estimate community-level income inequality. Individual-level and multilevel models controlled for point distance that patients lived from the clinic and quality of life, and included participant gender as a moderator. We found that for women, income inequality, internalized stigma, and enacted stigma were significantly associated with HIV suppression. For men, there were no significant associations between viral suppression and model variables. The null findings for men are consistent with gender-based health disparities and suggest the need for gender-tailored prevention interventions to improve the health of people living with HIV in rural areas. Results confirm and help to explain previous research on the impact of HIV stigma and income inequality among people living with HIV in rural settings.

Bringing close others to the emergency department for an acute coronary event is associated with increased patient perception of threat.

OBJECTIVE: Relationship quality is one of the most consistent psychosocial predictors of physical and mental health. Yet, little research examines relationship types or support within the immediate context of acute health events. We tested the unexplored role that close others play in patients' experience of threat during evaluation for acute coronary syndrome (ACS) in the Emergency Department (ED), as well as the indirect effect of close others on ACS-induced posttraumatic stress disorder (PTSD). METHOD: Participants were 871 patients evaluated for ACS at an urban academic ED (60.86 years old; 54.08% male; 56.37% Hispanic, 19.86% Black, 16.65% White). Threat perceptions were assessed in-ED and median 3 days later. ACS-induced PTSD was assessed median 41 days later using the PTSD checklist cued to a specific stressor. Non-overlapping categories were created representing close others in the ED (i.e., spouse/significant other, child), non-close others (e.g., neighbor), or no one. RESULTS: Patients who brought close others recalled experiencing greater threat in the ED: vs. no one, b = 0.11, p = .072; vs. non-close others, b = 0.16, p = .030. There was no direct effect of close others on ACS-induced PTSD; however, recalled threat mediated the effect of close others on development of ACS-induced PTSD, ps < .05. CONCLUSIONS: Close others were associated with recalling greater threat during ED evaluation, which predicted ACS-induced PTSD. ACS-induced PTSD is associated with medication nonadherence, event recurrence, and mortality, highlighting the need to develop a greater understanding of the impact stressful medical environments have on patients and close others.

Physiological linkage to an interaction partner is negatively associated with stability in sympathetic nervous system responding.

Recent work has demonstrated that people can be influenced by the physiological states of their interaction partners, showing physiological linkage to them from one moment to the next. In a study of unacquainted dyads who interacted for 30 min (ndyads = 47), we examine the novel question: Are people who show physiological linkage to their partners in sympathetic nervous system responding also less stable in their own responses? Understanding this relationship has important implications for how social relationships impact affective functioning and health. Results using multilevel modeling demonstrated that the within-person correlation between linkage and stability was negative-the more dyad members were physiologically influenced by their interaction partners, the less stable they were in their own physiological responding. This work shows that physiological linkage can come at a cost to people's own stability, meaning our physiological states are more vulnerable to social influence than previously thought.

Experiences of stigma and health care engagement among Black MSM newly diagnosed with HIV/STI.

Rates of HIV/STI transmission among Black men who have sex with men (BMSM) are alarmingly high and demand urgent public health attention. Stigma related concerns are a key barrier to accessing health care and prevention tools, yet limited research has been focused in this area. Experiences of stigma related to health care were evaluated among 151 BMSM residing in the Atlanta, GA area, both prior to and post HIV or STI diagnosis in a longitudinal study (data collected from 2014 to 2016). Findings demonstrated that inadequate health care engagement is associated with post-diagnosis anticipated stigma (b = - 0.38, SE  = 0.17 p  ≤ .05). Pre-diagnosis prejudice is a predictor of post-diagnosis enacted (b = 0.39, SE = 0.14, p < .01), anticipated (b = .28, SE = 0.14, p < .05), and internalized (b = .22, SE  = 0.06, p < .001) stigmas. This study is the first of its kind to assess experiences of stigma among BMSM during a critical time (i.e., before and after diagnosis) for HIV/STI prevention and treatment. Results provide a novel understanding of how stigma unfolds over-time and provide direction for stigma intervention development.

Adult adiposity linked to relationship hostility for low-cortisol reactors.

Past research on the relation between hostility in intimate relationships and adiposity has yielded mixed findings. The present study investigated whether the association between relationship hostility and adiposity is moderated by people's biological reactions to couple conflict. Cohabiting adult couples (N = 117 couples) engaged in two conflict interactions, before and after which salivary cortisol levels were measured. Results revealed an association between relationship hostility and adiposity, but this association was concentrated among people with relatively low levels of cortisol reactivity to couple conflict. Results are interpreted in light of research demonstrating that cortisol reactivity can become blunted over time in response to repeated stressors. These results provide precision to etiological models of obesity by identifying cortisol reactivity as a factor that moderates the association between relationship hostility and adiposity. (PsycINFO Database Record

Measuring physiological influence in dyads: A guide to designing, implementing, and analyzing dyadic physiological studies.

Scholars across domains in psychology, physiology, and neuroscience have long been interested in the study of shared physiological experiences between people. Recent technological and analytic advances allow researchers to examine new questions about how shared physiological experiences occur. Yet comprehensive guides that address the theoretical, methodological, and analytic components of studying these processes are lacking. The goal of this article is to provide such a guide. We begin by addressing basic theoretical issues in the study of shared physiological states by presenting five guiding theoretical principles for making psychological inferences from physiological influence-the extent to which one dyad member's physiology predicts the other dyad member's physiology at a future time point. Second, keeping theoretical and conceptual concerns at the forefront, we outline considerations and recommendations for designing, implementing, and analyzing dyadic psychophysiological studies. In so doing, we discuss the different types of physiological measures one could use to address different theoretical questions. Third, we provide three illustrative examples in which we estimate physiological influence, using the stability and influence model. We conclude by providing detail about power analyses for the model and by comparing the strengths and limitations of this model with preexisting models. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Combining oxytocin administration and positive emotion inductions: Examining social perception and analytical performance.

Intranasal administration of the hypothalamic neuropeptide oxytocin (OT) has, in some studies, been associated with positive effects on social perception and cognition. Similarly, positive emotion inductions can improve a range of perceptual and performance-based behaviors. In this exploratory study, we examined how OT administration and positive emotion inductions interact in their associations with social and analytical performance. Participants (N=124) were randomly assigned to receive an intranasal spray of OT (40IU) or placebo and then viewed one of three videos designed to engender one of the following emotion states: social warmth, pride, or an affectively neutral state. Following the emotion induction, participants completed social perception and analytical tasks. There were no significant main effects of OT condition on social perception tasks, failing to replicate prior research, or on analytical performance. Further, OT condition and positive emotion inductions did not interact with each other in their associations with social perception performance. However, OT condition and positive emotion manipulations did significantly interact in their associations with analytical performance. Specifically, combining positive emotion inductions with OT administration was associated with worse analytical performance, with the pride induction no longer benefiting performance and the warmth induction resulting in worse performance. In sum, we found little evidence for main or interactive effects of OT on social perception but preliminary evidence that OT administration may impair analytical performance when paired with positive emotion inductions.

Morphometric roadmaps to improve accurate device delivery for fluoroscopy-free resuscitative endovascular balloon occlusion of the aorta.

BACKGROUND: Uncontrolled hemorrhage from vessel injuries within the torso remains a significant source of prehospital trauma mortality. Resuscitative endovascular balloon occlusion of the aorta can effectively control noncompressible hemorrhage, but this minimally invasive technique relies heavily on imaging not available in the field. Our goal was to develop morphometric roadmaps to enhance the safety and accuracy of fluoroscopy-free endovascular navigation of hemorrhage control devices. METHODS: Three-dimensional reconstructions of computed tomographic angiography scans from 122 trauma patients (mean [SD] age, 47 [24] years; range 5-93 years; 64 males; 58 females) were used to measure centerline distances from femoral artery access sites to the major aortic branch artery origins. Morphometric roadmap equations were created using multiple linear regression analysis to predict distances to the origins of the major arteries in the chest, abdomen, and pelvis using torso length, demographics, and risk factors as independent variables. A 40-mm-long occlusion balloon was then virtually deployed targeting Zones 1 and 3 of the aorta using these equations. Balloon placement accuracy was determined by comparing predicted versus actual measured distances to the target zone locations within the aortas from the database. RESULTS: Torso length and age were the strongest predictors of centerline distances from femoral artery access sites to the major artery origins. Male sex contributed to longer distances, while diabetes and smoking were associated with shorter distances. Hypertension, dyslipidemia, and coronary artery disease had no effect. With the use of morphometric roadmaps, virtual occlusion balloon placement accuracy was 100% for Zone 3 of the aorta, compared with 87% accuracy when using torso length alone. CONCLUSION: Morphometric roadmaps demonstrate a potential for improving the safety and accuracy of fluoroscopy-free aortic occlusion balloon delivery. Continued development of minimally invasive hemorrhage control techniques holds promise to improve prehospital mortality for patients with noncompressible exsanguinating torso injuries. LEVEL OF EVIDENCE: Therapeutic study, level IV; diagnostic study, level III.