Crying does not alleviate acute pain perception: Evidence from an experimental study.

BACKGROUND: Whereas previous studies revealed positive effects of emotional expressions such as swearing and laughing on acute pain, systematic research on the effects of crying on pain is missing. The rationale for the current study is that either a mere emotional distraction or changes in oxytocin and opioid levels represent a mechanism through which crying modulates pain, with the timing of mood changes as crucial information for distinguishing between potential mechanisms. METHODS: In two studies, we exposed participants (Study 1: n = 57; Study 2: n = 70) to a sad movie and measured their mood, and exposed them to pain induction procedures (electric shock and cold-pressor test, respectively) before and after the film. Dependent variables were pain threshold, tolerance, and intensity. In addition to baseline and one immediate post-crying mood and pain response measurement in both studies, in Study 2, we repeated these procedures 20 and 50 min later to discern between the potential role of neurobiological substances and distraction. RESULTS: Crying was elicited in 28 participants in Study 1 (49.1%) and 49 (70%) in Study 2. We found no systematic differences in pain and mood changes between criers and non-criers and no systematic dose-response relationship between crying and pain responses and mood. The only significant effects ran contrary to our hypotheses, showing detrimental effects of the occurrence (Study 1) and frequency of crying (both studies) on pain threshold. CONCLUSIONS: Results do not support the idea that crying has pain-alleviating effects, either via distraction or direct biological mechanisms. SIGNIFICANCE: Despite previous findings on pain alleviating effects of emotional expression and the widespread idea about the generally beneficial consequences of emotional crying, research on the possible pain alleviating effects of crying is largely missing. Two quasi-experimental studies demonstrated that crying induced in laboratory conditions does not alleviate acute pain responses, suggesting that role of crying in pain interventions is doubtful. Less directly, results cast light on the role of emotional distraction from acute pain and possible crying-related neurochemical changes.

Music and Lyric Characteristics of Popular Dutch Funeral Songs.

This study compared the characteristics of 150 songs (Dutch lyrics, N = 47, English lyrics, N = 103), popular at Dutch funerals, to an equal number of non-funeral songs. The variables explored included those linked with the music (valence, energy, danceability, acousticness, key, and tempo); and lyrics, namely: linguistics-related (first-person singular/plural, second-person pronouns; past, present, future tense; expressed emotion (positive, negative words, and the discrete emotional categories anger, anxiety, sadness); and category words (those relating to family, friends, death, religion). Funeral music was lower in valence, energy, and danceability and higher in acousticness than non-funeral music. Furthermore, English funeral music lyrics contained more second-person pronouns and were more future-focused than comparison songs. Funeral lyrics were not particularly negative, but English texts contained more words relating to sadness. In conclusion, funeral music differs in severable notable respects from general popular songs that may reflect the special purpose of this music.

A clinical practice review of crying research.

The goal of this clinical practice review is to assess the current state of the theoretical and empirical literature on emotional crying (i.e., crying in response to an emotional stimulus), a topic that has received surprisingly limited attention of behavioral scientists and clinicians. Although the empirical research on emotional crying remains in a nascent state, we draw upon the existing scientific knowledge to provide preliminary suggestions for clinicians on how to interpret and respond to crying in clinical contexts. We also identify research gaps and provide recommendations for further research to improve our understanding of this intriguing and still poorly understood human behavior. We suggest that a better understanding of individual differences in crying behavior and the postulated intraindividual and interindividual functions of crying is of critical importance for clinicians, given its frequent occurrence and notable associations with emotional and social functioning. An improved characterization of this important phenomenon will lead to improvements in clinical assessment, treatment planning, and psychotherapy interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Damaging Effects of Perceived Crocodile Tears for a Crier's Image.

Emotional tears are uniquely human and play an essential role in the communication of distress in adults. Several studies have shown that individuals are more willing to offer emotional support and help a person in tears. Preliminary evidence suggests that this greater willingness to provide support is mediated via perceived warmth and helplessness. Moreover, tearful individuals are regarded as more reliable and honest. In the current study, we examined whether people can reliably distinguish genuine and fake crying, and what the consequences for the further evaluation of the crier are. A total of 202 participants (73 men, 129 women) were exposed to brief movie clips of genuine and fake crying adults and were asked to assess the criers. Results show that women were slightly better at identifying fake and genuine crying. How the crying was perceived subsequently seemed to have a strong influence on the further evaluation of the "crier." Criers qualified as pretenders were perceived as significantly more manipulative, less reliable, less warm, and less competent. Further, the respondents felt less connected with the perceived pretenders, who also were less welcomed as friends, colleagues, neighbors, and babysitter. They were additionally qualified as significantly less fit for "reliable" professions (judge, teacher, police officer, scientist, and physician). In contrast, the ratings of their fitness for "unreliable" professions (banker, CEO, journalist, real estate salesman, and politician) yielded a significant difference in only one video clip (and contrary to expectations). Our findings thus indicate that the subjective labeling of crying as fake is associated with a significantly less positive perception of the "crying" person, regardless of whether the crying is actually fake or genuine. The qualification of tears as crocodile tears thus seems to affect the crier's image strongly negatively.

Using crying to cope: Physiological responses to stress following tears of sadness.

This research tested the hypothesis that emotional crying facilitates coping and recovery, specifically through physiological changes that occur during crying. Female undergraduate students (N = 197) were randomly assigned to either a sad or neutral condition using short videos. Sad videos were selected for their extreme emotion elicitation. We predicted that compared to those who did not cry to the stimuli and those who were exposed to neutral videos, people who cried would (a) be able to withstand a stressful task for longer; (b) show lower levels of cortisol following crying and exposure to the stressor; and (c) have faster recovery (i.e., return to baseline levels of affect). The final groups consisted of the neutral group (n = 65), sad criers (n = 71), and sad noncriers (n = 61). After a 5-min baseline period, participants watched either the sad or neutral videos for 17 min and then completed a physical stressor (cold pressor test). Heart rate and respiration were continuously recorded, whereas salivary samples for cortisol were taken at 4 separate time points during testing. Analyses revealed no differences between the 3 groups in time withstanding the stressor or cortisol changes. Respiration rate, however, increased in the neutral group and noncriers while watching the videos, with criers' respiration remaining stable. Furthermore, heart rate was found to decelerate just before crying, with a return to baseline during the first crying period. These results suggest that crying may assist in generally maintaining biological homeostasis, perhaps consciously through self-soothing via purposeful breathing and unconsciously through regulation of heart rate. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Nostalgia proneness and empathy: Generality, underlying mechanism, and implications for prosocial behavior.

OBJECTIVE: Nostalgia is a sentimental longing for one's past. We examined the hypotheses (rooted in attachment theory and research) that nostalgia prone individuals, by virtue of their greater attachment security, are more empathic and enact more prosocial behavior. METHOD: In five studies, testing 1,923 participants (Nrange  = 132-823, 52.42% women, Agerange  = 8-90 years), we measured nostalgia proneness and affective empathy. Additionally, we measured cognitive empathy in Study 3, attachment security in Studies 4-5, and prosocial behavior in Study 5. RESULTS: Nostalgia proneness was positively related to affective empathy among younger and older adults (Studies 1, 3-5) and among children (Study 2). This association was stronger for affective empathy than cognitive empathy (Study 3). Also, attachment security mediated the relation between nostalgia proneness and affective empathy (Studies 4-5). Finally, nostalgia prone individuals were more likely to engage in prosocial behavior, and this relation was serially mediated by attachment security and affective empathy (Study 5). CONCLUSION: The findings establish the empathic and prosocial character of nostalgia prone individuals, and clarify their personality profile.

The Relationship of Gender Roles and Beliefs to Crying in an International Sample.

This study aimed to (1) investigate the variation in self ascription to gender roles and attitudes toward gender roles across countries and its associations with crying behaviors, emotion change, and beliefs about crying and (2) understand how the presence of others affects our evaluations of emotion following crying. This was a large international survey design study (N = 893) conducted in Australia, Croatia, the Netherlands, Thailand, and the United Kingdom. Analyses revealed that, across countries, gender, self-ascribed gender roles, and gender role attitudes (GRA) were related to behavioral crying responses, but not related to emotion change following crying. How a person evaluates crying, instead, appeared to be highly related to one's beliefs about the helpfulness of crying, irrespective of gender. Results regarding crying when others were present showed that people are more likely both to cry and to feel that they received help around a person that they know, compared to a stranger. Furthermore, closeness to persons present during crying did not affect whether help was provided. When a crier reported that they were helped, they also tended to report feeling better following crying than those who cried around others but did not receive help. Few cross-country differences emerged, suggesting that a person's responses to crying are quite consistent among the countries investigated here, with regard to its relationship with a person's gender role, crying beliefs, and reactions to the presence of others.

The Physician's Tears: Experiences and Attitudes of Crying Among Physicians and Medical Interns.

We examined several aspects of the crying experiences of physicians and medical interns, including the most common reasons to cry in the workplace, and their perceptions of and attitudes towards crying in the workplace and in the presence of a patient. A sample of Dutch physicians and medical interns (Nphysicians = 1068 and Nmedical interns = 302 and for the full version Nphysicians = 776 and Nmedical interns = 181) completed an especially designed anonymous online questionnaire about experiences with crying in the workplace, and perceptions of and attitudes towards crying in the workplace and in the presence of patients. Crying is a rather frequent behavior among physicians, in particular when they have to deal with the severe suffering of patients and their relatives. We found a considerable variety in the attitudes and perception of crying in the work setting, although there was also much agreement that crying in the presence of a patient is only appropriate if it is over the condition of the patient. Physicians reported a slightly more positive attitude and a stronger need for more attention to this topic in training and education than medical interns. Crying in the medical setting is a common, though understudied phenomenon. There is a strong need for further research on this topic in order to understand it better and how and when it might interfere with or facilitate with the therapeutic process. We strongly feel that currently the time is ripe for this topic because in particular the physicians expressed a greater need for more attention to this topic in training and the medical interns showed signs of, perhaps unhealthy, suppression of their emotions.

Crying in borderline personality disorder patients.

Emotion dysregulation and hyperreactivity are considered central features of Borderline Personality Disorder (BPD). We assumed that such emotion dysregulation is also reflected in increased crying behavior of these patients and, consequently, hypothesized that BPD patients (N = 62), compared to Cluster C personality disorder patients (Cluster C-PD; N = 25) and non-patients (N = 54), would show higher scores on crying measures. To evaluate crying behavior, we used a set of specially designed tools. Compared to non-patients, BPD patients showed the anticipated higher crying frequency despite a similar crying proneness and ways of dealing with tears. They also reported less awareness of the influence of crying on others. However, Cluster C-PD patients showed a very similar pattern of findings. Overall, our results suggest that the increased crying of BPD patients likely results from environmental factors or the misperception of situations, rather than from stable traits. Remarkable is that the observed discrepancies in crying behavior compared to non-patients seem to be similar for Cluster-C PDs and BPD.

Haptotherapy as a new intervention for treating fear of childbirth: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of haptotherapy on severe fear of childbirth in pregnant women. DESIGN: Randomized controlled trial. SETTING: Community midwifery practices and a teaching hospital in the Netherlands. POPULATION OR SAMPLE: Primi- and multigravida, suffering from severe fear of childbirth (N = 134). METHODS: Haptotherapy, psycho-education via Internet and care as usual were randomly assigned at 20-24 weeks of gestation and the effects were compared at 36 weeks of gestation and 6 weeks and 6 months postpartum. Repeated measurements ANOVA were carried out on the basis of intention to treat. Since there were crossovers from psycho-education via Internet and care as usual to haptotherapy, the analysis was repeated according to the as treated principle. MAIN OUTCOME MEASURES: Fear of childbirth score at the Wijma Delivery Expectancy/Experience Questionnaire. RESULTS: In the intention to treat analysis, only the haptotherapy group showed a significant decrease of fear of childbirth, F(2,99) = 3.321, p = .040. In the as treated analysis, the haptotherapy group showed a greater reduction in fear of childbirth than the other two groups, F(3,83) = 6.717, p < .001. CONCLUSION: Haptotherapy appears to be more effective in reducing fear of childbirth than psycho-education via Internet and care as usual.

The neurobiology of human crying.

The production of emotional tears appears to be uniquely present in Homo sapiens. Despite the ubiquity of this human behavior, research is only just beginning to uncover the neurobiologic underpinnings of human emotional crying. In this article, we review the current state of the literature investigating the neurobiologic aspects of this uniquely human behavior, including the neuroanatomical, neurochemical, and psychophysiologic findings. To set the context for this review, we first provide a brief overview of the evolutionary background and functions of tearful crying. Despite an accumulating understanding of the neurobiology of human emotional crying, the primary sources of information are currently from animal studies and observations in neurologic patients suffering from pathologic crying. Currently, most of the research on the neurobiology of crying in humans has focused on autonomic physiologic processes underlying tearful crying, which may yield essential clues regarding the neural substrates of the production of crying behavior and its effects on the crier. Further challenges in elucidating the neurobiology of crying involve the complexity of crying behavior, which includes vocalizations, tear production, the involvement of facial musculature, subjective emotional experience, emotion regulatory behaviors, and social behaviors. Future research is needed to comprehensively characterize the neurobiology of this intriguing and complex human behavior.

Attachment styles and secure base priming in relation to emotional reactivity after frustration induction.

In two experimental studies, we explored the role of attachment in predicting emotional reactivity after frustration induction. In the first study, using a cognitive frustration task, we examined in a college sample (N = 134) how attachment styles related to the experience and expression of emotions after frustration induction. In the second study, we investigated in college students (N = 198) the effect of conscious priming of the secure base schema on mood disturbance after the performance of a cognitive frustration task. Results showed that individuals experienced and expressed emotions after frustration induction independent of their attachment styles. Conscious priming of the secure base script attenuated self-reported emotional reactivity after frustration induction independent of individuals' attachment styles. These findings suggest that the mechanism of attachment-related emotional reactivity might not pertain to frustration during an unsolvable cognitive task, but that the activation of the sense of having a secure base is useful in reducing mood disturbance in the context of a frustrating performance task.

Factors associated with poor satisfaction with treatment and trial discontinuation in chronic schizophrenia.

IntroductionDespite consistently high discontinuation rates due to withdrawal of consent (WOC) and insufficient therapeutic effect (ITE) in schizophrenia trials, insight into the underlying factors contributing to poor satisfaction with treatment and dropout is limited. A better understanding of these factors could help to improve trial design and completion rates. METHODS: Using data from 1,136 trial participants with schizophrenia or schizoaffective disorder, we explored associations between predictor variables with (1) dropout due to WOC and ITE and (2) satisfaction with treatment among patients and investigators by means of hierarchic multiple regression analyses. RESULTS: ITE was associated with poor clinical improvement, poor investigator satisfaction with treatment, and poor patient insight into their own disease, whereas WOC only showed a meaningful association with poor patient satisfaction with treatment. Investigator satisfaction with treatment appeared most strongly associated with Positive and Negative Syndrome Scale (PANSS) positive factor endpoint scores, whereas patient satisfaction with treatment was best predicted by the endpoint score on the PANSS emotional distress factor. The occurrence of severe side effects showed no meaningful association to satisfaction with treatment among investigators and patients, and neither did a patient's experienced psychopathology, nor their self-rating of functional impairment. CONCLUSIONS: Whereas trial discontinuation due to ITE is associated with poor treatment effectiveness, a patient's decision to withdraw from an antipsychotic trial remains unpredictable and may occur even when the investigator observes a global clinical improvement and is satisfied with the treatment.

The Effects of Tears on Approach-Avoidance Tendencies in Observers.

Emotional tears have been proposed to represent a robust affiliative signal whose main function is to promote the willingness to help the crying individual. However, little is known about the psychological mechanisms at the basis of such responses. To investigate whether tears facilitate approach relative to avoidance tendencies, we exposed participants ( N = 77) to pictures of faces with and without visible tears, in two different approach-avoidance tasks. In the first task, participants were instructed to either move toward tearful faces and away from nontearful faces, or the other way around, by using a joystick. In the second task, participants made approaching or avoiding responses to tearful and nontearful faces by pressing buttons. The results suggest that tears facilitate behavior that reduces the distance between the observer and the crying person. However, while tears appear to promote approach relative to avoidance behavior, the current findings do not allow firm conclusions about whether tears specifically facilitate approach or rather block avoidance tendencies in observers, or whether they possibly have both effects. Findings are discussed in the context of tears' ability to act as a prosocial stimulus that signals non-aggressive intentions, as well as in the context of the functional goals that predispose humans to approach or avoid crying individuals.

Why Only Humans Shed Emotional Tears : Evolutionary and Cultural Perspectives.

Producing emotional tears is a universal and uniquely human behavior. Until recently, tears have received little serious attention from scientists. Here, we summarize recent theoretical developments and research findings. The evolutionary approach offers a solid ground for the analysis of the functions of tears. This is especially the case for infant crying, which we address in the first part of this contribution. We further elaborate on the antecedents and (intra- and interpersonal) functions of emotional tears in adults. The main hypothesis that emerges from this overview is that crying evolved as an emotional expression that signals distress and promotes prosocial behaviors in conspecifics. Further, shedding tears may influence the mood of the crier and his/her outlook on life primarily as a consequence of fulfillment of the proposed signaling function of tears. We also describe how cultural phenomena such as ritual weeping nicely fit within this framework, as they often aim to support a request for help to a powerful person or deity and promote social bonding.

Different aspects of emotional intelligence of borderline personality disorder.

OBJECTIVES: The present study investigated deficiencies in different components of emotional intelligence in borderline personality disorder (BPD). METHOD: The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and the Emotional Quotient Inventory (EQ-i) were used to assess EI dimensions. BPD patients (N = 85; 69 women; M = 33.6 years) were compared with Cluster C personality disorder (PD) patients (N = 39; 23 women; M = 36.6 years) and nonpatients (N = 69; 44 women; M = 35.6 years). RESULTS: Compared to the Cluster C PD patients and the nonpatient group, BPD patients displayed only deficits in their ability to understand emotions as measured with the Mayer-Salovey-Caruso Emotional Intelligence Test. The Emotional Quotient Inventory only revealed deficits in stress management in BPD patients compared to Cluster C PD patients. CONCLUSIONS: Our findings suggest that BPD patients have the ability to regulate emotions effectively, but they subjectively experience deficits in emotion regulation and therefore may not use this ability when they need it.

Social and psychological consequences of not crying: possible associations with psychopathology and therapeutic relevance.

OBJECTIVE: Emotional crying is hypothesized to serve intra- and interpersonal functions. Intrapersonal functions are assumed to facilitate the capacity to recover from emotional distress, thus promoting well-being. Interpersonal functions are postulated to have a major impact on social functioning. We hypothesized that non-criers would have lower well-being and poorer social functioning than criers. METHODS: Study participants included 475 people who reportedly lost the capacity to cry and 179 "normal" control criers. Applied measures assessed crying, well-being, empathy, attachment, social support, and connection with others. Prevalence estimates of not crying by gender were obtained from a panel survey of 2,000 Dutch households. RESULTS: In the main survey, tearless cases had less connection with others, less empathy, and experienced less social support, but were equal in terms of well-being. They also reported being less moved by emotional stimuli and had a more avoidant and less anxious attachment style. In multivariate analyses, being male, having an avoidant attachment style, and lacking empathy were independent predictors of tearlessness. Some 46.1% felt that not being able to cry affected them negatively; however, despite these findings, only 2.9% had sought any kind of professional help. Loss of the capacity to cry occurred in 8.6% of the men and 6.5% of the women in the large panel survey. CONCLUSIONS: Despite reduced empathy, less connection with others, and a more avoidant/less anxious attachment type, well-being is maintained in tearless people. Additional clinical and therapeutic investigations of tearlessness may lead to clarification of bidirectional associations between psychiatric disorders (e.g., alexithymia, posttraumatic stress disorder, psychopathy) and tearlessness.

Maternal psychological distress after preterm birth: Disruptive or adaptive?

BACKGROUND: Maternal postpartum distress is often construed as a marker of vulnerability to poor parenting. Less is known, however, about the impact of postpartum distress on parenting an infant born prematurely. The present study investigated whether high distress levels, which are particularly prevalent in mothers of preterm born infants, necessarily affect a mother's quality of parenting. METHOD: Latent Class Analysis was used to group mothers (N=197) of term, moderately, and very preterm born infants, based on their levels of distress (depression, anxiety, and PTSD symptoms) at one month postpartum, and their quality of parenting at one and six months postpartum. Parenting quality was assessed on the basis of maternal interactive behaviors (sensitivity, intrusiveness, and withdrawal) using observations, and maternal attachment representations (balanced, disengaged, or distorted) using interviews. RESULTS: A 5-Class model yielded the best fit to the data. The first Class (47%) of mothers was characterized by low distress levels and high-quality parenting, the second Class (20%) by low distress levels and low-quality parenting, the third Class (22%) by high distress levels and medium-quality parenting, the fourth Class (9%) by high distress levels and high-quality parenting, and finally the fifth Class (2%) by extremely high levels of distress and low-quality parenting. CONCLUSIONS: While heightened distress levels seem inherent to preterm birth, there appears to be substantial heterogeneity in mothers' emotional responsivity. This study indicates that relatively high levels of distress after preterm birth do not necessarily place these mothers at increased risk with regard to poor parenting. Conversely, low distress levels do not necessarily indicate good-quality parenting. The results of the present study prompt a reconsideration of the association between postpartum distress and parenting quality, and challenge the notion that high levels of maternal distress always result in low-quality parenting practices.

Behavioral and neural responses to infant and adult tears: The impact of maternal love withdrawal.

The current study examined behavioral and neural responses to infant and adult tears, taking into account childhood experiences with parental love-withdrawal. With functional MRI (fMRI), we measured neural reactivity to pictures of infants and adults with and without tears on their faces in nulliparous women with varying childhood experiences of maternal use of love withdrawal. Behavioral responses to infant and adult tears were measured with an approach-avoidance task. We found that individuals with experiences of love withdrawal showed less amygdala and insula reactivity to adult tears, but love withdrawal did not affect amygdala and insula reactivity to infant tears. During the approach-avoidance task, individuals responded faster to adult tears in the approach condition compared with the avoidance condition, indicating that adult tears facilitate approach behavior. Individuals responded faster to infant tears than to adult tears, regardless of approach or avoidance condition. Our findings suggest that infant tears are highly salient and may, therefore, overrule the effects of contextual and personal characteristics that influence the perception of adult crying. (PsycINFO Database Record