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Concept: Metacommunicative competence

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Facial expression of emotion is a foundational aspect of social interaction and nonverbal communication. In this study, we use a computer-animated 3D facial tool to investigate how dynamic properties of a smile are perceived. We created smile animations where we systematically manipulated the smile’s angle, extent, dental show, and dynamic symmetry. Then we asked a diverse sample of 802 participants to rate the smiles in terms of their effectiveness, genuineness, pleasantness, and perceived emotional intent. We define a “successful smile” as one that is rated effective, genuine, and pleasant in the colloquial sense of these words. We found that a successful smile can be expressed via a variety of different spatiotemporal trajectories, involving an intricate balance of mouth angle, smile extent, and dental show combined with dynamic symmetry. These findings have broad applications in a variety of areas, such as facial reanimation surgery, rehabilitation, computer graphics, and psychology.

Concepts: Psychology, Computer graphics, Communication, Paul Ekman, 3D computer graphics, Nonverbal communication, Metacommunicative competence, Eye contact

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Facial expressions of emotion are thought to have evolved from the development of facial muscles used in sensory regulation and later adapted to express moral judgment. Negative moral judgment includes the expressions of anger, disgust and contempt. Here, we study the hypothesis that these facial expressions of negative moral judgment have further evolved into a facial expression of negation regularly used as a grammatical marker in human language. Specifically, we show that people from different cultures expressing negation use the same facial muscles as those employed to express negative moral judgment. We then show that this nonverbal signal is used as a co-articulator in speech and that, in American Sign Language, it has been grammaticalized as a non-manual marker. Furthermore, this facial expression of negation exhibits the theta oscillation (3-8Hz) universally seen in syllable and mouthing production in speech and signing. These results provide evidence for the hypothesis that some components of human language have evolved from facial expressions of emotion, and suggest an evolutionary route for the emergence of grammatical markers.

Concepts: Gene expression, Sentence, Morality, Paul Ekman, Nonverbal communication, Sign language, Facial expression, Metacommunicative competence

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Black patients are more likely than white patients to die in the intensive care unit with life-sustaining treatments. Differences in patient/surrogate-provider communication may contribute to this phenomenon.

Concepts: Life, Intensive care medicine, Physician, Writing, Communication, Nonverbal communication, Paralanguage, Metacommunicative competence

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Loss of verbal language production makes people with dementia appear unreachable. We previously presented a case study applying nonverbal communication techniques with a lady with dementia who could no longer speak, which we termed Adaptive Interaction. The current small-n study examines the applicability of Adaptive Interaction as a general tool for uncovering the communication repertoires of non-verbal individuals living with dementia. Communicative responses of 30 interaction sessions were coded and analysed in two conditions: Standard (Baseline) and Adaptive Interaction (Intervention). All participants retained the ability to interact plus a unique communication repertoire comprising a variety of nonverbal components, spanning eye gaze, emotion expression, and movement. In comparison to Baseline sessions, Intervention sessions were characterised by more smiling, looking at ME and imitation behaviour from the people with dementia. These findings allude to the potential of Adaptive Interaction as the basis for interacting with people living with dementia who can no longer speak.

Concepts: Writing, Communication, Paul Ekman, Nonverbal communication, Paralanguage, Metacommunicative competence

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Deficits in the perception of social cues are common in schizophrenia and predict functional outcome. While effective communication depends on deciphering both verbal and non-verbal features, work on non-verbal communication in the disorder is scarce.

Concepts: Writing, Communication, Nonverbal communication, Paralanguage, Metacommunicative competence

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In the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students' awareness of their nonverbal communication.

Concepts: Clinical trial, Crossover study, Learning, Writing, Communication, Nonverbal communication, Paralanguage, Metacommunicative competence

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Recent evidence found that patients with schizophrenia display non-verbal behaviour designed to avoid social engagement during the opening moments of their meetings with psychiatrists. This study aimed to replicate, and build on, this finding, assessing the non-verbal behaviour of patients and psychiatrists during meetings, exploring changes over time and its association with patients' symptoms and the quality of the therapeutic relationship.

Concepts: Therapy, Writing, Communication, Nonverbal communication, Paralanguage, Metacommunicative competence

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There is a gap in the medical education literature on teaching nonverbal detection and expression of empathy. Many articles do not address nonverbal interactions, instead focusing on “what to say” rather than “how to be.” This focus on verbal communication overlooks the essential role nonverbal signals play in the communication of emotions, which has significant effects on patient satisfaction, health outcomes, and malpractice claims. This gap is addressed with a novel teaching tool for assessing nonverbal behavior using the acronym E.M.P.A.T.H.Y.-E: eye contact; M: muscles of facial expression; P: posture; A: affect; T: tone of voice; H: hearing the whole patient; Y: your response. This acronym was the cornerstone of a randomized controlled trial of empathy training at Massachusetts General Hospital, 2010-2012. Used as an easy-to-remember checklist, the acronym orients medical professionals to key aspects of perceiving and responding to nonverbal emotional cues. An urgent need exists to teach nonverbal aspects of communication as medical practices must be reoriented to the increasing cultural diversity represented by patients presenting for care. Where language proficiency may be limited, nonverbal communication becomes more crucial for understanding patients' communications. Furthermore, even in the absence of cultural differences, many patients are reluctant to disagree with their clinicians, and subtle nonverbal cues may be the critical entry point for discussions leading to shared medical decisions. A detailed description of the E.M.P.A.T.H.Y. acronym and a brief summary of the literature that supports each component of the teaching tool are provided.

Concepts: Psychology, Writing, Emotion, Communication, Nonverbal communication, Paralanguage, Metacommunicative competence, Eye contact

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Recent studies of naturalistic face-to-face communication have demonstrated coordination patterns such as the temporal matching of verbal and non-verbal behavior, which provides evidence for the proposal that verbal and non-verbal communicative control derives from one system. In this study, we argue that the observed relationship between verbal and non-verbal behaviors depends on the level of analysis. In a reanalysis of a corpus of naturalistic multimodal communication (Louwerse, Dale, Bard, & Jeuniaux, ), we focus on measuring the temporal patterns of specific communicative behaviors in terms of their burstiness. We examined burstiness estimates across different roles of the speaker and different communicative modalities. We observed more burstiness for verbal versus non-verbal channels, and for more versus less informative language subchannels. Using this new method for analyzing temporal patterns in communicative behaviors, we show that there is a complex relationship between verbal and non-verbal channels. We propose a “temporal heterogeneity” hypothesis to explain how the language system adapts to the demands of dialog.

Concepts: Scientific method, Logic, Communication, Proposal, Proposals, Nonverbal communication, Paralanguage, Metacommunicative competence