Patient information leaflets: informing or frightening? A focus group study exploring patients' emotional reactions and subsequent behavior towards package leaflets of commonly prescribed medications in family practices.

BACKGROUND The purpose of patient information leaflets (PILs) is to inform patients about the administration, precautions and potential side effects of their prescribed medication. Despite European Commission guidelines aiming at increasing readability and comprehension of PILs little is known about the potential risk information has on patients. This article explores patients' reactions and subsequent behavior towards risk information conveyed in PILs of commonly prescribed drugs by general practitioners (GPs) for the treatment of Type 2 diabetes, hypertension or hypercholesterolemia; the most frequent cause for consultations in family practices in Germany. METHODS We conducted six focus groups comprising 35 patients which were recruited in GP practices. Transcripts were read and coded for themes; categories were created by abstracting data and further refined into a coding framework. RESULTS Three interrelated categories are presented: (i) The vast amount of side effects and drug interactions commonly described in PILs provoke various emotional reactions in patients which (ii) lead to specific patient behavior of which (iii) consulting the GP for assistance is among the most common. Findings show that current description of potential risk information caused feelings of fear and anxiety in the reader resulting in undesirable behavioral reactions. CONCLUSIONS Future PILs need to convey potential risk information in a language that is less frightening while retaining the information content required to make informed decisions about the prescribed medication. Thus, during the production process greater emphasis needs to be placed on testing the degree of emotional arousal provoked in patients when reading risk information to allow them to undertake a benefit-risk-assessment of their medication that is based on rational rather than emotional (fearful) reactions.

First valence, then arousal: the temporal dynamics of brain electric activity evoked by emotional stimuli

The temporal dynamics of the neural activity that implements the dimensions valence and arousal during processing of emotional stimuli were studied in two multi-channel ERP experiments that used visually presented emotional words (experiment 1) and emotional pictures (experiment 2) as stimulus material. Thirty-two healthy subjects participated (mean age 26.8 +/- 6.4 years, 24 women). The stimuli in both experiments were selected on the basis of verbal reports in such a way that we were able to map the temporal dynamics of one dimension while controlling for the other one. Words (pictures) were centrally presented for 450 (600) ms with interstimulus intervals of 1,550 (1,400) ms. ERP microstate analysis of the entire epochs of stimulus presentations parsed the data into sequential steps of information processing. The results revealed that in several microstates of both experiments, processing of pleasant and unpleasant valence (experiment 1, microstate #3: 118-162 ms, #6: 218-238 ms, #7: 238-266 ms, #8: 266-294 ms; experiment 2, microstate #5: 142-178 ms, #6: 178-226 ms, #7: 226-246 ms, #9: 262-302 ms, #10: 302-330 ms) as well as of low and high arousal (experiment 1, microstate #8: 266-294 ms, #9: 294-346 ms; experiment 2, microstate #10: 302-330 ms, #15: 562-600 ms) involved different neural assemblies. The results revealed also that in both experiments, information about valence was extracted before information about arousal. The last microstate of valence extraction was identical with the first microstate of arousal extraction.

An electrophysiological investigation of emotional change: preliminary data

Many psychotherapy researchers agree that emotional change is critical to therapeutic progress. In emotion-focused and Gestalt therapy, one technique to foster emotional change is the empty chair dialogue. Psychotherapy research has yielded ample evidence that this technique helps to alleviate longstanding interpersonal grievances (‘unfinished business’) and facilitates emotional change. Until now, little is known about the neurophysiological correlates of such emotional change. The present study thus aims at adding a further level of analysis to psychotherapy research, and may enrich knowledge about mechanisms of change. Neurophysiological correlates of emotional change were investigated using multi-channel electroencephalography. Individuals experiencing ‘unfinished business’ were guided by experienced therapists to participate in an empty chair dialogue. Event-related brain potentials were recorded before and after the intervention while participants were viewing pictures of the person central to their interpersonal grievance as well as pictures of control persons. Event related potentials are compared regarding topography and overall signal strength. Preliminary results will be discussed regarding neurophysiological mechanisms of action potentially occurring during emotional change.

Negative emotional stimuli enhance vestibular processing

Recent studies have shown that vestibular stimulation can influence affective processes. In the present study, we examined whether emotional information can also modulate vestibular perception. Participants performed a vestibular discrimination task on a motion platform while viewing emotional pictures. Six different picture categories were taken from the International Affective Picture System: mutilation, threat, snakes, neutral objects, sports and erotic pictures. Using a Bayesian hierarchical approach we were able to show that vestibular discrimination improved when participants viewed emotionally negative pictures (mutilation, threat, snake) when compared to neutral objects. There was no difference in vestibular discrimination while viewing emotionally positive compared to neutral pictures. We conclude that some of the mechanisms involved in the processing of vestibular information are also sensitive to emotional content. Emotional information signals importance and mobilizes the body for action. In case of danger, a successful motor response requires precise vestibular processing. Therefore, negative emotional information improves processing of vestibular information.

Negative emotional stimuli enhance vestibular processing

Recent studies have shown that vestibular stimulation can influence affective processes. In the present study, we examined whether emotional information can also modulate vestibular perception. Participants performed a vestibular discrimination task on a motion platform while viewing emotional pictures. Six different picture categories were taken from the International Affective Picture System: mutilation, threat, snakes, neutral objects, sports and erotic pictures. Using a Bayesian hierarchical approach we were able to show that vestibular discrimination improved when participants viewed emotionally negative pictures (mutilation, threat, snake) when compared to neutral objects. There was no difference in vestibular discrimination while viewing emotionally positive compared to neutral pictures. We conclude that some of the mechanisms involved in the processing of vestibular information are also sensitive to emotional content. Emotional information signals importance and mobilizes the body for action. In case of danger, a successful motor response requires precise vestibular processing. Therefore, negative emotional information improves processing of vestibular information.

Xinjiang’s geographies in motion

Starting from the idea that places are socially constructed, this essay explores how place is established and lived in Xinjiang by the members of the area’s two largest ethnicities, the Uyghur and the Han. This paper demonstrates that there are differences in the ways Han and Uyghur imagine and ‘live’ Xinjiang. At the same time it asserts that Uyghur and Han do not establish distinct spatial relationships just because of their ethnicity, but also to enhance ethnic solidarity and boundaries vis-à-vis the other. This essay also demonstrates that places are historically contingent, and it discusses the ways in which the influx of Han temporary migrants and settlers—and Han capital—has generated new layers of spatial meaning and new power differentials.

Emotional stability promotes intelligence

Emotional stability promotes intelligence In the research field of the relationship between intelligence and personality factors, one of the most consistent findings is that intelligence is positively correlated with emotional stability. However, few studies have considered this relationship in children, and very few have differentiated between types of intelligence as well as underlying differences in working memory capacity when explaining the relationship between intelligence scores and emotional stability. In this study, the level of emotional stability and performance in a proxy for fluid and crystallized intelligence as well as in two working memory tasks was assessed in a sample of 397 primary school children. Results reveal that emotional stability is significantly positively related to vocabulary (crystallized intelligence), moderated by high working memory performance, but unrelated to abstract reasoning (fluid intelligence). This was interpreted as indicating that the positive relationship between intelligence and emotional stability is mainly due to learning advantages starting in early age, due to high working memory performance, rather than to higher general intelligence. This bears the important implication that emotionally labile children (high level of neuroticism) should be supported to regulate their negative emotions, intrusive thoughts and anxiety as early as possible to eliminate progressive learning disadvantages. One approach to do so is by specific working memory training targeting the improvement of emotional regulation skills.

Emotional processing in a ten-session general psychiatric treatment for borderline personality disorder: a case study

This study examines the effects of a borderline-specific treatment, called general psychiatric management, on emotional change, outcome and therapeutic alliance of an outpatient presenting with borderline personality disorder. Based on the sequential model of emotional processing, emotional states were assessed in a 10-session setting. The case showed an increase in expressions of distress and no change in therapeutic alliance and tended towards general deterioration. Results suggest emotional processing may play a lesser role in general psychiatric management in early phase treatment than previously hypothezised.

Facilitating Emotional Processing: An Experimental Induction of Psychotherapeutically Relevant Affective States

Psychotherapy research has shown that cognitive-affective meaning making is related to beneficial therapy outcomes. This study explores the underlying micro-processes by inducing specific cognitive-affective states and studying their immediate effects on emotional activation, the resolution of interpersonal grievances, and factors related to therapeutic progress, e.g., mastery experiences, clarification of meaning. Participants suffering from interpersonal grievances were randomly assigned to two conditions. A sentence completion task was employed to induce either the expression of emotional distress or cognitive-affective meaning making. Expressive writing was used to deepen processing. Findings of those participants adhering to the induction procedure (n = 85) showed no differences between conditions at baseline. During writing, participants in both conditions were equally emotionally activated. Directly after the writing task, participants in the meaning making condition (n = 50) reported less unresolved interpersonal grievances, and more mastery experiences, but, e.g., not more clarification, compared to those in the emotional expression condition (n = 35). Results suggest that engagement in specific states that promote meaning making of emotional experience facilitates emotional processing and is related to therapeutic benefit.