Patients' autonomic activation during clinical interaction: a review of empirical studies

OBJECTIVE: To investigate how patients' autonomic responses are related to verbal or non-verbal communication during clinical encounters. METHODS: The SCOPUS database was searched to identify papers. Studies were included if measures of autonomic arousal were related to patients' emotions or patient-clinician interaction during clinical consultations such as psychotherapy, counseling or medical interviews. The search was conducted according to PRISMA criteria. The included studies were assessed using the 16 item quality assessment tool QATSDD. RESULTS: A total of 24 publications were identified. The studies varied greatly in design and quality. However, a few trends could be observed across studies. Patients' expressions of emotions were associated with significant autonomic arousal. Clinician behavior affected arousal levels; and in a few studies, a patient centered way of presenting information was found to attenuate arousal level, interpreted as stress reduction. There was a general, but not consistent, trend in the reduction of arousal level over time within the consultation. Examples of individual differences in autonomic responses were found. CONCLUSION AND PRACTICE IMPLICATIONS: Increased awareness of potential impact of clinician behavior on patient' arousal level may be helpful for clinicians, in particular how different communication styles may augment or attenuate arousal in response to stressors.