Part V : Methodological Interlude
Chapter 9: Concluding Discussion
9.4 How do these findings fit with previous research in the field?
This study was the first 3-D analysis of patients’ social interactions. It was also the first empirical assessment of nonverbal communication in patients’ three-way social interactions, with others who are unfamiliar to them and unaware of their diagnosis. As such, the methodology used in this study is not directly comparable to previous studies. However, the nonverbal behaviour indexed by this method can be compared to that derived in previous studies using alternative methods.
9.4.1 Nonverbal behaviour of patients and their partners
The majority of studies investigating nonverbal behaviour in schizophrenia have employed ethnological methods to assess the behaviour of patients during their two-way clinical interactions. The findings of such studies reveal a reduction in patients’ nonverbal behaviour, with a particular reduction in pro-social expression such as, eye gaze, head and hand gestures (Brüne et al., 2008; Brüne, Abdel-Hamid, Sonntag, Lehmkämper, & Langdon, 2009; Dimic et al., 2010; Pitman, Kolb, Orr, & Singh, 1987; Troisi, Pasini, Bersani, Di Mauro, & Clani, 1991; Troisi, Pompili, Binello, & Sterpone, 2007; Troisi, Spalletta, & Pasini, 1998). The findings of the current study corroborate with these findings, demonstrating that patients display a similar reduction in their nonverbal behaviour during their three-way interactions with those who are unfamiliar to them. Specifically, approximations of patients’ nodding and gesture, both in the role of speaker and primary recipient, were significantly reduced.
Few studies have investigated the impact of the patient on the behaviour of their interacting partners. Once again, these studies have predominately focused on patients’ two–way clinical interactions and found patients’ partners to show reduced nonverbal
behaviour similar to that of the patient (Fairbanks, McGuire, & Harris, 1982). In contrast to this, the current findings suggest that patients’ partners compensate for patients’ reduced pattern by increasing their nonverbal communication. The discrepancy between findings may be explained by the difference in interaction conditions. As discussed previously, interactions involving more than two people are more complex and demanding. The exchange of nonverbal cues between participants becomes more salient in these situations, as participants must monitor all partners for potentially relevant cues regarding the dynamics of the conversation and the conversational processes, i.e. interpreting when turns are starting and ending, knowing when to take the next turn of speech, when to provide feedback and the level of mutual attention and affiliation between partners (Kendon, 1970; Clarke & Schaefer, 1989; Allwood, Cerrato, Jokinen, Navarretta & Paggio, 2008). As such, the patterns displayed in patients’ three-way interactions may reflect those that occur under more demanding interacting conditions, and may be masked under the less demanding conditions of two-way interaction.
A previous investigation of patients’ clinic interactions found that psychiatrists direct their gaze more towards their interacting partner when interacting with a schizophrenia patient (Fairbanks, McGuire, & Harris, 1982). In line with this, the current study found patients’ partners looked more towards the patient than the other healthy participant during their three-way interaction. This was seen even though patients’ partners were not medically trained and unaware they were interacting with a patient. This suggests that there is something atypical in the patients’ behaviour that is being detected and responded to by others.
9.4.2 Interpersonal coordination
This study conducted the first empirical assessment of interpersonal coordination in patients’ interactions. The findings revealed a reduction in interpersonal coordination in patients’ three-way interactions but not in their two-way interactions. A previous study using micro-analysis of whole body movements in only three patients’ clinical interactions found interpersonal coordination to be reduced in this sample (Condon & Ogston, 1966). The findings of the current study may differ due to the different criteria used to define interpersonal coordination in both studies. In the current analysis,
coordination was limited to head movements, due to the pivotal role of the head in conversation management processes (McClave, 2000; Boholm & Allwood, 2010). Furthermore, coordinated movements were defined by strict criteria, with only significantly similar head movements occurring in the same axis of movement being defined as coordination. During interaction people coordinate with each other on a variety of levels. Perhaps the strict criteria imposed in the current study limited the detection of other forms of coordination that may be reduced in patients’ two-way interactions.
9.4.3 Links with patients’ clinical features & rapport
The reduced interpersonal coordination in patients’ three-way interactions was found to be associated with patients’ healthy participant partners experiencing less rapport with the patient. This finding agrees with previous studies providing evidence of a link between interpersonal coordination and rapport in non-clinical populations (Bernieri & Rosenthal, 1991; Chartrand & Bargh, 1999; Miles, Nind, & Macrae, 2009). Although patients’ negative symptoms were mild in the current sample, patients’ increased negative symptoms were also associated with others experiencing less rapport with the patient. This corroborates with previous studies finding psychiatrists to experience a greater intuitive Praecox feeling (i.e. difficulty connecting) with patients who had more affective symptoms (Grube, 2006).
In line with Brüne et al., (2008), the current study found patients’ increased negative symptoms was associated with patients’ reduced nonverbal behaviour. The current study also found an association between patients’ symptoms and the behaviour of their interacting partners, which has not been reported in previous studies. Specifically, patients’ increased positive and negative symptoms were associated with their partners’ reduced interpersonal coordination and increased co-speech gestures respectively.
9.4.4 Links with social cognition & social functioning
A wealth of previous research in the field of social cognition has found that patients with a diagnosis of schizophrenia have difficulty interpreting nonverbal social cues when assessed using social cognitive tests (Penn, Sanna, & Roberts, 2007). This study has
demonstrated that patients are capable of displaying adaptation to the nonverbal behaviour of their partners over time. This provides evidence for their ability to detect and respond to nonverbal cues in actual interaction. In the current study, patients’ nonverbal patterns were not associated with any measure of social cognition. This may have been due to the limited variance on these measures. However, due to the nature of social cognitive assessments, it is also likely that social cognitive abilities used to complete such tests differ from the ability to perform these skills during live interaction. Future studies would be required to provide a more robust investigation of this association.
Few studies have investigated associations between patients’ nonverbal behaviour and their social functioning. Troisi et al. (2008) found patients’ reduced pro-social facial expression to be associated with poorer social functioning. In the current study, patients’ increased hand movements, in the role of primary recipient, was associated with their poorer social functioning. However, these findings are not necessarily contradictory as they investigate two different features of patients’ nonverbal behaviour, which could occur simultaneously.