- 2019 - Pilot Grant
Evidence indicates that emotions profoundly affect human behavior, and theory indicates that negative self-conscious emotions specifically, such as shame and embarrassment, elicit avoidance of stigmatized health behaviors. [2–4] However, accurate measurement of emotions such as shame is challenging due to reporting bias and variations in emotional presentations, making these behaviorally influential emotions difficult to assess and address. Given this challenge, we propose that a novel multimodal method of assessment will enable more accurate measurement of shame, thereby enabling clinical assessment and more effective intervention strategies. In this pilot study, we will test the feasibility and acceptability of innovative technology-supported interdisciplinary strategies to identify which measurement modalities for assessing shame covary and the extent that these measurement modalities differentially predict shame compared to two other emotions (i.e., frustration and pride). We will do this by using machine learning techniques to assess the concurrently captured multiple embodied and tech-supported measurements during responses to three emotion-evoking narrative prompts. These results will inform more accurate measurement of shame and other emotions, including the embodiment of emotion more broadly, which will enable more precise assessment of the relationship between shame and self-care behaviors, and will inform increasingly effective intervention strategies. Together, this work will address an important gap in the science, by facilitating future rigorous investigation that could lead to enhancements in our ability to identify individuals struggling with the painful emotion of shame and to develop more effective interventions to improve health and well-being.
Affective science research indicates that shame is a behaviorally influential emotion associated with a range of health problems,3 that paradoxically evokes either an avoidance response or a desire to change oneself or one’s behavior.[2,4] The effects of shame on behavior may be most clearly demonstrated among people living with explicitly stigmatized health problems (e.g., HIV, mental illness, obesity). While we hypothesize that the relationship between shame and avoidance of stigmatized health-behaviors occurs across populations, given the stigma associated with HIV and Dr. Batchelder’s ongoing studies that will serve as recruitment sources for this pilot, this initial pilot study will involve individuals living with HIV. We plan to investigate a more generalizable sample in future work.
In this pilot study, we will assess the feasibility and acceptability of multimodal measurement of emotion in a sample of 30 participants living with HIV. Prior to testing, we will develop and refine protocols for testing emotion using six measurement methods (postural movement, facial movement, autonomic stress response, vocal characteristics, narrative content, and self-reported emotion). We will then assess each method concurrently in response to three emotion induction narrative tasks designed to elicit shame, frustration, and pride (counter-balancing order) separated by benign induction attention tasks. Specifically, we will video-record each narrative, while collecting data on postural and facial movement, autonomic stress, and speech patterns.
After each narrative, we will collect self-reported emotion. We will then transcribe each narrative to assess the content using a previously developed narrative evaluation tool, which leverages Linguistic Inquiry Word Count software.[6,7] We will then use machine-learning methods to assess the extent that the multiple measurement strategies are associated with one another, differ between elicited emotions, and predict the corresponding self-reported emotions. Further, we will assess the extent that covarying measurements of emotion are associated with self-care behaviors, including antiretroviral medication adherence, HIV-related medical appointment attendance, annual primary care attendance, and willingness to engage in a range of self-care behaviors, including mental healthcare and mind-body interventions.
Aim 1: Assess the feasibility and acceptability of the instrumentation and data collection methods to assess the covariance of six measures of emotion (postural movement, facial movement, autonomic stress response, vocal characteristics, narrative content, and self-reported emotion) in response to shame, frustration, and pride-evoking narrative induction tasks, as well as a rich battery of health-related outcomes.
Aim 2: Develop protocols for collecting and testing six measures of emotion within the context of three experimental emotion inductions tasks as well as protocols for analyzing the results.
Aim 3: Explore novel analytic approaches, including machine learning techniques, to assess the covariance of six measures of each assessed emotion and to differentiate measurements of three evoked emotions (i.e., shame, frustration, and pride). The results from this pilot as well as the innovative interdisciplinary methods and team, will facilitate a larger R34 or similar NIH grant (e.g., PAR-18-114 R61/R33) application to develop methods to accurately measure negative self-conscious emotion, which will not only lead to improved intervention strategies to reduce barriers to stigmatized self-care behaviors but will contribute to the growing field of embodied cognition and emotion.
The internalization of stigma has been repeatedly associated with avoidance of self-care behaviors across populations, including people living with mental illness, stigmatized medical illnesses such as HIV or diabetes, as well as substance use. Research indicates that the emotional correlates of internalized stigma are negative self-conscious emotions, such as shame, which result from a negative appraisal of how an experience pertains to the self (e.g., “I am less valuable than others”). Negative self-conscious emotions are thought to be particularly behaviorally influential. Literature informed by Stress and Coping Theory suggests that persistent identity-related stressors may lead to chronic negative self-conscious emotion, which may exacerbate avoidance coping, or maladaptive avoidance of a stressor. Negative self-conscious emotions have been associated with two paradoxical behavioral responses: avoidance of behaviors associated with the emotion (e.g., not taking medication for a stigmatized illness) and a desire to change one’s self or behavior (e.g., to become a healthier person). The elicitation of avoidance, as well as the potential to galvanize behavioral change, make negative self-conscious emotions potential points of leverage for initiating self-care behaviors (e.g., engagement in stigmatized preventative care or treatment for a stigmatized illness).[11–13] Given the potentially integral role negative self-conscious emotions play in avoidance of self-care behaviors, accurate assessment of their relationship to health behaviors has substantial public health relevance.
However, accurate measurement of negative self-conscious emotions is challenging, as negative selfconscious emotions are thought to be systematically under-reported due to reporting bias as well as the challenges of measuring the complex presentations of emotions more broadly. While non-self-report measurement of these emotions have been investigated (i.e., autonomic stress responses, narratives, postural movement,[16,17]) the existing single modality evidence has not resulted in reliable and valid assessment of negative self-conscious emotions. Additional measures of emotion, such as speech quality have not been systematically investigated. More broadly, non-self-report measurement strategies of emotion have not consistently enabled the differentiation of emotions.[8–21] Given the well-documented challenges of measuring and differentiating emotions from one another, as well as the variability of emotional presentations, seminal researchers in the field have called for multimodal methods of measuring emotions. Some of the most promising emerging research on self-conscious emotions demonstrates that postural
movements are associated with self-reported negative self-conscious emotions,[16,17] consistent with the rapidly developing research exploring embodiment of emotion.[14,22–24] Should postural movement be associated with other measurement modalities of negative self-conscious, investigation into effects of mind-body interventions on negative self-conscious emotions may be warranted. A better understanding of the relationships between postural movement and negative self-conscious emotions may inform our understanding of the embodiment of emotions more broadly.
Given the high levels of HIV-related stigma and shame experienced among people living with HIV,25 as well as Dr. Batchelder’s experience working with people living with HIV,[9,10,26–28] we propose testing this measurement paradigm with people living with HIV in this pilot study. This work will serve as a model for subsequent investigation with a more generalizable sample.
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