Words are stones, he was able to denounce the writer Andrea Camilleri among others, inviting reflection on the need to make the younger generations aware of this destructive power. Patients sometimes experience it on their skin: the doctor’s words can be balm that heals, or sharp arrows that can hurt. And in the latter case they hurt, literally physical pain. The proof is in the brain. An Italian study, with the help of brain imaging, photographed just this: negative and indelicate words – even more so if they are those of a doctor who has entrusted their life – activate the same neural circuits of pain.
The experimental investigation, presented today during a conference in Milan, was called ‘Fiore 2 (Functional Imaging of Reinforcement Effects)’. It was promoted by the Giancarlo Quarta Onlus Foundation in collaboration with the University of Padua and the Padua Neuroscience Center (Pnc). The authors measured the cerebral effects of poor communication in the therapeutic relationship. What they discovered is that when faced with words, but also with behaviors that offend us, which do not respond to our needs, we can experience pain that, at the level of brain activations, is comparable to the physical one. This experience has a distinct neuroscientific substance and is all the more important when viewed in a nursing relationship, experts note.
What happens at the neural level when doctor-patient communication doesn’t work? What effects can harsh words or unwelcoming attitudes have on the patient? These are the questions that the study carried out with the Venetian structures by the Quarta Foundation, which has been involved for years in exploring the importance of the doctor-patient relationship from a psychological, clinical and social point of view, tries to answer, with the aim of alleviating the suffering of the sick. Fiore 2 is the continuation of a first study that measured the effects on the brain of a communication that met the patient’s needs. In this second work, once again carried out using neuroimaging techniques (functional magnetic resonance), the focus was instead on what happens in the brain, the relationship with the doctor does not work.
30 healthy participants (11 males and 19 females, aged between 19 and 33 years) were subjected, in brain scan, to a series of cartoons depicting various social situations of interaction between two people in which the subject receives three types of stimuli called ‘reinforcement’: a negative reinforcement, in which the behavior of the other does not respond to the need of the subject, a neutral / controlling one and a positive reinforcement. For example: you are getting on the train with a heavy suitcase and the person behind you snorts and doesn’t help you (negative reinforcement), stands still and waits for you to get on (neutral), smiles at you and helps you load the suitcase (positive reinforcement) ).
In addition to the resonance, the subjects completed two personality and affectivity tests: the Bfq – Big Five Questionnaire and the Qdf – Questionnaire on Daily Frustrations. On the basis of the data collected, the study measured and analyzed: the activation responses, ie which brain areas are more activated by negative stimuli than other stimuli; connectivity responses, or how different areas of the brain dialogue (or do not) when there is negative reinforcement and brain-behavior-personality correlations. Result: it emerged that receiving negative reinforcement – the word aggressive, devaluing, which leaves one unsatisfied – is an all-encompassing experience, because it activates at the same time areas of the brain belonging to the cognitive, emotional and motor spheres.
At the level of connectivity between the different areas of the brain, it has been observed that negative reinforcement activates the network that perceives and processes pain with areas that can be superimposed on physical pain: the negative word, therefore, hurts. When communication does not work, an activation of the motor areas was observed, as if the person felt their integrity undermined and was ready to flee / react. Not only that: the negative word favors non-social behavior, evidence that can be found in the brain with less dialogue between the two hemispheres of the brain.
“Failure to recognize the needs of a person, and of the patient in particular, represents a significant violation of the social relationship”, and “causes an immediate emotional psychic and physical reaction with the activation of an important alarm system involving a neural circuit similar to that of physical pain “, highlights one of the authors of the survey, Fabio Sambataro, Department of Neuroscience of the University of Padua.
“If the need-response misalignment persists – he warns – the relationship can become impoverished, lose its meaning and even undermine self-esteem and be useless, if not harmful”. Any medical act, recalls Andrea Di Ciano, head of scientific research at the Quarta Foundation, “is also achieved through words, which, as demonstrated by an ever-increasing number of scientific researches, are an essential component of the effectiveness of the medical act. same”.
Therefore, concludes the expert, “it is right and useful to take care of the words, of those spoken, so that they are a guide and comfort for the patient, but also of the unspoken words when they would have been necessary. In fact it is not possible not to communicate, take a step back from the dimension of the word: ignoring the patient’s need constitutes a negative reinforcement that can make the patient feel not considered and not welcomed, both the patient as sick and, above all, the patient as a person “.
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