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The sociophysiology of caring in the doctor-patient relationship

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Abstract

The emotional investment required to construct a caring doctor-patient relationship can be justified on humane grounds. Can it also be justified as a direct physiologic intervention? Two lines of evidence point in this direction. People in an empathic relationship exhibit a correlation of indicators of autonomic activity. This occurs between speakers and responsive listeners, members of a coherent group, and bonded pairs of higher social animals. Furthermore, the experience of feeling cared about in a relationship reduces the secretion of stress hormones and shifts the neuroendocrine system toward homeostasis. Because the social engagement of emotions is simultaneously the social engagement of the physiologic substrate of those emotions, the process has been labeled sociophysiology. This process can influence the health of both parties in the doctor-patient relationship, and may be relevant to third parties.

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References

  1. House JS, Robins C, Metzner HL. The association of social relationships and activities with mortality: prospective evidence from the Tecumseh community health study. Am J Epidemiol. 1982;116:123–40.

    PubMed  CAS  Google Scholar 

  2. Cobb S. Social support as a moderator of life stress. Psychosom Med. 1976;38:300–14.

    PubMed  CAS  Google Scholar 

  3. Russek LG Schwartz GE. Perceptions of parental caring predict health status in midlife: a 35-year follow-up of the Harvard Mastery of Stress Study. Psychosom Med. 1997;59:144–9.

    PubMed  CAS  Google Scholar 

  4. Peabody F. The care of the patient. JAMA. 1927;88:877–82.

    Google Scholar 

  5. Rabin P Rabin D. The care of the patient; Francis Peabody revisited. JAMA. 1984;252:819–20.

    PubMed  CAS  Google Scholar 

  6. Siegel D. The Developing Mind. New York: Guilford Press; 1999:149.

    Google Scholar 

  7. Adler HM. The history of the present illness as treatment: who’s listening, and why does it matter? J Am Board Fam Pract. 1997;10:28–35.

    PubMed  CAS  Google Scholar 

  8. Shortt J, Pennebaker J. Talking versus hearing about Holocaust experiences. Basic Appl Soc Psych. 1992;13:165–79.

    Google Scholar 

  9. Pennebaker J, Barger S, Tiebout J. Disclosure of traumas and health among Holocaust survivors. Psychosom Med. 1989;51:577–89.

    PubMed  CAS  Google Scholar 

  10. Levin J. How prayer heals: a theoretical model. Altern Ther Health Med. 1996;2:66–73.

    PubMed  CAS  Google Scholar 

  11. Mendoza S. Sociophysiology of well-being in nonhuman primates. Lab Anim Sci. 1991;41:344–9.

    PubMed  CAS  Google Scholar 

  12. Uvnas-Moberg K. Physiological and endocrine effects of social contact. Ann N Y Acad Sci. 1997;807:146–63.

    PubMed  CAS  Google Scholar 

  13. House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988;241:540–5.

    PubMed  CAS  Google Scholar 

  14. Uchino B, Cacioppo J, Kiecolt-Glaser J. The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychol Bull. 1996;119:488–531.

    PubMed  CAS  Google Scholar 

  15. DiMascio A, Boyd R, Greenblatt M, Solomon H. The psychiatric interview: a sociophysiologic study. Dis Nerv Syst. 1955;16:4–9.

    CAS  Google Scholar 

  16. DiMascio A, Boyd R, Greenblatt M. Physiological correlates of tension and antagonism during psychotherapy: a study of “interpersonal physiology.”. Psychosom Med. 1957;19:99–104.

    PubMed  CAS  Google Scholar 

  17. Malmo R, Boag T, Smith A. The physiological study of personal interaction. Psychosom Med. 1957;19:105–19.

    PubMed  CAS  Google Scholar 

  18. Bales R. Interaction Process Analysis. Cambridge, Mass: Addison-Wesley Press; 1951.

    Google Scholar 

  19. Coleman R, Greenblatt M, Solomon H. Physiological evidence of rapport during psychotherapeutic interviews. Dis Nerv Syst. 1956;17:2–8.

    Google Scholar 

  20. Gormly J. Social interactions and psychophysiology. In: Waid WM, ed. Sociophysiology. New York: Springer-Verlag; 1984:199–223.

    Google Scholar 

  21. Robinson J, Herman A, Kaplan B. Autonomic responses correlate with counselor-client empathy. J Couns Psychol. 1982;29:195–8.

    Google Scholar 

  22. Levenson R, Ruef A. Empathy, a physiological substrate. J Pers Soc Psychol. 1992;63:234–46.

    PubMed  CAS  Google Scholar 

  23. Mason J, Brady J. The sensitivity of psychoendocrine systems to social and physical environment. In: Leiderman P, Shapiro D, eds. Psychobiological Approaches to Social Behavior. Stanford, Calif: Stanford University Press; 1964:4–23.

    Google Scholar 

  24. McClintock MK. Menstrual synchrony and suppression. Nature. 1971;229:244–5.

    PubMed  CAS  Google Scholar 

  25. Vernikos-Danellis J. Adrenocortical responses of humans to group hierarchy, confinement, and social interaction. In: Levine S, Ursin H, eds. Coping and Health. New York: Plenum Press; 1980.

    Google Scholar 

  26. Vernikos-Danellis J, Winget C. The importance of light, postural and social cues in the regulation of the plasma cortical rhythms in man. In: Reinberg A, Halbert F, eds. Chronopharmacology. New York: Pergamon; 1979:101–6.

    Google Scholar 

  27. Mason J. Psychological influences on the pituitary adrenal-cortical system. Recent Prog Horm Res. 1959;15:345–89.

    CAS  Google Scholar 

  28. Waid WM. Origins of sociophysiology. In: Waid WM, ed. Sociophysiology. New York: Springer-Verlag; 1984:3–20.

    Google Scholar 

  29. Gardner RJ. Sociophysiology as the basic science of psychiatry. Theor Med. 1997;18:335–56.

    PubMed  Google Scholar 

  30. Gardner R, Price J. Sociophysiology and depression. In: Joiner T, Coyne J, eds. The Interactional Nature of Depression: Advances In Interpersonal Approaches. Washington, DC: American Psychological Association; 1999:247–68.

    Google Scholar 

  31. Harlow H, Harlow M. The affectional systems. In: Schrier A, Harlow H, Stolnitz F, eds. Behavior of Nonhuman Primates. Vol 2. New York: Academic Press; 1965:287–334.

    Google Scholar 

  32. Mason W. Socially mediated reduction in emotional responses of young monkeys. J Abnorm Soc Psychol. 1960;60:100–4.

    PubMed  CAS  Google Scholar 

  33. Barchas P, Mendoza S. Preface: social cohesion: essays toward a sociophysiological perspective. In: Barchas P, Mendoza S, eds. Social Cohesion: Essays Toward a Sociophysiological Perspective. Westport, Conn: Greenwood Press; 1984:xi-xiv.

    Google Scholar 

  34. Saltzman W, Mendoza S, Mason W. Sociophysiology of relationships in squirrel monkeys. I. Formation of female dyads. Physiol Behav. 1991;50:271–80.

    PubMed  CAS  Google Scholar 

  35. Gianakos D. Empathy revisited. Arch Intern Med. 1996;156:135–6.

    PubMed  CAS  Google Scholar 

  36. Reite M, Capitanio J. On the nature of social separation and social attachment. In: The Psychobiology of Attachment and Separation. Orlando: Academic Press; 1985.

    Google Scholar 

  37. Bowlby J. Attachment and Loss. Vol I, Attachment. New York: Basic Books; 1969.

    Google Scholar 

  38. Mendoza S. The psychobiology of social relationships. In: Barchas P, Mendoza S, eds. Social Cohesion: Essays Toward a Sociophysiological Perspective. Westport, Conn: Greenwood Press; 1984:3–30.

    Google Scholar 

  39. Stern D The Interpersonal World of the Infant. New York: Basic Books; 1985.

    Google Scholar 

  40. Hofer M. Relationships as regulators: a psychobiological perspective on bereavement. Psychosom Med. 1984;46:183–97.

    PubMed  CAS  Google Scholar 

  41. Insel TR. A neurological basis of social attachment. Am J Psychiatry. 1997;154:726–35.

    PubMed  CAS  Google Scholar 

  42. Field T. The effects of mother’s physical and emotional unavailability on emotion regulation. Monogr Soc Res Child Dev. 1994;59:208–27.

    PubMed  CAS  Google Scholar 

  43. Coe C, Mendoza S, Smotherman W, Levine S. Mother-infant attachment in the squirrel monkey: adrenal response to separation. Behav Biol. 1978;22:256–63.

    PubMed  CAS  Google Scholar 

  44. Gunnar M, Larson M, Hertsgaard L, Harris M, Brodersen L. The stressfulness of separation among nine-month-old infants: effects of social context variables and infant temperament. Child Dev. 1992;63:290–303.

    PubMed  CAS  Google Scholar 

  45. Simpson JA, Rholes WS. Stress and secure base relationships in adulthood. Advances Personal Relationships. 1994;5:181–204.

    Google Scholar 

  46. Carter C. Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology. 1998;23:779–818.

    PubMed  CAS  Google Scholar 

  47. Hofer M. On the nature and consequences of early loss. Psychosom Med. 1996;58:570–81.

    PubMed  CAS  Google Scholar 

  48. Conger JJ, Sawrey W, Turrell ES. The role of social experience in the production of gastric ulcers in hooded rats placed in a conflict situation. J Abnorm Soc Psychol. 1958;57:214–20.

    CAS  Google Scholar 

  49. Carden S, Tempel A, Hernandez N, Hofer M. Isolation alters striatal met-enkephalin immunoreactivity in rat pups. Physiol Behav. 1996;60:51–3.

    PubMed  CAS  Google Scholar 

  50. Bowlby J. The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. Br J Psychiatry. 1977;130:201–10.

    Article  PubMed  CAS  Google Scholar 

  51. Ainsworth M. Attachments beyond infancy. Am Psychol. 1989;44:709–16.

    PubMed  CAS  Google Scholar 

  52. Virgin CJ, Sapolsky R. Styles of male social behavior and their endocrine correlates among low-ranking baboons. Am J Primatol. 1997;42:25–39.

    PubMed  CAS  Google Scholar 

  53. McEwen B, Stellar E. Stress and the individual. Mechanisms leading to disease. Arch Intern Med. 1993;153:2093–101.

    PubMed  CAS  Google Scholar 

  54. Sterling P, Eyer J. Allostasis: a new paradigm to explain arousal pathology. In: Fisher S, Reason J, eds. Handbook of Life Stress, Cognition and Health. New York: John Wiley; 1988:629–49.

    Google Scholar 

  55. McEwen B. Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44.

    PubMed  CAS  Google Scholar 

  56. Nemeroff C. The persistent neurobiological consequences of early untoward life events: treatment implications. Presented at the 152nd Annual Meeting of the American Psychiatric Association, Washington DC, October, 1999.

  57. McEwen B. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338:171–9.

    PubMed  CAS  Google Scholar 

  58. Adler HM, Hammett VO. The doctor-patient relationship revisited, an analysis of the placebo effect. Ann Intern Med. 1973;78:595–8.

    PubMed  CAS  Google Scholar 

  59. Vanderpool J, Barratt E. Empathy: towards a psychophysiological definition. Dis Nerv Syst. 1970;31:464–7.

    PubMed  CAS  Google Scholar 

  60. Jordan J. The role of mutual empathy in relational/cultural therapy. J Clin Psychol. 2000;56:1005–16.

    PubMed  CAS  Google Scholar 

  61. Osler W. Aequanimitas with Other Addresses to Medical Students, Nurses, and Practitioners of Medicine, 3rd ed. Philadelphia: Blackiston; 1932:3–4.

    Google Scholar 

  62. Rogers C. The necessary and sufficient conditions of therapeutic personality change. J Consult Psychol. 1957;21:95–103.

    PubMed  CAS  Google Scholar 

  63. Adler HM. Toward a multimodal communication theory of psychotherapy: the vicarious coprocessing of experience. Am J Psychother. 1997;51:54–66.

    PubMed  CAS  Google Scholar 

  64. Miller A. Psychoneuroendocrinology: neuroendocrine and immune system interactions in stress and depression. Psychiatr Clin North Am. 1998;21:443–63.

    PubMed  CAS  Google Scholar 

  65. Melamed S, Ugarten U, Shirom A, Kahana L, Lerman Y, Froom P. Chronic burnout, somatic arousal and elevated salivary cortisol levels. J Psychosom Res. 1999;46:591–8.

    PubMed  CAS  Google Scholar 

  66. Nakamura H, Nagase H, Yoshida M, Ogino K. Natural killer (NK) cell activity and NK cell subsets in workers with a tendency of burnout. J Psychosom Res. 1999;46:569–78.

    PubMed  CAS  Google Scholar 

  67. Burke RJ, Richardsen AM, Stress, burnout, and health. In: Cooper CL, ed. Handbook of Stress, Medicine, and Health. New York: CRC Press; 1996:101–17.

    Google Scholar 

  68. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422.

    PubMed  CAS  Google Scholar 

  69. Bakker AB, Killmer CH, Siegrist J, Schaufeli WB. Effort-reward imbalance and burnout among nurses. J Adv Nurs. 2000;31:884–91.

    PubMed  CAS  Google Scholar 

  70. Rainey DW, Hardy L. Sources of stress, burnout and intention to terminate among rugby union referees. J Sports Sci. 1999;17:797–806.

    PubMed  CAS  Google Scholar 

  71. Pruessner JC, Hellhammer DH, Kirschbaum C. Burnout, perceived stress, and cortisol responses to awakening. Psychosom Med. 1999;61:197–204.

    PubMed  CAS  Google Scholar 

  72. Sundin-Huard D, Fahy K. Moral distress, advocacy and burnout: theorizing the relationships. Int J Nurs Pract. 1999;5:8–13.

    PubMed  CAS  Google Scholar 

  73. Balint M. The Doctor, His Patient, and the Illness. New York: International Universities Press; 1957.

    Google Scholar 

  74. Brock CD, Stock RD. A survey of Balint group activity in U.S. family residency programs. Fam Med. 1987;22:33–7.

    Google Scholar 

  75. Smyth J, Stone A, Hurewitz A, Kaell A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. JAMA. 1999;281:1304–9.

    PubMed  CAS  Google Scholar 

  76. Gundersen L. Physician burnout. Ann Intern Med. 2001;135:145–8.

    PubMed  CAS  Google Scholar 

  77. DiMatteo M, Sherbourne C, Hays R, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993;12:93–102.

    PubMed  CAS  Google Scholar 

  78. Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S110–27.

    PubMed  CAS  Google Scholar 

  79. Seeman T. Social ties and health: the benefits of social integration. Ann Epidemiol. 1996;6:442–51.

    PubMed  CAS  Google Scholar 

  80. Lee HS, Brennan PF, Daly BJ. Relationship of empathy to appraisal, depression, life satisfaction, and physical health in informal caregivers of older adults. Res Nurs Health. 2001;24:44–56.

    PubMed  CAS  Google Scholar 

  81. Cape J. Patient-rated therapeutic relationship and outcome in general practitioner treatment of psychological problems. Br J Clin Psychol. 2000;39:383–95.

    PubMed  Google Scholar 

  82. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021–7.

    PubMed  CAS  Google Scholar 

  83. Barsky A, Borus J. Functional somatic syndromes. Ann Intern Med. 1999;130:910–21.

    PubMed  CAS  Google Scholar 

  84. Green J, Shellenberger R. The healing energy of love. Altern Ther Health Med. 1996;2:46–56.

    PubMed  CAS  Google Scholar 

  85. Krupnic JL, Sotsky SM, Simmens S, et al. The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol. 1996;64:532–9.

    Google Scholar 

  86. Cacioppo JT, Ernst JM, Burleson MH, et al. Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies. Int J Psychophysiol. 2000;35:143–54.

    PubMed  CAS  Google Scholar 

  87. Bosma H, Marmot M, Hemingway H, Nicholson A, Brunner E, Stansfeld S. Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study. BMJ. 1997;314:558–65.

    PubMed  CAS  Google Scholar 

  88. Grbich C, Parker D, Maddocks I. The emotions and coping strategies of caregivers of family members with a terminal cancer. J Palliat Care. 2001;17:30–6.

    PubMed  CAS  Google Scholar 

  89. Elliott R, Dolan R. Neural response during preference and memory judgments for subliminally presented stimuli: a functional neuroimaging study. J Neurosci. 1998;18:4697–704.

    PubMed  CAS  Google Scholar 

  90. Rugg M, Mark R, Walla P, Schloerscheidt A, Birch C, Allan K. Dissociation of the neural correlates of implicit and explicit memory. Nature. 1998;392:595–8.

    PubMed  CAS  Google Scholar 

  91. Gershon M. The enteric nervous system: a second brain. Hosp Pract (Off Ed). 1999;34:31–2, 35–8, 41–2.

    CAS  Google Scholar 

  92. Wood JD, Alpers DH, Andrews PLR. Fundamentals of neurogastroenterology. Gut. 1999;45:S6–16.

    Article  Google Scholar 

  93. Schore A. Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Hillside, NJ: Lawrence Erlbaum; 1994.

    Google Scholar 

  94. Issel LM, Kahn D. The economic value of caring. Health Care Manage Rev. 1998;23:43–53.

    PubMed  CAS  Google Scholar 

  95. Barsky AJ, Borus JF. Somatization and medicalization in the era of managed care. JAMA. 1995;274:1931–4.

    PubMed  CAS  Google Scholar 

  96. Smith G, Monson R, Ray D. Patients with multiple unexplained symptoms: their characteristics, functional health, and health care utilization. Arch Intern Med. 1986;146:69–72.

    PubMed  Google Scholar 

  97. Donovan J, Blake D. Patient non-compliance: deviance or reasoned decision making. Soc Sci Med. 1992;34:507–13.

    PubMed  CAS  Google Scholar 

  98. Clark L. Improving compliance and increasing control of hypertension: needs of a special hypertensive population. Am Heart J. 1991;121:664–9.

    PubMed  CAS  Google Scholar 

  99. Hinds P. The relation of nurses’ caring behaviors with hopefulness and health care outcomes in adolescents. Arch Psychiatr Nurs. 1988;2:21–9.

    PubMed  CAS  Google Scholar 

  100. Hornberger J, Thom D, McCurdy T. Effects of a self-administered previsit questionnaire to enhance awareness of patients’ concerns in primary care. J Gen Intern Med. 1997;12:597–606.

    PubMed  CAS  Google Scholar 

  101. Terry K. Telling patients more will save you time. Med Econ. 1994;71:40–52.

    PubMed  CAS  Google Scholar 

  102. Levinson W, Roter D, Mullooly J, Dull V, Frankel R. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–9.

    PubMed  CAS  Google Scholar 

  103. Clark J, Rager D, Calpin J. Animal well-being II. Stress and distress. Lab Anim Sci. 1997;47:571–9.

    PubMed  CAS  Google Scholar 

  104. Kuhn C, Schanberg S. Responses to maternal separation: mechanisms and mediators. Int J Dev Neurosci. 1998;16:261–70.

    PubMed  CAS  Google Scholar 

  105. Krebs JR, Davies NB. An Introduction to Behavioral Ecology, 3rd ed. London: Blackwell Science Ltd.; 1993.

    Google Scholar 

  106. DeVries A, DeVries M, Taymans S, Carter C. The effects of stress on social preferences are sexually dimorphic in prairie voles. Proc Natl Acad Sci USA. 1996;93:11980–4.

    PubMed  CAS  Google Scholar 

  107. Kiecolt-Glaser J, Newton T, Cacioppo J, MacCallum R, Glaser R, Malarkey W. Marital conflict and endocrine function: are men really more physiologically affected than women. J Consult Clin Psychol. 1996;64:324–32.

    PubMed  CAS  Google Scholar 

  108. Levenson RW. The influence of age and gender on affect, physiology, and their interrelations: a study of long-term marriages. J Pers Soc Psychol. 1994;67:56–68.

    PubMed  CAS  Google Scholar 

  109. Smith TW, Gallo LC. Hostility and cardiovascular reactivity during marital interaction. Psychosom Med. 1999;61:436–45.

    PubMed  CAS  Google Scholar 

  110. Lewis J. Repairing the bond in important relationships: a dynamic for personality maturation. Am J Psychiatry. 2000;157:1375–8.

    PubMed  CAS  Google Scholar 

  111. Lewis J. For better or worse: interpersonal relationships and individual outcome. Am J Psychiatry. 1998;582–9.

  112. Uvnas-Moberg K. Oxytocin may mediate the benefits of positive social interaction and emotions. Psychoneuroendocrinology. 1998;23:819–35.

    PubMed  CAS  Google Scholar 

  113. Salk L. The role of the heartbeat in the relations between mother and infant. Sci Am. 1973;228:24–9.

    Article  PubMed  CAS  Google Scholar 

  114. Knardahl S. Cardiovascular psychophysiology. Ann Med. 2000;32:329–35.

    PubMed  CAS  Google Scholar 

  115. Drossman D. Psychosocial factors in gastrointestinal disorders. In: Sleisenger M, Fordtran JS, eds. Gastrointestinal and Liver Disease, 6th ed. Philadelphia: W. B. Saunders Company; 1998:69–79.

    Google Scholar 

  116. Stoudemire A, McDaniel JS. History, classification, and current trends in psychosomatic medicine. In: Kaplan H, Saddock B, eds. Comprehensive Textbook of Psychiatry, Vol VI. Baltimore: Williams and Wilkins; 1995:1463–71.

    Google Scholar 

  117. Kemper TD. Toward a sociology of emotions: some problems and some solutions. Am Sociol. 1978;13:30–41.

    Google Scholar 

  118. Kasl SV. Theory of stress and health. In: Cooper CL, ed. Handbook of Stress, Medicine, and Health. New York: CRC Press; 1996:13–26.

    Google Scholar 

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    Herbert M. Adler MD, PhD

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Adler, H.M. The sociophysiology of caring in the doctor-patient relationship. J GEN INTERN MED 17, 883–890 (2002). https://doi.org/10.1046/j.1525-1497.2002.10640.x

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