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Title: Does feeling understood matter? : the effects of validating and invalidating interactions
Author: Greville-Harris , Maddy
Awarding Body: Exeter and Plymouth Peninsula Medical School
Current Institution: Exeter and Plymouth Peninsula Medical School
Date of Award: 2013
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Validation is a communication strategy, described by Linehan (1993) as part of dialectical behavioural therapy, which is used to communicate acceptance and understanding of the recipient. In contrast, invalidation communicates lack of understanding or acceptance of the individual, conveying that their thoughts, feelings or behaviours are somehow 'wrong'. This thesis examines the physiological, emotional and behavioural effects of validating and invalidating interactions, exploring the potential for validation in the medical consultation, particularly in the context of pain and distress. Three studies were carried out to examine validation both experimentally and in the context of the chronic pain consultation. In study one, 90 participants were randomly assigned to receive validating, invalidating or no feedback during a series of stressor tasks. Participants' physiological arousal, self-reported positive and negative mood, perceived safety and willingness to take part in the study again were measured. The experimenter-participant interactions were video recorded during the experiment and 42 video excerpts were later coded for participant social engagement behaviours. Seventeen participants also took part in semi-structured interviews to reflect on the experiment and the experimenter feedback that they received. Invalidated participants were found to have significantly lower levels of perceived safety, higher physiological arousal over time (in terms of heart rate and pre ejection period), increased negative affect over time and reported less willingness to take part in the study again compared with validated and control participants. In addition, invalidated participants showed significantly less social engagement behaviours whilst interacting with the experimenter than validated participants. These findings are examined using Porges' polyvagal theory as a framework to conceptualise the possible underlying physiological mechanisms that may be involved. Study two examined potential factors which may shape how individuals respond to validating and invalidating feedback. 425 participants completed an online battery of questionnaires to measure emotion regulation skill , attachment style, early invalidating experiences, feedback believability and socially desirable responding, before receiving either validating or invalidating feedback online. Willingness to take part again, perceived validation, change in mood and change in perceived safety were measured. There were significant differences across conditions in perceived validation, negative affect and perceived safety. Findings also suggest that factors such as difficulties with emotion regulation and early validating experiences shape individuals' perceptions of the feedback. Moreover, believability of the feedback, and whether feedback is congruent with an individual's self-views are both intrinsic in shaping how people respond . This is discussed with reference to Swann's (1983) verification theory. In study three, five patients suffering from chronic pain took part in semistructured interviews to discuss their experiences of feeling understood and accepted during their consultations. Various themes were described: 1) 'coping with their condition' 2) 'communicating understanding', and: 3) 'the impact of feeling understood'. Four video excerpts from consultations with one consultant were also coded using the validating and invalidating behaviour coding scale (VIBCS, Fruzzetti , 2010). These excerpts were discussed with the consultant and the patients involved during semi-structured interviews, in order to ascertain whether the consultants perspective, the patients perspective and the VIBCS coding of the consultant feedback corresponded. It was clear that whilst patients were very responsive to validation strategies and reported feeling understood and accepted, the consultant's aims were not to communicate understanding, but to understand the patient and their pain. The findings from these studies suggest that validation, or at least lack of invalidation, have great potential for alleviating pain and distress. This is particularly relevant for patients suffering from idiopathic conditions such as chronic pain. Such patients, whose symptoms have no obvious observable physical markers, often describe feeling disbelieved and misunderstood. This research sheds light on the potentially detrimental impact of receiving such feedback on physiological arousal, emotions, thoughts and behaviours. It appears that feeling understood does matter, both within the laboratory setting and beyond.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available