Thursday Thoughts #30: Negative Affect

At one of the recent meetings of the Radiological Society of North America we presented a study that looked at how patients’ mood affects the likelihood of adverse events during invasive medical procedures.

You all may have had the experience of interacting with a person who is giving off negative vibes. In daily life such interactions may be merely unpleasant and possibly risk contaminating one’s own mood [1]. I had always wondered though whether in a clinical encounter a patient’s negative emotions could become a self-fulfilling prophecy and complicate treatment. This question is more of immediate concern when getting a patient ready for an invasive medical procedures where one is always somewhat apprehensive of possible complications or poor outcomes.

For measuring mood we used the PANAS – the Positive Affect Negative Affect Schedule [2]. Interestingly the PANAS looks at negative and positive affect as independent from each other. In this instrument negative affect is determined and graded by patients rating on a 1-5 scale (1 = Very slightly/Not at All, 5 = Extremely) how much they feel distressed, upset, guilty, scared, hostile, irritable, ashamed, nervous, jittery, and afraid. Scores range from 10 to 50.

We did a secondary analysis on a prior trial [3] and looked at 230 patients who had filled out a PANAS prior to going in the operating room. In that study we recorded how often adverse events happened during their procedures. We split the participants into two groups at the middle value (24) into those with a high negative affect and those with a low one. It turned out that patients scoring high on negative affect had significantly more adverse events such as blood pressure drops or major increases, heart rhythm changes, and/or poor breathing than those low on it (17% vs. 9%).

These reactions all suggested less ability to adapt cardiovascular and respiratory responses to the need of the moment. A similar impairment in managing acute stress was found in a meta-analysis Chida and colleagues performed [4]. They analyzed multiple experiments in which subjects were subjected to public speaking, problem solving tasks, math tests, and socially demanding interactions, and found that people with negative affect did much poorer handling the situation and also recovered less quickly. They had faster heart rates and higher blood pressures. Other studies also showed that persons with high negative affect to have higher stress hormone levels, impaired platelet functions, and less fine regulations through their sympathetic nervous system and heart rate variability, which is a factor in maintaining a healthy blood pressure and heart rate [5, 6]. Anger and hostility also have been linked with future coronary heart disease {Chida, 2009 #1613}.

The good news in our study was that one could avert the risk of increased adverse effects in patients with a negative affect: A short guidance in self-hypnotic relaxation according to what we now call Comfort Talk® significantly reduced adverse events. Thus there is no need to get a sinking feeling when a patient shows up with a negative affect – this can be helped quickly and guarantee a better experience for all involved.

Next Thursday I will address more the effects of positive affect on outcomes and what some of the newest research is on that aspect. It may surprise you.



  1. Gump BB, Kulik JA. Stress, affiliation, and emotional contagion. J Pers Soc Psychol 1997;72:305-19.
  2. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988;54:1063-70.
  3. Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000;355:1486-90.
  4. Chida Y, Hamer M. Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations. Psychol Bull 2008;134:829-85.
  5. Sirois BC, Burg MM. Negative emotion and coronary heart disease. A review. Behav Modif 2003;27:83-102.
  6. Bleil ME, Gianaros PJ, Jennings JR, et al. Trait negative affect: toward an integrated model of understanding psychological risk for impairment in cardiac autonomic function. Psychosom Med 2008;70:328-37.


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