Emotional contagion in the consultation-liaison setting

To the Editor

Emotional contagion is an important concept to be aware of especially within the consultation-liaison context. The most widely accepted definition is by Hatfield et al. (1993), described as the tendency to automatically mimic and synchronize expressions, vocalizations, postures and movements with those of another person, and as a result to converge emotionally. It is one of the basic components to empathy with a neurophysiological basis within the mirror neuron system comprising the inferior frontal and inferior parietal regions of the brain (Gallese et al., 1996). In this letter, we discuss the usefulness in understanding emotional contagion within the consultation-liaison setting, along with strategies to assist in emotional regulation.

The term used for emotional contagion is helpful in a medical ward context where it parallels the infection model, making a complex psychological concept inherently understandable. The language used is less pejorative, and understood as a concept external to the persons involved where blame is directed away from the patient and the self.

Emotional contagion becomes apparent in the shared experience with the difficult patient, extending beyond one’s own experience with the patient to various staff members within the ward context. The difficult patient can evoke outrage and frustration, where the tension is palpable, with heightened anxiety transferred among other healthcare disciplines, resulting in demands to remove the problem swiftly. If unchecked, emotional contagion can result in burnout, compassion fatigue, increasing cynicism, disengagement and vicarious trauma. It also impacts on decision making, where we find ourselves reacting impulsively rather than reflectively.

In order to preserve our personal health and wellbeing, it is important to recognize emotional contagion and utilize emotional regulation strategies. Gross (1998) describes (1) selecting a setting or (2) modifying the situation to minimize contagion effects, (3) attentional deployment to focus on specific aspects of the interaction rather than being swept up in the emotions, (4) cognitive change such as cognitive reframing of the situation and (5) response modulation to limit one’s own emotional display, for example through relaxation and mindfulness techniques during the interaction. Other strategies include self-awareness of internal urges to react and act outside of what one would normally do, attending to one’s own self-cares by engaging in relaxing and enjoyable activities, remembering the success stories within one’s clinical practice to instil hopefulness, and ensuring supervision or a mentoring system that allows for reflection to reduce the need and impulse to react.