Episode 016: Microexpressions: Fear, Surprise, Disgust, Empathy, and Creating Connection Part 2
In the last Psychiatry and Psychotherapy podcast and blog, we talked about how Microexpressions make Microconnections, their role in therapy and how learning about them can increase our emotional connection to others.
This week, we will continue uncovering how different microexpressions look on the face and feel in our body, and their corresponding emotions.
David Puder, MD, Ariana Cunningham
There are no conflicts of interest for this episode.
Fear
Fear is an adaptive emotion—its original goal is to keep us safe and alive. When someone pulls into our lane on the interstate, it’s fear and our ability to quickly jerk the steering wheel straight that saves our lives. When we encounter heights, snakes, or frightening people in a dark alley at night, fear is the emotion we feel.
As children, we have fears of abandonment from our mothers, and at around two years old, we begin to experience stranger anxiety. As we grow, we read our parents and see what they are afraid of, so we can form protective fear patterns. Even different genders receive different messaging about fear. Parents teach male children to be more fearless, empowering and enabling, more courageous. They teach females to be more cautious, careful and more fearful.
Fear, demonstrated on the face in a microexpression, looks like:
Eyebrows drawing up and together with tension in the forehead
Lower eyelids tensing
Mouth opening horizontally in an interaction
Fear can bond people together but also separate us from having an emotional connection. In any emotional interaction, we are experiencing a state of calmness, fight/flight, or disconnection.
Fear and anger come into play in both fight and flight. When we notice someone exhibiting fear when we are interacting with them, it’s important to be curious as to why. Are they fearful because of the interaction with us? Or are they fearful because they are accounting a story about something that scared them?
When someone experiences fear, it’s important to strive for a healthy connection again. That person may experience fear because of vulnerability or shame. Because fear’s goal is to stay safe, it can cause disconnection. Establish a psychologically safe place for them to feel connected, rather than fight or flight.
Dealing with fear
Listen to your voice of courage that’s inside of you. Anytime there is fear, there is also a courageous part of us that is sending different messages too, we just need to focus on it and therefore turn up the volume of the courage signals. When we get stuck, frozen, in a state of fight or flight, we can choose to engage the object of fear anyway. We can choose courage.
Experiencing fear during sporting events or performances is a great way to think about this. Fear can be decreased over time. When we train often enough, or compete often enough, that fear response slowly decreases. After plenty of performances, after plenty of sport competition events, we start to normalize that fear and courage takes over—training gives us confidence in the face of fear.
We can learn how to handle fear without being totally overwhelmed by facing the cause of our fear in slow, small increments. It can create an adaptation, rather than stress. Even cardiovascular health is tied to your emotional ability to handle fight or flight. By training physically, you are actually training for interpersonal stressors as well by spiking your adrenaline, breathing, and heart rate.
Beyond behavioral therapy help, you can do mental exercises to regain control of your body during fear. Even simply saying out loud, “I am experiencing fear” can feel normalizing. Also, through meditation and breathing, you can reset your heart rate and breathing, and calm your body’s fear responses.
Surprise
On the face, the microexpression of surprise looks similar to fear, but where fear affects the face on a more horizontal axis, surprise affects the face on a more vertical axis. Surprise looks like:
Rising and rounding eyebrows
Rising upper eyelid
Sometimes mouth falling open with lips relaxing
Note: rising eyebrows can also be a conversational signal emphasizing something.
Surprise can be awe, curiosity, a revelation. It can be a more transitory emotion—quickly moving on to fear, anger or joy. When someone is exhibiting surprise on their face, be curious about why, ask them if the answer isn’t obvious—such as them arriving at their own surprise party—and you may learn something new about them.
Disgust
People rarely use the word “disgust.” They’ll talk about happiness, anger or fear or other emotions. But disgust is something that we don’t understand as easily without dipping back into the primal reasons for the emotion, and how it is helpful in modern day interactions.
Originally, disgust was an important emotion for survival. It standardized hygiene and behavioral norms. If a caveman or woman ate something gross, or fell out of line with the accepted hygiene of the day, they were shunned from the group. If they slept with a relative or animal, ate another human, or did not clean food properly, they aroused disgust in their tribe, and were exiled or even killed.
Without disgust, there would be less social norms, less “rules” for relating to each other and maintaining health codes. It’s a powerful emotion that drives behavior.
Disgust as a microexpression looks like:
Wrinkling around the nose
Upper lip rising
Eyebrows move down without tension (contrast this with anger where the eyebrows are pulled together and the eyelids are raised and tense).
I feel that people need to be more aware of disgust as a microexpression, and learn what it is trying to communicate to them. It’s not just about a survival mechanism, such as smelling rancid milk and being able to avoid getting sick. It’s also about how our spouse treats us, how we feel when we watch interactions between other people.
The negative effects of disgust, when it is taken too far, can be damaging and horrific. Racism and sexism are examples of disgust gone wrong. It can be dehumanizing. Even listening to Hitler’s conversation at his dinners, experts have analyzed disgust-oriented language. Much of his propaganda was even disgust-provoking propaganda.
People who are an object of someone’s disgust experience deep shame. Sometimes, that is warranted—such as when that person has broken a societal rule like pedophilia. But as a therapist, I have to have a lower threshold of disgust when it comes to hearing people’s secrets.
After awhile, I think that disgust, like fear, can be adaptable. I have heard all manners of secrets, and I rarely feel disgust anymore. Instead, I feel I need to exhibit psychological safety, so the patient feels open to talking about the things they cannot tell anyone. Through talk therapy, hopefully I can help them feel less shame and understand their unique journey and struggles more fully.
Using Microexpressions In Interactions
The first key to using microexpressions is to pay attention. Look at the person’s face, be interested and curious about what emotional state they are in. Notice the facial movements, and listen to what they are saying. Is what they are expressing maybe outside of their awareness as they talk? Does the emotion they are showing match what they are talking about?
As a therapeutic tool, understanding microexpressions is a way of gathering information about someone else. Use that information to respond in a way that shows the person you are desiring to connect.
Paying attention to microexpressions actually creates empathy. We have mirror neurons—neurons in our brain that are devoted to telling us what someone else is feeling. Those neurons light up when we watch someone else doing something, or feeling something. When we see someone bite into a hamburger on a commercial, it might make us hungry, even causing our stomach to rumble or our mouths to make extra saliva. When we see someone cry, it might make us cry. Your brain will light up, to some degree, as if you are experiencing someone else's emotions. We can train ourselves to pay attention to those neurons to better be able to connect with people.
Some people experience either less or more empathy than what is considered normal. This can be because of a disorder, or because of emotional burnout. Even experiencing emotional overload causes a decrease in empathy.
Being able to determine the difference between yourself and the other person is another important part of empathy. Learning about microexpressions can help you do that—you can see their emotions, and recognize they are the one experiencing it, and you can respond to the emotion, but you do not have to own it as your own.
Tune in next week to hear part three of Microexpressions.
Since posting these episodes Dr. Puder has launched EmotionConnection.com which is an advanced training in Microexpression, built for people wanting to integrate Microexpression in their mental health practice. We will have a link in the show notes, or just go to EmotionConnection.com to take our free test of how good you are at reading microexpressions.
Reference
Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of clinical psychology, 65(7), 755-768.
Van Baaren, R. B., Holland, R. W., Steenaert, B., & van Knippenberg, A. (2003). Mimicry for money: Behavioral consequences of imitation. Journal of Experimental Social Psychology, 39(4), 393-398.
Bänninger-Huber, E. (1997). Prototypical affective microsequences in psychotherapeutic interaction.What the face reveals, 414-433.
Barrett‐Lennard, G. T. (1993). The phases and focus of empathy. Psychology and Psychotherapy: Theory, Research and Practice, 66(1), 3-14.
Bechara, A., Damasio, H., & Damasio, A. R. (2000). Emotion, decision making and the orbitofrontal cortex. Cerebral cortex, 10(3), 295-307.
Blanch-Hartigan, D. (2011). Medical students’ self-assessment of performance: results from three meta-analyses.Patient Education and Counseling,84(1), 3-9.
Blanch-Hartigan, D. (2012). An effective training to increase accurate recognition of patient emotion cues. Patient education and counseling, 89(2), 274-280.
Bruno, A., Pandolfo, G., Scimeca, G., Leonardi, V., Cedro, C., Racchiusa, S., ... & Muscatello, M. R. A. (2014). Anger in Health, Benign Breast Disease and Breast Cancer: A Prospective Case–Control Study. In Vivo, 28(5), 973-977.
Carlozzi, A. F., Bull, K. S., Stein, L. B., Ray, K., & Barnes, L. (2002). Empathy theory and practice: A survey of psychologists and counselors. The Journal of psychology, 136(2), 161-170.
Carson, J. W., Keefe, F. J., Goli, V., Fras, A. M., Lynch, T. R., Thorp, S. R., & Buechler, J. L. (2005). Forgiveness and chronic low back pain: A preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress. The Journal of Pain, 6(2), 84-91.
Carstensen, L. L., Gottman, J. M., & Levenson, R. W. (1995). Emotional behavior in long-term marriage. Psychology and aging, 10(1), 140.
Chartrand, T. L., & Bargh, J. A. (1999). The chameleon effect: the perception–behavior link and social interaction. Journal of personality and social psychology, 76(6), 893.
Clark, T. F., Winkielman, P., & McIntosh, D. N. (2008). Autism and the extraction of emotion from briefly presented facial expressions: stumbling at the first step of empathy. Emotion, 8(6), 803.
Clark, A. (2010). Empathy and sympathy: Therapeutic distinctions in counseling. Journal of mental health counseling, 32(2), 95-101.
Creswell, J. D., Way, B. M., Eisenberger, N. I., & Lieberman, M. D. (2007). Neural correlates of dispositional mindfulness during affect labeling. Psychosomatic medicine, 69(6), 560-565.
Darwiche, J., de Roten, Y., Stern, D. J., von Roten, F. C., Corboz-Warnery, A., & Fivaz-Depeursinge, E. (2008). Mutual smiling episodes and therapeutic alliance in a therapist-couple discussion task. Swiss Journal of Psychology, 67(4), 231-239.
Davis, D. A., Mazmanian, P. E., Fordis, M., Van Harrison, R. T. K. E., Thorpe, K. E., & Perrier, L. (2006). Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.Jama,296(9), 1094-1102.
Del Canale, S., Louis, D. Z., Maio, V., Wang, X., Rossi, G., Hojat, M., & Gonnella, J. S. (2012). The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine, 87(9), 1243-1249.
Di Tella, M., Castelli, L., Colonna, F., Fusaro, E., Torta, R., Ardito, R. B., & Adenzato, M. (2015). Theory of mind and emotional functioning in fibromyalgia syndrome: an investigation of the relationship between social cognition and executive function. PLoS One, 10(1), e0116542.
DiMatteo, M. R., Hays, R. D., & Prince, L. M. (1986). Relationship of physicians’ nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload. Health Psychology, 5(6), 581-594.
Ekman, P., & Friesen, W. V. (1977). Facial action coding system.
Ekman, P., & Friesen, W. V. (1986). A new pan-cultural facial expression of emotion.Motivation and emotion,10(2), 159-168.
Ekman, P. (1992). An argument for basic emotions.Cognition & emotion,6(3-4), 169-200.
Ekman, P. (1994). Strong evidence for universals in facial expressions: a reply to Russell's mistaken critique.
Ekman, P. (2003). Micro expression training tool (METT) and subtle expression training tool (SETT). San Francisco, Paul Ekman Company.
Ekman, P. (2007). Emotions revealed: Recognizing faces and feelings to improve communication and emotional life. Macmillan.
Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy.
Fischmann, T. (2016). Dreams, Unconscious Fantasies and Epigenetics. In A Neuro-Psychoanalytical Dialogue for Bridging Freud and the Neurosciences (pp. 91-105). Springer International Publishing.
Galinsky, A. D., & Moskowitz, G. B. (2000). Perspective-taking: decreasing stereotype expression, stereotype accessibility, and in-group favoritism. Journal of personality and social psychology, 78(4), 708.
Gallese, V. (2001). The'shared manifold'hypothesis. From mirror neurons to empathy. Journal of consciousness studies, 8(5-6), 33-50.
Gallese, V., & Goldman, A. (1998). Mirror neurons and the simulation theory of mind-reading. Trends in cognitive sciences, 2(12), 493-501.
Gazzola, V., Aziz-Zadeh, L., & Keysers, C. (2006). Empathy and the somatotopic auditory mirror system in humans. Current biology, 16(18), 1824-1829.
Gery, I., Miljkovitch, R., Berthoz, S., & Soussignan, R. (2009). Empathy and recognition of facial expressions of emotion in sex offenders, non-sex offenders and normal controls. Psychiatry research, 165(3), 252-262.
Gottman, J., Levenson, R., & Woodin, E. (2001). Facial expressions during marital conflict.Journal of Family Communication,1(1), 37-57.
Greenwood, K. A., Thurston, R., Rumble, M., Waters, S. J., & Keefe, F. J. (2003). Anger and persistent pain: current status and future directions. Pain, 103(1-2), 1-5.
Guttman, H., & Laporte, L. (2002). Alexithymia, empathy, and psychological symptoms in a family context. Comprehensive psychiatry, 43(6), 448-455.
Harker, L., & Keltner, D. (2001). Expressions of positive emotion in women's college yearbook pictures and their relationship to personality and life outcomes across adulthood. Journal of personality and social psychology, 80(1), 112.
Hassenstab, J., Dziobek, I., Rogers, K., Wolf, O. T., & Convit, A. (2007). Knowing what others know, feeling what others feel: a controlled study of empathy in psychotherapists. The Journal of nervous and mental disease, 195(4), 277-281.
Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C., & Gonnella, J. S. (2011). Physicians' empathy and clinical outcomes for diabetic patients. Academic Medicine, 86(3), 359-364.
Hurley, C. M., Anker, A. E., Frank, M. G., Matsumoto, D., & Hwang, H. C. (2014). Background factors predicting accuracy and improvement in micro expression recognition. Motivation and Emotion, 38(5), 700-714.
Hurley, C. M. (2012). Do you see what I see? Learning to detect micro expressions of emotion.Motivation and Emotion,36(3), 371-381.
Jennings, L., & Skovholt, T. M. (1999). The cognitive, emotional, and relational characteristics of master therapists. Journal of counseling psychology, 46(1), 3.
Kenny, D. T. (1995). Determinants of patient satisfaction with the medical consultation. Psychology and Health, 10(5), 427-437.
Kim, S. S., Kaplowitz, S., & Johnston, M. V. (2004). The effects of physician empathy on patient satisfaction and compliance. Evaluation & the health professions, 27(3), 237-251.
Kohut, H. (1959). Introspection, empathy, and psychoanalysis an examination of the relationship between mode of observation and theory. Journal of the American Psychoanalytic Association, 7(3), 459-483.
Krause, R., Steimer-Krause, E., Merten, J., & Ullrich, B. (1998). Dyadic interaction regulation, emotion, and psychopathology. Emotions and psychopathology: Theory and research, 70-80.
Lakin, J. L., Jefferis, V. E., Cheng, C. M., & Chartrand, T. L. (2003). The chameleon effect as social glue: Evidence for the evolutionary significance of nonconscious mimicry.Journal of nonverbal behavior,27(3), 145-162.
Leuchter, A. F., Hunter, A. M., Tartter, M., & Cook, I. A. (2014). Role of pill-taking, expectation and therapeutic alliance in the placebo response in clinical trials for major depression. The British Journal of Psychiatry, 205(6), 443-449.
Lieberman, Matthew D., et al. "Putting feelings into words."Psychological science18.5 (2007): 421-428.
Matsumoto, D., LeRoux, J., Wilson-Cohn, C., Raroque, J., Kooken, K., Ekman, P., ... & Amo, L. (2000). A new test to measure emotion recognition ability: Matsumoto and Ekman's Japanese and Caucasian Brief Affect Recognition Test (JACBART). Journal of Nonverbal behavior, 24(3), 179-209.
Matsumoto, D., & Hwang, H. S. (2011). Evidence for training the ability to read microexpressions of emotion.Motivation and Emotion,35(2), 181-191.
McKay, K. M., Imel, Z. E., & Wampold, B. E. (2006). Psychiatrist effects in the psychopharmacological treatment of depression. Journal of affective disorders, 92(2), 287-290.
Merten, J. (2005). Facial microbehavior and the emotional quality of the therapeutic relationship. Psychotherapy Research, 15(3), 325-333.
Miller, W. (1998). The anatomy of disgust Harvard University Press. Cambridge MA.
Molenberghs, P., Cunnington, R., & Mattingley, J. B. (2012). Brain regions with mirror properties: a meta-analysis of 125 human fMRI studies. Neuroscience & Biobehavioral Reviews, 36(1), 341-349.
Morrongiello, B. A., & Dawber, T. (1999). Parental influences on toddlers' injury-risk behaviors: Are sons and daughters socialized differently?. Journal of Applied Developmental Psychology, 20(2), 227-251.
Murata, A., Saito, H., Schug, J., Ogawa, K., & Kameda, T. (2016). Spontaneous facial mimicry is enhanced by the goal of inferring emotional states: evidence for moderation of “automatic” mimicry by higher cognitive processes. PloS one, 11(4), e0153128.
Nelson, A. A., Gold, B. H., Hutchinson, R. A., & Benezra, E. (1975). Drug default among schizophrenic patients. American Journal of Health-System Pharmacy, 32(12), 1237-1242.
Okiishi, J., Lambert, M. J., Nielsen, S. L., & Ogles, B. M. (2003). Waiting for supershrink: An empirical analysis of therapist effects. Clinical Psychology & Psychotherapy, 10(6), 361-373.
Panksepp, J., Herman, B. H., Vilberg, T., Bishop, P., & DeEskinazi, F. G. (1980). Endogenous opioids and social behavior. Neuroscience & Biobehavioral Reviews, 4(4), 473-487.
Panksepp, J. (2005). Affective consciousness: Core emotional feelings in animals and humans. Consciousness and cognition, 14(1), 30-80.
Rakel, D. P., Hoeft, T. J., Barrett, B. P., Chewning, B. A., Craig, B. M., & Niu, M. (2009). Practitioner empathy and the duration of the common cold. Family medicine, 41(7), 494.
Regenbogen, C., Schneider, D. A., Finkelmeyer, A., Kohn, N., Derntl, B., Kellermann, T., ... & Habel, U. (2012). The differential contribution of facial expressions, prosody, and speech content to empathy. Cognition & emotion, 26(6), 995-1014.
Riess, H., Kelley, J. M., Bailey, R. W., Dunn, E. J., & Phillips, M. (2012). Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. Journal of general internal medicine, 27(10), 1280-1286.
Rogers, C. R. (1975). Empathic: An unappreciated way of being.The counseling psychologist,5(2), 2-10.
Rosenthal, R. (1979). Sensitivity to nonverbal communication: The PONS test. Johns Hopkins Univ Pr.
Russell, T. A., Chu, E., & Phillips, M. L. (2006). A pilot study to investigate the effectiveness of emotion recognition remediation in schizophrenia using the micro‐expression training tool. British journal of clinical psychology, 45(4), 579-583.
Scherer, K. R., & Scherer, U. (2011). Assessing the ability to recognize facial and vocal expressions of emotion: Construction and validation of the Emotion Recognition Index. Journal of Nonverbal Behavior, 35(4), 305.
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. American psychologist, 62(4), 271.
Trippany, R. L., Kress, V. E. W., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling & development, 82(1), 31-37.
Turk, D. C., & Okifuji, A. (1999). Assessment of patients' reporting of pain: an integrated perspective. The Lancet, 353(9166), 1784-1788.
Vaillant, G. E. (1992). The struggle for empirical assessment of defenses. Ego mechanisms of defense: A guide for clinicians and researchers, 89-104.
Verhulst, J., Kramer, D., Swann, A. C., Hale-Richlen, B., & Beahrs, J. (2013). The medical alliance: from placebo response to alliance effect. The Journal of nervous and mental disease, 201(7), 546-552.