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Spring 2009, Issue 10

The Effects of Expressive Masking

Linda Tickle-DegnenLinda Tickle-Degnen, PhD, joined the Department of Occupational Therapy in 2006 and became the department’s chair in 2007. Research in her Health Quality of Life Lab is directed toward understanding and promoting positive social functioning and wellness in individuals with Parkinson’s disease and other chronic conditions. She is especially intrigued by the wide-reaching effects of reduced facial expressivity, a symptom of Parkinson’s.

Parkinson’s disease is a progressive motor system disorder that appears to result from the loss of dopamine-producing brain cells. Symptoms include tremors, stiffness, slowness of movement, and loss of facial expressiveness. Tickle-Degnen’s research group studies nonverbal and verbal communication, cross-cultural healthcare interactions, interpersonal rapport, engagement in meaningful daily activities, and quality of life for people with Parkinson’s disease.

Tickle-Degnen earned an MA in occupational therapy from the University of Southern California, and an MA in psychology and a PhD in social psychology from Harvard University. For the last 18 years she was a member of the faculty of the Department of Occupational Therapy at Boston University, where she remains an adjunct associate professor. While at BU Tickle-Degnen collaborated with Robert Wagenaar (BU Sargent College) on a major randomized controlled trial—likely the first of its kind—that tested the effectiveness of a self-management program for people with Parkinson’s disease. The program taught participants how to identify barriers that limit quality of life, and how to lower or remove the barriers. “They learned to do what therapists do, which is to break down a problem in quality of life into the key factors involved,” says Tickle-Degnen. “Do we need to change something about the environment, something about the person, or something about the task that’s involved in daily living? We were teaching the clients to be their own therapist, and it was effective.” Therapists from the disciplines of physical therapy, occupational therapy, and speech and language pathology provided rehabilitation. The program not only slowed the progressive decline in quality of life for individuals practicing self management in comparison with controls, but actually improved quality of life. “That’s what you’re looking for,” says Tickle-Degnen, “because in Parkinson’s there are critical periods in which you hit this threshold where you lose an important ability, such as driving a car. We hope to delay getting to that threshold, so people can live independently longer.”

In a study of stigma in healthcare, for which Tickle-Degnen was principal investigator, practitioners in the US and Taiwan viewed videotapes of Parkinson’s disease patients who displayed various levels of expressive masking, the term used for lowered facial expressivity due to a decrease in the ability to move facial muscles. Expressive masking is commonly misread as sadness, hostility, incompetence, or other inaccurate perceptions. Researchers asked the practitioners to judge the patients’ social, emotional, and cognitive competence based on 80-second video clips. Preliminary results indicate that practitioners perceived patients with more severe expressive masking as having diminished social, emotional, and cognitive competence when, in fact, the degree of masking was uncorrelated with patients’ actual competence. The study also looked at the moderating roles of patient gender and culture on the stigma of expressive masking. Results indicate that in judgments by both US and Taiwanese healthcare practitioners of patients’ social, emotional and cognitive competence, expressive masking was more discrediting for women than for men. In judgments of social competence, expressive masking was most discrediting for women observed by US practitioners. Among men, higher facial masking was more discrediting for judgments of cognitive competence by Taiwanese practitioners than by US practitioners. The results were consistent with social and cultural expectations regarding expressivity; that is, groups expected to be more expressive were discredited more for lack of expressivity than groups expected to be less expressive.

Tickle-Degnen and members of her lab are using these results to help train perceivers to look beyond the mask of Parkinson’s to more valid cues to a person’s emotional and cognitive competence. “The observer, the person interacting with the individual, has to be sensitive to the meaning of cues,” says Tickle-Degnen. “We find that they use some valid cues of what this person is feeling, and some invalid cues, like the facial mask that is a symptom of Parkinson’s.” Tickle-Degnen’s research group is testing a program to train healthcare professionals to avoid biased and stigmatizing perceptions of individuals with Parkinson’s disease. The program teaches novice healthcare professionals to look beyond the expressive mask and attend more carefully to speech content. Preliminary results indicate that exposure to the training program improved novice healthcare professionals’ ability to ignore expressive masking and focus on speech content when forming first impressions.

“I’m also interested in the kinematics of facial movements,” says Tickle-Degnen. “The face has a lot of movement capacity in it. We do all sorts of very quick movements that are only for expression.” She says researchers in facial kinematics can use little reflective points on the face and little cameras to study facial movement. Tickle-Degnen would like to collaborate with someone interested in studying facial kinematics. She is also very interested in doing more community-based research, and in increasing occupational therapists’ participation in interdisciplinary clinical interventions and research activities. Investigators interested in collaboration are welcomed to contact her at linda.tickle_degnen@tufts.edu.

For more information, please go to the Health Quality of Life Lab.


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