Universität zu Köln

Dietz, Thilo ORCID: 0000-0002-9378-6799 (2023). Speechlessness: A new psychological concept. PhD thesis, Universität zu Köln.

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Abstract

Background: Physician-patient communication is critical in modern medicine. To address these aspects, verbal communication between patient and healthcare provider is necessary. Verbal communication involves multiple, sequenced levels and is a highly complex process that can be influenced by a variety of external factors. Emotions and emotion regulation strategies have a significant impact on the process of speech production, and extreme emotions can even lead to speechlessness. Patients in emotionally distressing situations may experience speechlessness, reticence, or avoidance of certain topics when communicating with healthcare providers. Cancer patients are a particularly vulnerable group of patients, as they suffer from increased psychological distress due to the burden of the disease and the constant threat of death, and are less likely to share their feelings with those around them and their physicians. For this group of patients, shared decision making is particularly important and can be compromised by a lack of verbal communication between both parties. This non-speaking or silence in communication situations is to be perceived as the observable phenomenon of speechlessness. In the scientific literature, speechlessness has hardly been studied from a non-pathological, psychological point of view. Also, only limited explanatory approaches for patients' non-speech or silence in medical conversational situations have been investigated. However, based on previous research, it can be assumed that a lack of verbal communication interferes with the functioning of physician-patient communication and is associated with negative consequences for the patient's treatment and quality of life. Three research papers investigated the phenomenon of speechlessness using different scientific methodologies and attempted to explain this phenomenon conceptually, measure it empirically and situate it in the context of clinical care. Research: (1) A systematic literature search using theory-based search terms identified a total of N = 7 publications that examined the phenomenon of speechlessness. Based on these findings, a conceptual framework of the emergence of speechlessness was developed. The core element of this framework is formed by “meaningful emotions” which are perceived and processed by the speechless individual and result in a dimension of intentional speechlessness, as a conscious silence of the person, or a dimension of non-intentional speechlessness, as a verbal inhibition to speak. (2) The Cologne Questionnaire on Speechlessness (ger.: Kölner Fragebogen zur Sprachlosigkeit; KFS), which was developed to address the relevance of emotional perception, contains a total of N = 19 items in four subscales: “General Emotion Description”, “Emotional Awareness”, “Emotional Uncertainty”, and “Positive Emotion Description”. The KFS allows quantification of emotional speechlessness as a difficulty in communicating and perceiving one's emotional state and has been validated in a sample of N = 1,293 clinician and non-clinician participant groups. The KFS and its factorial structure indicated a high model fit (χ2 (df, 146) = 953.856; p < .001; Tucker-Lewis-Index = .891; Comparative Fit Index = .916; Root Mean Square Error of Approximation = .065; p < .001; N = 1293), suggesting an adequate and robust measurement of the phenomenon of (emotional) speechlessness. (3) The results of a pilot study with N = 22 cancer patients in music and art therapy showed increased emotional speechlessness (measured by the subscales of the KFS) in both creative art therapy groups at baseline. Specifically designed interventions to promote patients' own emotional awareness in combination with each creative arts therapy program indicated a nonsignificant reduction in emotional speechlessness and maladaptive cancer coping strategies for participants in the music therapy group (N = 8) at the end of the study. Conclusion: These results and the overall discussion of them against the background of physician-patient communication, considering linguistic theories of the speech process, indicate that the phenomenon of speechlessness has a scientific justification. The explanatory approaches for the developmental process of intentional and non-intentional speechlessness, as well as an increased emotional speechlessness as an upstream element in its emergence, can be identified in clinical samples and allow the conclusion that an existing speechlessness can potentially negatively influence the communication between physician and patient. Furthermore, the dimensions of speechlessness can be incorporated into the speech process and provide an explanatory approach as to why individuals, especially those who have no concept or words for their emotions, remain verbally silent about their emotional state in communication situations. This dissertation identifies a first theory-driven and empirically measurable concept that can be applied to explain and define the psychological phenomenon of speechlessness. The results of the individual papers suggest that the primary elements of each study (e.g., the conceptual framework or the KFS) can be operationalized in the context of health care and indicate the need for future studies in this area of research.

Item Type:	Thesis (PhD thesis)
Creators:	Creators Email ORCID ORCID Put Code Dietz, Thilo tdietz1@t-online.de orcid.org/0000-0002-9378-6799 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-718468
Date:	7 August 2023
Place of Publication:	Köln
Language:	English
Faculty:	Faculty of Human Sciences
Divisions:	Faculty of Human Sciences > Department Heilpädagogik und Rehabilitation
Subjects:	Psychology Language, Linguistics Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language speechlessness, non-speaking, silence, concept, questionnaire, health service research, psychology, speech production, emotions, emotion regulation English Sprachlosigkeit, Nichtsprechen, Schweigen, Konzept, Fragebogen, Versorgungsforschung, Psychologie, Sprachproduktion, Emotionen, Emotionsregulation German
Date of oral exam:	13 December 2023
Referee:	Name Academic Title Pfaff, Holger Prof. Dr. Karbach, Ute PD Dr. rer. pol. Kusch, Michael PD Dr. phil
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/71846