This Is Your Brain on Zoom

Leah Croll

MedScape.com

Originally posted 21 Dec 23

Here is an excerpt:

Zoom vs In-Person Brain Activity

The researchers took 28 healthy volunteers and recorded multiple neural response signals of them speaking in person vs on Zoom to see whether face-processing mechanisms differ depending upon social context. They used sophisticated imaging and neuromonitoring tools to monitor the real-time brain activity of the same pairs discussing the same exact things, once in person and once over Zoom.

When study participants were face-to-face, they had higher levels of synchronized neural activity, spent more time looking directly at each other, and demonstrated increased arousal (as indicated by larger pupil diameters), suggestive of heightened engagement and increased mutual exchange of social cues. In keeping with these behavioral findings, the study also found that face-to-face meetings produced more activation of the dorsal-parietal cortex on functional near-infrared spectroscopy. Similarly, in-person encounters were associated with more theta oscillations seen on electroencephalography, which are associated with face processing. These multimodal findings led the authors to conclude that there are probably separable neuroprocessing pathways for live faces presented in person and for the same live faces presented over virtual media.

It makes sense that virtual interfaces would disrupt the exchange of social cues. After all, it is nearly impossible to make eye contact in a Zoom meeting; in order to look directly at your partner, you need to look into the camera where you cannot see your partner's expressions and reactions. Perhaps current virtual technology limits our ability to detect more subtle facial movements. Plus, the downward angle of the typical webcam may distort the visual information that we are able to glean over virtual encounters. Face-to-face meetings, on the other hand, offer a direct line of sight that allows for optimal exchange of subtle social cues rooted in the eyes and facial expressions.

The info is here.

Key findings:

• Zoom meetings are less stimulating for the brain than face-to-face interactions. A study by Yale University found that brain activity associated with social processing is lower during Zoom calls compared to in-person conversations.
• Reduced social cues on Zoom lead to increased cognitive effort. The lack of subtle nonverbal cues, like facial expressions and body language, makes it harder to read others and understand their intentions on Zoom. This requires the brain to work harder to compensate.
• Constant video calls can be mentally taxing. Studies have shown that back-to-back Zoom meetings can increase stress and fatigue. This is likely due to the cognitive demands of processing visual information and the constant pressure to be "on."

Implications:

• Be mindful of Zoom fatigue. Schedule breaks between meetings and allow time for your brain to recover.
• Use Zoom strategically. Don't use Zoom for every meeting or interaction. When possible, opt for face-to-face conversations.
• Enhance social cues on Zoom. Use good lighting and a clear webcam to make it easier for others to see your face and expressions. Use gestures and nonverbal cues to communicate more effectively.

How to Combat Zoom Fatigue

Liz Fosslien and Mollie West Duffy
Harvard Business Review
Originally posted 29 April 20

If you’re finding that you’re more exhausted at the end of your workday than you used to be, you’re not alone. Over the past few weeks, mentions of “Zoom fatigue” have popped up more and more on social media, and Google searches for the same phrase have steadily increased since early March.

Why do we find video calls so draining? There are a few reasons.

In part, it’s because they force us to focus more intently on conversations in order to absorb information. Think of it this way: when you’re sitting in a conference room, you can rely on whispered side exchanges to catch you up if you get distracted or answer quick, clarifying questions. During a video call, however, it’s impossible to do this unless you use the private chat feature or awkwardly try to find a moment to unmute and ask a colleague to repeat themselves.

The problem isn’t helped by the fact that video calls make it easier than ever to lose focus. We’ve all done it: decided that, why yes, we absolutely can listen intently, check our email, text a friend, and post a smiley face on Slack within the same thirty seconds. Except, of course, we don’t end up doing much listening at all when we’re distracted. Adding fuel to the fire is many of our work-from-home situations. We’re no longer just dialing into one or two virtual meetings. We’re also continuously finding polite new ways to ask our loved ones not to disturb us, or tuning them out as they army crawl across the floor to grab their headphones off the dining table. For those who don’t have a private space to work, it is especially challenging.

Finally, “Zoom fatigue” stems from how we process information over video. On a video call the only way to show we’re paying attention is to look at the camera. But, in real life, how often do you stand within three feet of a colleague and stare at their face? Probably never. This is because having to engage in a “constant gaze” makes us uncomfortable — and tired. In person, we are able to use our peripheral vision to glance out the window or look at others in the room. On a video call, because we are all sitting in different homes, if we turn to look out the window, we worry it might seem like we’re not paying attention.

The info is here.

A Psychological Exploration of Zoom Fatigue

Jena Lee
Psychiatric Times
Originally published 27 July 20

Here is an excerpt:

This neuropathophysiology may explain other proposed reasons for Zoom fatigue. For example, if the audio delays inherent in Zoom technology are associated with more negative perceptions and distrust between people, there is likely decreased reward perceived when those people are videoconferencing with each other. Another example is direct mutual gaze. There is robust evidence on how eye contact improves connection—faster responses, more memorization of faces, and increased likeability and attractiveness. These tools of social bonding that make interactions organically rewarding are all compromised over video. On video, gaze must be directed at the camera to appear as if you are making eye contact with an observer, and during conferences with 3 or more people, it can be impossible to distinguish mutual gaze between any 2 people.

Not only are rewards lessened via these social disconnections during videoconferencing compared to in-person interactions, but there are also elevated costs in the form of cognitive effort. Much of communication is actually unconscious and nonverbal, as emotional content is rapidly processed through social cues like touch, joint attention, and body posture. These nonverbal cues are not only used to acquire information about others, but are also directly used to prepare an adaptive response and engage in reciprocal communication, all in a matter of milliseconds. However, on video, most of these cues are difficult to visualize, since the same environment is not shared (limiting joint attention) and both subtle facial expressions and full bodily gestures may not be captured. Without the help of these unconscious cues on which we have relied since infancy to socioemotionally assess each other and bond, compensatory cognitive and emotional effort is required. In addition, this increased cost competes for people’s attention with acutely elevated distractions such as multitasking, the home environment (eg, family, lack of privacy), and their mirror image on the screen. Simply put, videoconferences can be associated with low reward and high cost.

The info is here.

Reframing Clinician Distress: Moral Injury Not Burnout

W. Dean, S. Talbot, and A. Dean
Fed Pract. 2019 Sep; 36(9): 400–402.

For more than a decade, the term burnout has been used to describe clinician distress. Although some clinicians in federal health care systems may be protected from some of the drivers of burnout, other federal practitioners suffer from rule-driven health care practices and distant, top-down administration. The demand for health care is expanding, driven by the aging of the US population. Massive information technology investments, which promised efficiency for health care providers, have instead delivered a triple blow: They have diverted capital resources that might have been used to hire additional caregivers, diverted the time and attention of those already engaged in patient care, and done little to improve patient outcomes. Reimbursements are falling, and the only way for health systems to maintain their revenue is to increase the number of patients each clinician sees per day. As the resources of time and attention shrink, and as spending continues with no improvement in patient outcomes, clinician distress is on the rise. It will be important to understand exactly what the drivers of the problem are for federal clinicians so that solutions can be appropriately targeted. The first step in addressing the epidemic of physician distress is using the most accurate terminology to describe it.

Freudenberger defined burnout in 1975 as a constellation of symptoms—malaise, fatigue, frustration, cynicism, and inefficacy—that arise from “making excessive demands on energy, strength, or resources” in the workplace. The term was borrowed from other fields and applied to health care in the hopes of readily transferring the solutions that had worked in other industries to address a growing crisis among physicians. Unfortunately, the crisis in health care has proven resistant to solutions that have worked elsewhere, and many clinicians have resisted being characterized as burned out, citing a subtle, elusive disconnect between what they have experienced and what burnout encapsulates.

In July 2018, the conversation about clinician distress shifted with an article we wrote in STAT that described the moral injury of health care. The concept of moral injury was first described in service members who returned from the Vietnam War with symptoms that loosely fit a diagnosis of posttraumatic stress disorder (PTSD), but which did not respond to standard PTSD treatment and contained symptoms outside the PTSD constellation. On closer assessment, what these service members were experiencing had a different driver. Whereas those with PTSD experienced a real and imminent threat to their mortality and had come back deeply concerned for their individual, physical safety, those with this different presentation experienced repeated insults to their morality and had returned questioning whether they were still, at their core, moral beings. They had been forced, in some way, to act contrary to what their beliefs dictated was right by killing civilians on orders from their superiors, for example. This was a different category of psychological injury that required different treatment.

The article is here.

Hospitals prepare for wave of mental health disorders among their workers

Del Quentin Wilber
The Los Angeles Times
Originally posted May 6, 2020

Here is an excerpt:

Mental health practitioners pointed to the suicide late last month of Dr. Lorna Breen as a warning flare. Colleagues said the 49-year-old Breen, an emergency room physician at NewYork-Presbyterian Allen Hospital in Manhattan, took her life after becoming overwhelmed by the volume of coronavirus patients who died on her watch.

“People at these elite medical institutions are talented, disciplined, strong and resilient,” said Dr. Jeffrey Lieberman, the chair of psychiatry at Columbia University Medical Center, where Breen was an assistant professor of emergency medicine. “But everyone has a breaking point. Tragically, in her case, her dedication pushed her past the breaking point.”

Healthcare professionals said the potential for trouble is particularly acute in New York, which has emerged as ground zero in the U.S. for COVID-19, the disease caused by the coronavirus.

Its hospitals have been crushed by an onslaught of severely ill patients. With no proven treatments or cures, physicians and nurses say they have often felt powerless to prevent the sickest from dying. Nearly 14,000 people have perished from the disease in the city, health officials say. During the height of the outbreak a month ago, doctors at Mt. Sinai Hospital were reporting at least 20 deaths a day. Typically, the hospital has one or two.

“The mortality that even veteran clinicians are witnessing has been massive and devastating to healthcare workers,” Lieberman said.

The info is here.

What Is 'Decision Fatigue' and How Does It Affect You?

Rachel Fairbank
LifeHacker
Originally published 14 April 20

Here is an excerpt:

Too many decisions result in emotional and mental strain

“These are legitimately difficult decisions,” Fischhoff says, adding that people shouldn’t feel bad about struggling with them. “Feeling bad is adding insult to injury,” he says.

This added complexity to our decisions is leading to decision fatigue, which is the emotional and mental strain that comes when we are forced to make too many choices. Decision fatigue is the reason why thinking through a decision is harder when we are stressed or tired.

“These are difficult decisions because the stakes are often really high, while we are required to master unfamiliar information,” Fischhoff says.

But if all of this sounds like too much, there are actions we can take to reduce decision fatigue. For starters, it’s best to minimize the number of small decisions, such as what to eat for dinner or what to wear, you make in a day. The fewer smaller decisions you have to make, the more bandwidth you’ll have for the bigger one.

For this particular crisis, there are a few more steps you can take, in order to reduce your decision fatigue.

The info is here.

Not “burnout,” not moral injury—human rights violations

Pamela Wible
www.idealcare.org
Originally posted March 18, 2019

Here is an excerpt:

Moral injury now extends beyond combat veterans to include physicians in 2018 when Dean and Talbot announced their opposition and alternative to the label physician “burnout.” They believe (as I do) that physician cynicism, exhaustion, and decreased productivity are symptoms of a broken system. Economic forces, technological demands, and widespread intergenerational physician mental health wounds have culminated in a highly dysfunctional and toxic health care system in which we find ourselves in daily forced betrayal of our deepest values.

Manifestations of moral injury in victims include self-harm, poor self-care, substance abuse, recklessness, self-defeating behaviors, hopelessness, self-loathing, and decreased empathy. I’ve witnessed all far too frequently among physicians.

Yet moral injury is not an official diagnosis. No specific solutions are offered at medical institutions to combat physician moral injury though moral injury treatment among military may include listening circles (where veterans share battlefield stories), forgiveness rituals, and individual therapy. The fact is most victims of moral injury struggle on their own.

With no evidence-based treatments for physician moral injury and zero progress after forty years of burnout prevention, what next? Enter the real diagnosis—human rights violations—with clear evidence-based solutions.

The info is here.

Doctors’ mental health at tipping point

Chris Hemmings
BBC.co.uk
Originally posted September 3, 2018

Here is an excerpt:

'Last taboo'

Dr Gerada says the lack of confidentiality is a barrier and wants NHS England to extend the London approach to any doctor who needs support.

She believes acknowledging that doctors also have mental health problems is "the last taboo in the NHS".

Louise Freeman, a consultant in emergency medicine, says she left her job after she felt she could not access appropriate support for her depression.

"On the surface you might think 'Oh, doctors will get great mental health care because they'll know who to go to'.

"But actually we're kind of a hard-to-reach group. We can be quite worried about confidentiality," she said, adding that she believes doctors are afraid of coming forwards in case they lose their jobs.

"I was absolutely desperate to stay at work. I never wavered from that."

One of the biggest issues, according to Dr Gerada, is the effect on doctors of complaints from the public, which she says can "shatter their sense of self".

The info is here.

Moral Fatigue: The Effects of Cognitive Fatigue on Moral Reasoning

S. Timmons and R. Byrne
Quarterly Journal of Experimental Psychology (March 2018)

Abstract

We report two experiments that show a moral fatigue effect: participants who are fatigued after they have carried out a tiring cognitive task make different moral judgments compared to participants who are not fatigued. Fatigued participants tend to judge that a moral violation is less permissible even though it would have a beneficial effect, such as killing one person to save the lives of five others. The moral fatigue effect occurs when people make a judgment that focuses on the harmful action, killing one person, but not when they make a judgment that focuses on the beneficial outcome, saving the lives of others, as shown in Experiment 1 (n = 196). It also occurs for judgments about morally good actions, such as jumping onto railway tracks to save a person who has fallen there, as shown in Experiment 2 (n = 187). The results have implications for alternative explanations of moral reasoning.

The research is here.

Burnout at Work Isn’t Just About Exhaustion. It’s Also About Loneliness

Emma Seppala and Marissa King
Harvard Business Review

First published June 29, 2017

More and more people are feeling tired and lonely at work. In analyzing the General Social Survey of 2016, we found that, compared with roughly 20 years ago, people are twice as likely to report that they are always exhausted. Close to 50% of people say they are often or always exhausted due to work. This is a shockingly high statistic — and it’s a 32% increase from two decades ago. What’s more, there is a significant correlation between feeling lonely and work exhaustion: The more people are exhausted, the lonelier they feel.

This loneliness is not a result of social isolation, as you might think, but rather is due to the emotional exhaustion of workplace burnout. In researching the book The Happiness Track, we found that 50% of people — across professions, from the nonprofit sector to the medical field — are burned out. This isn’t just a problem for busy, overworked executives (though the high rates of loneliness and burnout among this group are well known). Our work suggests that the problem is pervasive across professions and up and down corporate hierarchies.

Loneliness, whether it results from social isolation or exhaustion, has serious consequences for individuals. John Cacioppo, a leading expert on loneliness and coauthor of Loneliness: Human Nature and the Need for Social Connection, emphasizes its tremendous impact on psychological and physical health and longevity. Research by Sarah Pressman, of the University of California, Irvine, corroborates his work and demonstrates that while obesity reduces longevity by 20%, drinking by 30%, and smoking by 50%, loneliness reduces it by a whopping 70%. In fact, one study suggests that loneliness increases your chance of stroke or coronary heart disease — the leading cause of death in developed countries — by 30%. On the other hand, feelings of social connection can strengthen our immune system, lengthen our life, and lower rates of anxiety and depression.

The article is here.

Fewer Hours for Doctors-in-Training Leading To More Mistakes

By Alexandra Sifferlin
Time
Originally published March 26, 2013

Giving residents less time on duty and more time to sleep was supposed to lead to fewer medical errors. But the latest research shows that’s not the case. What’s going on?

Since 2011, new regulations restricting the number of continuous hours first-year residents spend on-call cut the time that trainees spend at the hospital during a typical duty session from 24 hours to 16 hours. Excessively long shifts, studies showed, were leading to fatigue and stress that hampered not just the learning process, but the care these doctors provided to patients.

And there were tragic examples of the high cost of this exhausting schedule. In 1984, 18-year old Libby Zion, who was admitted to a New York City hospital with a fever and convulsions, was treated by residents who ordered opiates and restraints when she became agitated and uncooperative. Busy overseeing other patients, the residents didn’t evaluate Zion again until hours later, by which time her fever has soared to 107 degrees and she went into cardiac arrest, and died. The case highlighted the enormous pressures on doctors-in-training, and the need for reform in the way residents were taught. In 1987, a New York state commission limited the number of hours that doctors could train in the hospital to 80 each week, which was less than the 100 hour a week shifts with 36 hour “call” times that were the norm at the time. In 2003, the Accreditation Council for Graduate Medical Education followed suit with rules for all programs that mandated that trainees could work no more than 24 consecutive hours.

The entire article is here.

Team Decisions Better for the Weary

by Robert Preidt
MedicineNet.com

Teamwork can help tired people avoid making poor decisions, a new study indicates.

Pilots, doctors and others in demanding professions can make dangerous errors when they're weary. But, fatigued people who work as a team have better problem-solving skills than those who work alone, British researchers report.

They asked 171 army officer cadets, aged 18 to 24, at a weekend training exercise to solve a series of math problems. Some were tested before they began the training session and were rested, while others did the math problems at the end of the weekend when they were exhausted.

Individual cadets who were fatigued did far worse on the tests than those who were rested. However, teams of exhausted cadets did just as well as teams of rested cadets.

The study appears online in the Journal of Experimental Psychology: Applied.

"Teams appear to be more highly motivated to perform well, and team members can compare solutions to reach the best decision when they are fatigued. This appears to allow teams to avoid the inflexible thinking experienced by fatigued individuals," study author Daniel Frings, a senior lecturer in social psychology at London South Bank University, said in a journal news release.

In situations where fatigue is a concern, decisions should be made by teams rather than individuals if possible, the study concluded.

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This research supports the idea that group consultation can be very helpful for tired and overworked psychologists, especially when working with high risk or clinically challenging patients.