Social support has been studied from a sociological, psychological and communicative perspectives. All of them have recognized the protective effects of social support in the physical and mental health of individuals. The sociological and psychological perspectives operationalize social support as social integration (e.g. participation and integration in social networks) and perceived availability of support (the perception that support is going to be available if needed), respectively. Yet, both of these views present theoretical issues regarding the exact causal mechanisms linking their operationalizations of social support with health outcomes. In other words, researchers have failed to understand exactly how social integration or perceived availability of support provide protection against health-damaging factors [8, 16].
In both perspectives, there had always been an implicit notion that communication played a role in the social support process . And thus, a third alternative known as supportive communication has been explored more recently which assesses socialsupport as a communicative process rather than a “hidden mechanism or a perceptual outcome” . This third perspective studies – in a more direct way – the verbal and nonverbal behaviors enacted when seeking or providing support. In other words, supportive communication analyzes more closely the mechanisms that connect different forms of supportive communication with physical and mental health in order to address the unresolved questions and go beyond the theoretical issues of the sociological and psychological approaches.
Working from the communication perspective, scholars in the field of communication sciences have been trying to explain findings of previous research with the aid of a more rigorous theoretical background derived from a detailed analysis of interactionsand message features. Burleson et al. (1994) indicate that “social support ascommunication means studying the messages through which people both seek andexpress support; studying the interactions in which supportive messages are produced and interpreted; and studying the relationships that are created by and contextualize the supportive interactions in which people engage.” In this sense, researchers has identified factors that moderate the outcomes of social support communication. In other words, researchers have found that in order for supportive communication to lead topositive outcomes (a distressed person feeling better), there is a set of factors that haveto be in place so that the provision of support – and its effects – can reach maximum effects. These factors are varied and could be related to message content, nonverbal behaviors, motivation of provider and recipient, communicative ability, interactants’ relationship, trust, physical and psychological features, among others [5, 11, 12, 17]. For example, research has found that when the recipient’s cognitive complexity (ability to scrutinize verbal messages) is low, or when the supporter does not have the necessary social-cognitive abilities to produce sophisticated supportive messages, the supportive communication interaction has a lesser impact on the recipient’s emotional state [5, 7].
As a result of the multidimensionality of factors affecting the supportive communication process, Burleson has proposed a dual-process theory of supportive communication outcomes which groups all of these factors into a simplified model that takes into account the verbal person centeredness (VPC) in emotional supportive messages, the recipient’s cognitive complexity, and motivation to process supportive messages and the outcomes of the supportive intervention (message outcomes). In sum, the theory proposes that when messages receive a high level of scrutiny form the receiver, the outcomes will be influenced mainly by verbal person centeredness of the messages. However, if the recipient assigns little scrutiny to the messages, then features of the context or the helper, or nonverbal behaviors may influence the outcomes of the supportive interaction [1, 3, 5].
VPC has received enormous attention form the research field due to its centrality in emotional support and appraisal theories [3, 6, 10, 15]. Emotional support, which is considered the most important type of social support by many scholars, is understood as the communicative behavior between a supporter and an emotionally distressed recipient. Studies have found that the more person-centeredness supportive messages have, the better the emotional outcomes (e.g. [10, 12, 14]). VPC derives from a constructivist perspective originally proposed by Applegate (1978) that refers to the extent to which messages acknowledge and legitimize the feelings and perspective of the recipients. This constructivist approach proposed a nine-level hierarchical coding system that helps determine the person-centeredness of a message. Eventually, Burleson (1982) adapted this hierarchical coding system to emotional social support communication research and it is what most researchers have been using in order to “measure” person-centeredness as a feature of emotionally supportive messages and provider’s sensitivity [7, 10]. Although the hierarchy has nine levels, the majority of studies in social support communication generally collapse all nine categories into three main levels: highly person-centered (HPC) messages which explicitly elaborate and recognize the other’s feelings (e.g. “It is understandable what you are feeling after what happened,”) moderately person-centered (MPC) messages which infer recognition (rather than explicit acknowledge) of the other’s feelings and perspectives (e.g. “I am sorry you guys broke up. But things like these happen in many relationships”), and low person-centered (LPC) which deny the other’s feelings (e.g. “You are worrying about nothing!”) [5, 7]. Initial research studies dealing with VPC have identified that, on average, people were more likely to produce MPC messages, although LPC and HPC messages were also commonly observed, being the HPC messages the least frequent.
Consequently, a great many studies have tried to understand how VPC affects the communication of social support (even before the advent of the dual-processtheory). These studies have relied on a methodology that consists of dyads of college students interacting in face-to-face or computer-mediated conditions (e.g. [7, 21].) Experiments have followed either a naturalistic paradigm (e.g. ) (recipients recalling messages received in response to a stressor), a message perception paradigm (e.g. [3,7]) (recipients’ evaluation of messages used in hypothetical dialogues or scenarios) or an experimental paradigm (recipients participating in actual emotional support situation) (e.g. [2, 14, 15]). Across the literature, limitations and lack of ecological validity have been found in the naturalist and message perception paradigms, respectively. For example, recipients’ evaluations may not be accurate as they rely on retrospective self-report data, or when recipients are exposed to hypothetical situations. The experimental paradigm overcomes these limitations by having the recipients interact with another person (often times a confederate) in a video-taped conversation (often times of about five minutes in duration) where person- centeredness (PC) of supportive messages is manipulated by researchers (e.g. [1, 10, 14]).
The design of these studies have identified the level of PC in messages (operationalized via the nine-level hierarchy) as the main independent variable. On the other hand, the dependent variables have been the recipients’ emotional outcome after receiving the messages (a.k.a. MO: message outcome), perception of message quality(a.k.a. ME: message evaluation) and evaluation of supporter’s competence [7, 14, 15]. These variables have been generally measured via coding of conversation transcriptsand with the use of a set of Likert scales which are filled by participants, confederatesand/or experimental observers (e.g. [7, 15]). In addition, quite recently, physiological measures such as cortisol levels, blood pressure and heart rate have been used in a few studies in order to assess the impact of VPC on stress (e.g. [2, 18]).
Although VPC has been found to be universally linked to positive outcomes, few studies have been unpacking the interactions between VPC and supportive communication outcomes. In this sense, ME has been found to mediate the effect of VPC on MO (entirely according to Bodie et al. (2012) and partially according to High & Dillard (2012),) further supporting the notion of message scrutiny of the dual-process approach. In addition, while Bodie (2011) did not found a direct linear effect of message VPC on cardiovascular reactivity , Priem & Solomon (2014) have provided empiricalevidence of the interactions (at a conversation rather than a message level) between supportive communication and cortisol levels in distressed individuals .
Precisely, these newer studies have shed light on the limitations that VPC research hashad so far. One of these limitations is the lack of verification for support adequacy. Support adequacy has been found to have effects on how recipients evaluate support provision. For example, a provider’s HPC messages could have different effects on emotional outcomes depending on the type of support (and how much of that support)the recipient wants [4, 18]. Another limitation is a lack of analysis on how VPC equates in invisible support. Research has found that there are benefits of receiving invisible support (not perceived when provided), for it reduces the costs of enacted support [9, 18]. In this sense, HPC messages may make support more visible and thus lower their positive effects on emotional outcomes. A distressed person may prefer MPC rather than HPC supportive messages, for the lower-level PC messages may be less facethreatening and may spare the recipient from being obliged to return favors to the provider in the future. Another limitation is that the effect of time in supportive communication is not always taken into account in the sense of longitudinal outcomes (persistency of outcomes). VPC research lacks an experimental approach to assess actual – rather than perceived – emotional improvement. Five- minute conversations may make it difficult for researchers to really know whether person- centeredness in support provision is actually helping individuals in the long term. Yet another shortcoming of VPC research has been the isolated assessment of recipient’s perceptions rather than collecting and finding linkages between both recipients’ and providers’ impressions on the same supportive interaction in a conversational rather than message-level approach. Moreover, a meta-analysis of research on person-centeredness and support outcomes done by High & Dillard (2012), found that the interaction between strangers attenuates the effects of PC on support outcomes due probably to the absence of real relational history between interactants. Finally, the majority of studies rely on college students for their experiments and this lack ofdiversity in terms of age, culture and socio-economical background could limit the validity and generalizability of findings.
Consequently, future research should further assess the effects of support adequacy, invisibility, outcomes persistency and both interactants’ perceptions on VPC in supportive communication using a more diverse group of real relational partners. Moreover, in order to encourage a more conversation-level approach in VPC research,it would be interesting to explore a unification of the VPC and message design logics perspectives, for the latter perspective has identified certain ways of talking that are more effective than others at the moment of eliciting support provision depending on the situation and relational goals of the interactants . In addition, there seems to bea sense of impracticality of the nine-level hierarchy that operationalizes VPC messages; after all, many studies group all those nine categories into three main levels, as explained previously. In this sense, as High & Dillard (2012) point out, more research is needed to confirm the validity of all nine levels in the hierarchy.
Last but not least, the majority of research on social support has been conducted in Face- to-Face (FtF) interactions. An increasing number of people are using video-mediated communication (VMC) as a practical means for communicating from geographically dispersed locations. Video-based technologies such as Skype, Google Hangout and Facetime have become very popular due to a cheaper, faster and moreubiquitous broadband Internet access . Thus, it is very likely to infer that people maybe using video-mediated platforms to seek and provide social support. Nevertheless, there is a complete lack of research that studies video-mediated social support (VMSS). Given the importance of social support communication and its increasing prevalence in VMC platforms, it is quite important to continue research that assesses towhat extent VMC environments are affecting the communication of social support.
Research on social support in CMC environments has found that an increasing number of people are turning to online social support networks because of the anonymity, heterogeneity, objectivity and asynchronicity such environments provide, making it easier for individuals to disclose information and access a varied array of problem-focused resources while being honest and open about their feelings without having to worry about embarrassment, inter-personal costs, stigma-related and time-space constraints [19, 21, 22]. Therefore, VPC should be extensively explored in CMCdue to the benefits such digital environments provide for support communication. This line of research has already found that VPC effects have different interactions in CMC. For example, Brock and Lawrence (2009) found that, unlike what takes place in FtF interactions, men evaluated as more effective the HPC messages coming from male supporters . However, one of the most noticeable shortcomings of this type ofresearch is the lack of customized software that would allow researchers to have more control over how digital environments affect outcomes in experiments. For instance,customized and controlled access to historical data of logged computer- mediated support interactions could aid in the assessment of actual effectiveness and long term effects of support. Eventually, research on VPC, CMC and VMSS will lay down theguidelines for the design and development of computer-assisted support software in thenear future. For example, it would be interesting to create knowledge-based interactive computer applications that could assist a supporter in the elaboration of VPC messages while they are interacting remotely with a support seeker in real time.
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