Nonverbal communication is all aspects of communication other than words themselves.

Nonverbal Communications (Emblems)

In the first category, nonverbal communications, the patient is using a commonly accepted symbol associated with a specific meaning. You will sometimes see the word “emblem,” as coined by Ekman and Friesen,5 used as a synonym for nonverbal communications.

An irate American football fan “throwing the finger” to the quarterback of the visiting team is displaying a piece of rather vivid nonverbal communication. Entire subcultures or organizations may develop a set of emblems for internal use. To once again use American football as a reference, the referees use a complex set of emblems to communicate the various penalties that have been committed by the players. Emblems may also be used in situations where speech is not possible (skin diving) or where it might not be practical (raising a hand for a question in a classroom).

Generally speaking, nonverbal communications (emblems) are relatively easy to interpret, for they evolved to communicate specific messages, but a word of caution is in order, which is of immediate importance to initial interviewers: Different cultures may attach significantly different meanings to the same nonverbal communication.6

The American “okay sign,” which indicates that one approves of the current suggestion or situation, is viewed as somewhat vulgar in Brazil, and in France simply means “zero.” On the other hand, in Arab countries the exact same “okay sign” is viewed as a rude sexual gesture. An initial interviewer using an okay sign to indicate to a patient in the closing phase of the interview that the patient has nicely understood a complex recommendation could result in a puzzling or discordant communication if it is to an Arab patient who is naive to the use of this emblem in American culture.

The Arab culture also provides a bridge into our second word of caution, which relates to the ease with which nonverbal activities can be misinterpreted as being forms of nonverbal communication. For example, a non-specific nonverbalactivity from the clinician's culture may be seen as a quite specific nonverbalcommunication in the patient's culture or vice versa. For instance, Americans cross their legs frequently in everyday conversation, a nonverbal activity that often results in their companions seeing the bottom of their foot. Indeed, if a clinician crosses his or her legs with one ankle on the opposite leg's knee, the bottom of the clinician's foot may be facing the patient at times. Unfortunately, in the Arab culture, showing the bottom of one's foot is viewed as an extreme insult, representing a quite specific emblem. Even when interviewing an Arab patient familiar and comfortable with the Western interpretation of such a posture, a wise clinician may choose to avoid it – for why risk a possibly deep-seated unconscious negative response in the patient?

A basic principle for clinicians evolves from these caveats on nonverbal communications. If a clinician has moved to a different culture or has begun to practice in a part of the country in which a large immigrant population is being served, it is advisable for him or her to ask experienced clinicians in that setting to describe the relevant cross-cultural emblems as soon as possible. Some early, and unnecessary, missteps in engagement may be averted from such a simple survey.

Abstract

Nonverbal behavior plays an important role for the communication of states such as emotions as well as in first impressions. The present article discusses models of nonverbal communication and then summarizes findings with regard to the nonverbal communication of emotions, via the face, voice, posture, touch, and gaze. A second section describes some newer research on dyadic synchronization and a final section discusses nonverbal cues in the context of first impressions. A point is made that nonverbal behavior is embedded in a social and cultural context, which forms both the behavior and its interpretation.

Non-verbal communication

Within any consultation, the non-verbal communication is as important as what the patient says. There may be contradictions such as a patient who does not admit to any worries or anxieties but who clearly looks as if he has many. Particular gestures during the description of pain symptoms can give vital clinical clues (Box 1.2). While concentrating on the conversation with the patient, the doctor should keep a wide awareness of all other clues that can be gleaned from the consultation. These include the patient's demeanour, dress and appearance, any walking aids, the interaction between the patient and any accompanying people and the way that the patient reacts to the developing consultation.

Webs of Verbal, Nonverbal, Vocal, and Nonvocal Communication

Nonverbal communication without obligatory ties to language is by far the most diverse category, and may be vocal, involving sounds originating in the vocal tract, or nonvocal. Nonvocal signs in turn may draw on sound production and interpretation, as in whistles and clapping, or may involve any other sense modality – such as vision, olfaction, taste, and touch, with vision paramount, whether through gesture, dress styles, or architecture.

Another foundational distinction made in nonverbal communication centers on context, especially whether face-to-face, more generally interpersonal, or between more remote actors (Goffman, 1963). Contemporary media have introduced many innovations for nonverbal communication. Cell-phone use is verbal, leading to some ordinary nonverbal signs accompanying speech being masked by the medium while others are exaggerated. Emailing represents the verbal both nonverbally and nonvocally, in writing; yet further nonvocal and vocal nonverbal expression seeps in through emoticons and yet-to-be standardized strings of icons, indexes, and symbols.

Finally, sign languages for the deaf, such as American Sign Language (ASL), are quintessentially both nonverbal and nonvocal communication (Armstrong et al., 1995). These constitute, however, genuine languages with full syntactic and productive properties, which cannot be said for so-called body language (Eibl-Eibesfeldt, [1967] 1975) or for the communication systems of other animals (Rauch and Carr, 1980).

Semiotic research on nonverbal communication by linguists, anthropologists, cognitive psychologists, and others ranges from the experimental (often quantitative, considering individual, internal, and microunits of analysis) to the naturalistic (usually qualitative, assessing social, relational, embodied, and emergent units of analysis) (Schere and Ekman, 1982; Poyatos, 1992).

Self-Image and Nonverbal Communication

In a social relationship, a person expresses views he has about himself: his words, and the way he says them, convey how he views his relationship with the other person and also how he sees himself, for example the shopkeeper ‘talking down’ to a child. Probably more important than this verbal manner of expressing, often unconscious, views on how we see ourselves isnonverbal communication. All gestures and postures, movements of the face and pauses in our conversation convey meaning to the person we are talking to; partly, this is also a comment on the way we see ourselves.

‘The central core of self-image consists for a person of his name, his bodily feelings, body image, sex and age. For a man the job will be central – unless he is suffering from job alienation. For a woman, her family and her husband's job may also be important’ (Argyle, 1975). The gender discrimination of that statement is now dated, but it emphasizes that for different people, there are varying aspects that form the essential concept of self. Nonverbal aspects of communication are important in sending and receiving information about the personality. The role in society one has adopted and the group with which one identifies are intentionally conveyed and therefore display self-image. These include ‘age, sex, race, social class, rank, occupation, school or college attended, nationality, regional origins, religious group and family connections’ (Argyle, 1975). These attributes of the person are often deliberately displayed, but there are other characteristics that will be received nonverbally by observers even when the person has no intention of revealing them, for example, temperament, personality traits such as introversion, intellect, beliefs and values and past experiences.

Nonverbal communication expresses the attitudes of a person, according to Argyle, for the following reasons.

There is in some areas of human concern a lack of language or ‘verbal coding’; for example, shape is more readily expressed with the hands than verbally. Describing personality, our own or another's, or commenting on personal relationships is more easily done nonverbally. A person will attempt to communicate nonverbally his or her own physical attractiveness, role and attitude towards the other person.

Nonverbal signals are more powerful: actions speak louder than words. For a schoolteacher, beckoning may be more likely to result in action than a verbal order.

Nonverbal signals are less censored and therefore more likely to be genuine. If conflicting messages are given verbally and nonverbally, the nonverbal signal is accepted as truthful.

Some messages, because of social censorship, cannot be made explicit in a social setting and therefore cannot be verbalized but can be conveyed nonverbally by appropriate posture, gesture and movement in space. For example, by facial expression and turning away, a person might suggest without making it explicit ‘I do not like you and am bored with speaking to you’.

Verbal messages are punctuated and emphasized nonverbally, for example, the pause at the end of a phrase or the cadence of voice used. These embellishments add meaning to the actual words used.

Abstract

Nonverbal communication involves the interchange of information and influence through contextual arrangements, static physical features, and ongoing nonverbal behavior. Nonverbal communication usually operates automatically and outside of awareness and, consequently, is highly efficient. It is pervasive in face-to-face interactions and in various forms of mediated communication. Biology, culture, gender, personality, and the environment combine to shape stable patterns of nonverbal communication. The utility of nonverbal communication is reflected in a number of different social functions, including providing information, regulating interaction, expressing intimacy, exercising influence, and managing impressions.

Nonverbal Communication

Nonverbal communication is about sending a message without using words. It includes body language, tone of voice, facial expressions, and the appearance of the communicator. Effective communication requires verbal and nonverbal aspects of communication to match each other. When we talk about the nonverbal aspects of written communication, we refer to the design, using, for example, colors, underline, bold letters, and capitals in an e-mail to emphasize its parts. Apart from paying attention to the nonverbal message that accompanies our verbal message, during questioning and interrogation, we look for nonverbal signals in the communication. We also use nonverbal communication in many ways during emergency communication. Our nonverbal communication will often make the difference between an orderly evacuation and a panic stampede.

Also, we use nonverbal communication to establish legitimacy. For instance, a security uniform (as well as almost any uniform) is a form of nonverbal communication whose aim is to establish authority. Moreover, a tidy appearance, including a tidy uniform, is likely to be more effective in nonverbal communication than an untidy appearance.

Introduction

Nonverbal communication, the communication of information through channels other than the written or spoken word, involves a vast array of behavior. Nonverbal cues include visual cues such as facial expressions (typically involving expressions of emotions), eye gaze and eye movements, head movements, gestures and body movement, posture, and gait. Other visual nonverbal cues include hairstyle, facial hair, use of cosmetics, grooming, and dress. Auditory nonverbal cues include tone of voice, pitch, speed and pace of speech, and volume. Nonverbal communication can also occur through touch and through olfactory cues. While a specific nonverbal cue, such as a wink, a nod, or a ‘thumbs-up’ gesture, can sometimes have an important and clear communicative function, nonverbal communication is fantastically complex, with multiple nonverbal cues, both visual and auditory, occurring simultaneously.

Nonverbal communication differs from verbal communication in several ways. First, while verbal communication is direct and involves the use of a single channel (spoken word, written word), nonverbal communication is continuous and ongoing and involves many channels communicating simultaneously. Verbal communication uses a shared code (i.e., language), while nonverbal communication is much more impressionistic, with the receiver of nonverbal communication giving a unique interpretation to what the nonverbal cues mean. In fact, most nonverbal behavior is not processed discretely (i.e., typically, we don’t just focus on one particular nonverbal cue), but is perceived as a ‘gestalt’. Verbal communication is precise and intentional, while nonverbal communication is often spontaneous and much of it is not intentionally communicated. Often, we are not even consciously aware of many of our nonverbal behaviors. Although nonverbal cues can communicate liking/positivity or dominance, and static nonverbal cues of appearance (e.g., attractiveness, shape of face, hair, or mode of dress) can communicate gender, age, and a variety of factors, nonverbal communication is best suited to convey affect. In fact, one could argue that it is impossible to accurately convey emotions without using nonverbal cues (e.g., if a person says that he or she is happy but his or her face doesn’t show it, you likely won’t believe him or her).

Perhaps the greatest focus of nonverbal communication research has been on increasing our understanding of the complex dynamics of facial expressions. Humans have evolved an intricate system of facial muscles that allow for the expression of many human emotions. Most studied are the common, and universally expressed, emotions of happiness, sadness, anger, fear, disgust, and surprise. Psychologist Paul Ekman and colleagues have devised a sophisticated method for coding the firing of facial muscles and how these combine to create various facial expressions of emotion. A good example of the complexity of facial emotions is the smile. Although we stereotypically consider a smile to be indicative of happiness or pleasure, nonverbal communication researchers can code the pattern of muscle firing that is indicative of a true, felt smile and distinguish it from smiles that are not consistent with a pleasant emotion, such as the smile that occurs when we are uncomfortable or the fake, social smile that we may give if we hear a not-very-funny joke. Facial expressions of emotion constitute the richest source of nonverbal cues, and play an important part both in interpersonal communication and in person perception.

Much research on nonverbal communication has focused on the part that static physical cues, such as cues of appearance, facial expression, or posture, play in communicating information or in the impression formation process. For example, there has been an entire line of research devoted to the role of facial physiognomy and attractiveness in impression ratings of dominance, intelligence, sociability, trustworthiness, and other traits of strangers. Yet, most nonverbal communication in social interaction is dynamic, involving faces and bodies in motion. This article explores nonverbal communication research that has focused on both static and dynamic expression through facial cues and body movements, the methods used to capture dynamic nonverbal communication, and the results of studies of both static and dynamic nonverbal cues in the process of impression formation. We will also discuss methodologies used to capture and study nonverbal behavior, as well as implications and applications of nonverbal communication research for practice.

COMMUNICATION

Communication includes all methods used to convey thoughts, feelings, and attitudes among people. It has also been described as a process of sending and receiving messages or transmissions of ideas to achieve mutual understanding between a communicator and a listener.25 Communication involves processes of encoding, transmission, decoding, and synthesis of information.26,27 A person selects specific information from all possible sources of information to engender a specific message. The message is then prepared in several ways so that if one way of saying it fails, another way can succeed. Thus, an effective message is one that includes a sender, a receiver, and a mechanism for feedback. On the basis of sources of information, the sender speaks the message and initiates communication. The receiver is the listener, who interprets and may transmit the message back to the sender. Feedback is the process of responding to messages after the receiver interprets them. Once this process is initiated, interference from psychological, social, or physical elements can distort the message. Figure 10-3 illustrates the dynamics of this process.

Patients may not feel they can communicate with a dental professional who restricts his/her interest to a very narrow set of clinical concerns and directives. Several advantages are associated with achieving good communication skills in the patient care setting. A clinician with good communication skills can provide comprehensive assessments that lead to improved diagnosis and patient satisfaction. This leads to a decreased potential for complaints and misunderstood self-care instructions. Similarly, the patient is more likely to exhibit improved self-efficacy in practicing routine preventive behaviors.

How can communication skills be tailored to meet the needs of dental clinical settings? The key to good communication is to practice and use good listening skills. A major problem with successful patient education occurs when the dental professional gives either insufficient, poorly understood information or far more information than is appropriate. Discussion of risk for dental disease, options for supportive clinical care and self-management, and longitudinal preventive behaviors associated with optimum health status require professional skills based on education, communication, and counseling principles.

Verbal and nonverbal communication are equally important in patient education and can occur simultaneously. Verbal communication includes the actual words crafted by the sender in message transfer. Nonverbal communication includes the manner and style of delivery, the immediate environment in which the message is delivered, and the inherent qualities of the sender and the receiver that can influence the interpretation of any external stimuli in the environment.25 A supportive climate is an important element of good communication. When one person speaks, the other listens, attending to the discussion rather than their own internal thoughts and feelings.28 Supportive climates are those that encourage descriptive rather than evaluative discussions of an issue or problem, problem solving versus manipulative discussion, provisional alternatives rather than dogma, an egalitarian rather than authoritative atmosphere, and an empathetic rather than neutral or self-centered attitude. Table 10-4 suggests examples of each of these approaches.

Nonverbal communication refers to the ways in which beings convey information about their emotions, needs, intentions, attitudes, and thoughts without the use of verbal language. Nonverbal cues serve important functions in human social life, including expressing emotions; conveying interpersonal attitudes such as friendliness, insult, or dominance; regulating affect; regulating turn taking between people in conversation; and facilitating one's own speech production. Nonverbal signals are important in many psychological processes, including attachment, attraction, social influence, deception, self-presentation, and interpersonal self-fulfilling prophecies. Cultural, gender, and other group differences in nonverbal behavior have been documented as well as individual differences in usage and in the accuracy of nonverbal cue transmission and reception.