Ouch that Hurt! The Neurobiology of Feedback

“Honest criticism is hard to take, particularly from a relative, a friend, an acquaintance, or a stranger.” 

 Franklin P. Jones

We can all recall a time that a partner, family member, friend, or colleague gave us some well-intended feedback that seemed to really hurt. Most of the time, the intention of feedback is to convey a perception others have of us and in many cases it is a direct or indirect request for us to change our behavior.  Our own research, and those of others, points out just how powerful both positive and negative feedback can be. However, if feedback were an available and controlled prescription drug, it just might have long been pulled from the U.S. market due to its potential harmful side effects.

New research about the neurobiology of feedback gives us some important clues about why feedback at times can do more harm than good, how much positive to negative feedback we receive becomes the “tipping point” to the discomfort we feel, as well as how we can frame information to others in a way to possibly minimize defensiveness and increase acceptance by others.

Danger–Interpersonal Interactions May Be Harmful to Your Health

Feedback is one important factor in defining the quality of our relationships both at home and at work.  Current research suggests that strong relationships with one’s partner, family members, co-workers, boss, and friends are significantly associated with a number of important emotional and health outcomes including:

• Less inflammation measured as C-Reactive Protein (CRP)
• Enhanced immunity  measured by natural killer cells and IL-6 cytokines
• Less burnout in professional working women–lower depersonalization and higher personal accomplishment
• Decreased depression
• Enhanced job satisfaction/engagement
• Less physical illness during life based on meta-analytics reviews of over 148 studies
• Greater longevity based on a 20-year longitudinal study

Using a well-known stress/health risk appraisal of ours (StressScan) we recently analyzed differences in perceived availability, utility, and satisfaction of social support by gender in a sample of over 800 working adults of diverse ages. We found that women reported statistically greater availability and use of their social support network away from work and on the job (supervisor/boss, colleagues/co-workers) relative to their male counterparts. The finding of greater utilization of social support at work is somewhat surprising given that current research suggests that successful women indicate that mentoring is generally less important to their career advancement than did less successful women.

We were also able to determine the relative amount of dissatisfaction with specific sources of social support. Both men and women rated being most dissatisfied with the quantity and quality of support received (e.g., emotional support, advice, information, direct assistance) with their:

• Boss/Supervisor 31.0%
• Colleagues/Co-Workers 16.8%
• Family 13.0%
• Partners/Significant Others 9.9%
• Friends 8.3%

Finally, men and women in our sample who reported greater satisfaction with their overall social support also reported significantly less work/life stress, enhanced resilience/hardiness, and higher overall life satisfaction and emotional happiness.  Indeed, as social animals the fabric of our relationships are strongly related to predicting our short-term well-being and long-term health.

Social Triggers of the Stress Response

We are biologically primed, within one-fifth of a second, to discern through verbal and non-verbal cues whether the individual we are interacting with is truly “friend” or “foe” and to react accordingly (and, women appear to be biologically more capable of doing this than their male counterparts).

Feedback to others might be purposefully untrue, skewed to be overly critical or flattering, accurate but hurtful or vague, and of limited value for desired behavioral change.  Newer neuroscience research sheds some interesting light on why negative feedback is potentially emotionally harmful.  In general, stressors that induce greater social-evaluative threat elicit significantly larger cortisol and ambulatory blood pressure responses. These social stressors result in the “fight or flight” stress hormone called cortisol being elevated three times higher than non-interpersonal stressors and it takes 50% longer for this important regulatory hormone to go back to our baseline state.

Interestingly, women apparently have a secondary biological stress reaction labeled the “tend and befriend” response by Shelly Taylor, a prominent social psychologist at the University of California, Los Angeles.  Her research, and those of others, suggests that women under stress are more likely to express emotions and behaviors consistent with nurturing, care taking, sensitivity, and bonding.

This secondary stress response appears to be largely due to a reproductive hormone called oxytocin (the “pro-social” or “cuddle” hormone).  Recent findings by social economist Dr. Paul Zak from Claremont University, and others, have shown that the hormone oxytocin plays an important role in facilitating trust and collaboration with others and might be a marker for those who lack basic warmth and empathy (e.g., sociopaths) as well as even being a possible short-term treatment approach for some of the autistic spectrum disorders. Research on oxytocin has demonstrated the importance of neurobiological systems that can greatly impact communications and relations with others.

Sticks and Stones Can Break My Bones….But Words Can Never Harm Me

It seems that emotional pain and physical pain follow the same physiological pathways in our brain and can both lead to the same outcomes of depression, inflammation, and fatigue. In a nifty study by Naomi Eisenberger and colleagues at UCLA, she was able to use the latest technology to peer into the inner workings of our brain called functional magnetic resonance (fMRI) while participants were involved in a social exercise (cyberball) designed to provoke feelings of social isolation and rejection.

She studied what part of the brain was activated while a group of subjects played a computer game with other individuals they did not know. She created two possibilities of being rejected–either actively or passively (she told them they could not continue because of some technical problems). Comparison of fMRI brain activity in the active exclusion group versus inclusion conditions revealed greater activity in the part of the brain that is associated with physical pain (anterior cingulate cortex). Additionally, the subjects who were rejected also reported feeling psychological distress based on self-report measures.

Four newer studies show that recall of past socially painful situations elicits greater pain than reliving a past physically painful event and has greater negative impact on cognitively demanding tasks. Of course we all know that feedback is the key necessary (but not sufficient) condition to create awareness, insight, and reflection to help us do things more, less or differently in the future–it really is the only way to enlighten those with the “no clue” gene.  So, what is the relationship between feedback and performance at work?

In one of the most cited review studies on performance feedback the authors found that although there was a significant effect for feedback interventions but one third of all studies showed that actual performance declined. Although the authors speculated about many reasons why performance feedback led to worse performance on the job, they seemed to suggest that in most cases it leads to individuals feeling hurt, demotivated, and emotionally upset. If Eisenberger and her UCLA researchers are correct, it would appear that prolonged negative feedback, in some cases, might indeed be potentially harmful to your health.

Take Two Aspirin and Call Me in the Morning

Everyone has experienced physical pain and one of the first things we often do is take a pain reliever, like aspirin or acetaminophen. But physical pain isn’t the only kind of pain we might experience. Our feelings can also be hurt from feeling slighted, having our ideas rejected, or even being given feedback we experience as judgmental and evaluative. Nathan DeWall of the University of Kentucky and his colleagues wondered whether acetaminophen, which acts on the central nervous system, could blunt social pain, too. In one experiment, healthy college students were randomly assigned to take acetaminophen or a placebo twice a day for three weeks. Those who took acetaminophen reported experiencing significantly fewer hurt feelings in their overall reporting of social interactions they had with others. In a second experiment, another set of healthy college students were randomly assigned to take acetaminophen or a placebo twice a day for three weeks. At the end of the three weeks, the students were scanned in an fMRI machine while playing again playing a virtual ball-tossing game with two other players.Those who had taken the acetaminophen exhibited significantly less neural activity in areas of the brain previously associated with experiencing social and physical pain when other players stopped tossing the ball to the subject who still reported social stress from being left out and rejected. These studies help to validate that physical hurt and social pain are strongly linked.   However, just how much “constructive criticism” or perceived negative feedback is really harmful to our mental and physical health?

The “Tipping Point” Between Positive and Negative Feedback

Is there a ratio of positive to negative communications, interactions, and behaviors that predicts individual health, longevity, performance, relationship success, and even how effectively a team performs?  Across different disciplines, researchers continue to find an interesting relationship between “positive to negative” expressions of thoughts, feelings, and behavior that do seem to predict things as diverse as how long we will live to how effectively teams function and produce great results. THere are a few examples:

1. Longevity in Life: In a widely cited study, developmental psychologist Deborah Dannner and colleagues from the University of Kentucky analyzed the one-page handwritten autobiographies from 180 Catholic nuns that were composed when they were a mean age of 22 years.  They were scored for emotional content and compared to longevity based on death certificates. The nuns were asked to include place of birth, parentage, interesting childhood events, schools attended, influences that led to the convent, religious life, and outstanding events.The study revealed that the nuns whose autobiographies contained the most sentences expressing positive emotions lived an average of seven years longer than nuns whose stories contained the fewest. Further, lifespan increased by 9.5 years for nuns whose autobiographies contained the most words referring to positive emotions and by 10.5 years for nuns who used the greatest variety of positive-emotion words.
2.  Positive Feedback: When coaches and organizations use an assessment referred to as 360-degree feedback (leaders and their it is typical to include at least 1-2 open-ended questions at the end of the questionnaire asking raters about perceived strengths to leverage and behaviors the leader can start doing, stop doing, do more, do less, or do differently to become even more effective.  In a published study in 2004, researchers analyzed the impact of upward feedback ratings as well as narrative comments over a one-year period for 176 managers. They found that those who received a small number of unfavorable behaviorally based comments improved more than other managers but those who received a large number (relative to positive comments) significantly declined in performance more than other managers.  This study suggests that a critical mass of negative qualitative feedback in 360-degree interventions might actually be highly disengaging and demoralizing to participants if the ratio of positive to negative feedback is low.
3. Marriage/Relationship Longevity: John Gottman, who is a Professor Emeritus of psychology at the University of Washington, followed 700 couples for ten years and found that when there was less than a 5 to 1 positive to negative interactions in a videotaped interaction of fifteen-minutes it predicted subsequent divorce with a high level of accuracy (81 to 94 percent). He has observed in his “love lab” at the University of Washington that a positive-to-negative ratio of 0.8 or less is a strong indicator of divorce with the most negative eliciting behaviors in a number of his published studies including:

• Criticism: Expressions indicating a defect in one’s partner’s personality (example: “You always talk about yourself”) or contempt: Expressions of superiority (example: “You just can’t get things right).”
• Defensiveness: Expressions of righteous indignation (example: “It’s not my fault that we’re always late—you are the one holding us up”).
• Stonewalling: Emotional withdrawal from interaction (e.g., ignoring the other individual).

Criticism predicted early divorcing (an average of 5.6 years after the wedding) and emotional withdrawal and anger predict later divorcing (an average of 16.2 years after the wedding).  Gottman’s research appears to be just as relevant for the relationships we have with our boss and team members we work so closely with every day as well as our family and life partners.

Perhaps there is substance behind the saying that “employees don’t leave organizations—they leave bad bosses” that is very consistent with the notion that when we feel undervalued and unfairly criticized by our boss, and/or colleagues, we are likely to feel a largely disengaged and having a diminished allegiance to staying with the organization given a chance to look elsewhere.

4. Psychological Well-Being/Life Satisfaction: University of Michigan researcher and psychologist Barbara Fredrickson examined students’ month-long diaries and the positive/negative ratio of emotions seemed to differentiate those who were languishing from those who were high in psychological well-being. She found that students who expressed a ratio of 3 times as many positive emotions as negative emotions reported significantly higher levels of life satisfaction and overall happiness than the other students.

An additional study of hers analyzed the emotions expressed in a single day and compared the positive versus negative emotions in three groups: those who were depressed, those who were not flourishing and those who were flourishing (i.e., to live within an optimal range of human functioning, one that connotes goodness, growth, and resilience). Her more recent results concluded that flourishers thrive because they experience greater positive emotional reactivity dealing with routine pleasant daily activities and build more coping resources over time.  Her findings suggest that positive emotions appear to actually seed the beneficial state of flourishing. Her well-respected “Broaden-and-Build” theory suggests that positive emotions help expand our awareness, relative to negative emotions, and to be the seeds to build relevant coping resources and responses.

Another line of well-being research by Robert Schwartz from the University Of Pittsburgh School Of Medicine and David Haaga from American University compared P/N rations in people with depression.  They found that that depression is marked by positivity ratios of less than 1:1 and that following treatment (either pharmacological or cognitive-behavioral therapy), ratios rise to about 2:1 for those with typical remission, whereas they rise to about 4:1 for those with what they term optimal remission.

5. Flourishing: In 2011, Manfred Diehl from the Department of Human Development and Family studies at Colorado State University asked 239 adults (77 older, 81 middle-aged, 81 younger adults) to maintain a daily journal for one month.  Their study specifically attempted to determine whether there exists a specific ratio between negative and positive cognitions that might differentiate the psychological well-being of adults.  Analyses of the journal entries over the entire month confirmed that higher positivity ratios were significantly associated with better mental health which they termed “flourishing.”  The positivity ration of 2.9 appeared to be a “critical value” in young adults but did not equally discriminate the mental health status of older or middle-aged adults (these differences are likely due to age-related differences in work, family and other life circumstances).

Taken together, this study and others provide support for the claim that “flourishing” mental health is associated with significantly higher positivity ratios than is nonflourishing.  Indeed, there is ample evidence to support the role of positive emotions in our psychological health, immune system, and even longevity.

Although some current research has questioned the appropriateness of the original mathematical models used in earlier P/N studies, overall it still appears that the secret to individual and team health and productivity might be as simple as accentuating the positive to negative ratio of emotions and behaviors and being aware of when our own self-talk and expressions seem tilted in the wrong direction.  Finally, it is important to emphasize that too much positivity in feedback (or feelings) doesn’t always equate to optimal functioning (i.e., the relationship is unlikely to truly be linear but closer to the classic inverted-U relationship).

No Feedback At All Is Apparently a Poor Option

“If you don’t have something nice to say, you should keep your mouth shut” is a mantra no doubt heard by just about every child at least once in its life.  For many of us, we are often hesitant to take a risk to share feedback that might be perceived as critical or judgmental even when it seems important to do so.

For example, in 2009, the Gallup organization asked a random sample of 1,003 employees in the U.S. how much they agreed with two statements: 1) “My supervisor focuses on my strengths/positive characteristics” and 2) “My supervisor focuses on my weaknesses or negative characteristics.” They were also asked whether they were engaged, not engaged, or actively disengaged with their work and job.  The findings suggest that no feedback might actually do more harm than giving negative feedback:

• Positive Feedback: In the group that reported their bosses gave them positive feedback in the form of focusing on what they did well (i.e., their strengths), only 1% reported being actively disengaged and 61% reported being fully engaged
• Negative Feedback: In the group that reported that their bosses tended to focus on the negative and provide ongoing critical feedback to them, 22% reported being actively disengaged and only 45% reported being engaged.
• No Feedback: In the group that reported being largely ignored by their bosses (no positive or negative feedback), 40% reported being actively disengaged and only 2% reported being engaged.

Interestingly, the most disengaged group of employees reported to bosses who seemed to ignore them and provide little or no feedback at all.

Conclusion

Feedback, when perceived critically, does indeed seem to negatively affect both individual and team effectiveness and health.  Yet, feedback is a necessary condition of successful behavior change. When possible, try to utilize feedforward to minimize defensiveness and increase acceptance to look for ways to grow and learn.  If you do need to ask others to change their behavior and provide them with constructive criticism, consider focusing on on specific things that are manageable and observable using “I statements” and avoiding using the qualifying words “always” and “never.”

There is no guarantee others will be motivated to want to change as a result of your feedback but without trying, it’s dumb luck that you will find spontaneous behavior change on the part of others tjat uniquely will meet your needs…..Be well….

Further Reading

1. Does rejection hurt? An fMRI study of social exclusion. Naomi Eisenberger et al., in Science, Vol. 302, pages 290-292; 2003.
2. Evidence Based Answers to 15 Questions about Leveraging 360-Degree Feedback. Kenneth Nowack and Sandra Mashihi in Consulting Psychology Journal: Practice and Research, Vol. 64, pages 157–182; 2012.
3. Justice at work and reduced risk of coronary heart disease among employees: The Whitehall Study.  Anna Nyberg et al. in Occupational and Environmental Medicine, Vol. 66, pages 51-55; 2008.
4. Updated thinking on positivity ratios. Barbara Fredrickson in American Psychologist. Advance online publication. doi: 10.1037/a0033584; 2013 (July 15).
5. Optimal and normal affect balance in psychotherapy of major depression: Evaluation of the balanced states of the mind model. Robert Schwartz, et al., in Behavioural and Cognitive Psychotherapy, Vol. 30, pages 439–450; 2002.
6. The role of positivity and connectivity in the performance of business teams: A nonlinear dynamics model. Marcial Losada and Emily Heaphy in American Behavioral Scientist, Vol.47, pages 740–765; 2004.

Ken Nowack

Kenneth Nowack, Ph.D. is a licensed psychologist (PSY13758) and President & Chief Research Officer/Co-Founder of Envisia Learning, is a member of the Consortium for Research on Emotional Intelligence in Organizations. Ken also serves as the Associate Editor of Consulting Psychology Journal: Practice and Research. His recent book Clueless: Coaching People Who Just Don’t Get It is available for free for a limited time by signing up for free blog updates (Learn more at our website)