Thesis: How do doctors talk to patients about sensitive topics?

During the last couple of weeks, I’ve been putting the final touches on my thesis research project. The question in the title of this post is the general question I’m pursuing with my thesis research.

A recent article published in the Chronicle of Higher Education reminded us that “despite decades of research, hundreds of campus task forces, and millions invested in bold experiments, college drinking remains as much of a problem as ever.” Thus, alcohol intervention conversations between medical providers and students about alcohol can be crucial to reducing problems associated with college binge drinking.

Presenting at my oral defense

Presenting at my oral defense

However, medical providers sometimes avoid alcohol-related conversations or brief alcohol interventions. So, I pursued with my thesis research the more specific question of, how do medical providers in university health centers communicate with patients about the sensitive topic of patient alcohol use?

Results from my qualitative analysis of 14 interviews with medical providers suggest that medical providers utilize the following communication techniques during alcohol-related conversations with patients:

Reading, writing, editing, reviewing, diagramming, etc etc etc!

The process: reading, writing, analyzing, editing, reviewing, diagramming, reflecting, etc etc etc!

  •  gathering more information (beyond screening data)
  • creating a nonthreatening environment
  • providing education about consequences
  • eliciting patient ownership
  • providing tips for harm reduction
  • continuing the conversation

Additionally, providers reported the following communication challenges to conducting brief alcohol interventions in this context:

  • choosing how and when to start the conversation
  • diagnosing a resistant population
  • establishing necessary rapport for a sensitive conversation
  • maintaining credibility despite uncertainty about the efficacy of interventions

With my poster at the graduate research symposium

I presented this research at the 10th annual NCSU Graduate Research Symposium earlier this month. My hope is that some of this research will be helpful to medical professionals in the field. I am also looking forward to submitting this research for publication. For now, I’m glad to be wrapping up this phase of my research!

With my committee at oral defense, from left to right: Chair, Dr. Deanna Dannels; Dr. Jessica Jameson; and Dr. Kami Kosenko

With my committee at oral defense, from left to right: Chair, Dr. Deanna Dannels; Dr. Jessica Jameson; me; and Dr. Kami Kosenko

I began this project more than a year ago and cannot be more excited to see it all come together! My thanks to the medical providers who met with me, the health center administrators who helped with this project, and to my committee.


Top Five Thesis Memes

Like many other graduate students out there, I’m in the thick of writing my thesis this winter. I’m researching the challenges and opportunities faced by medical providers when discussing patient alcohol use with patients. More specifically, I’m looking at how university medical providers communicate with college-age patients regarding binge drinking alcohol. It’s

Of course half of the time when I’m “writing my thesis,” I’m looking at #thesismemes. I’d like to share my favorites with my fellow thesis-writing friends. Here are my top five favorites:

Naturally, a cat meme to kick us off:


via thesis kitten

And of course, these classics:


via thesis memes


via thesis memes

Ah, the dreaded defense!

via dudelol

via dudelol

Now for my final pick. It is not actually a meme, but rather, my favorite song written about thesis-ing, John Sampson’s When I Write My Masters Thesis. Fellow thesis writes, I trust you’ll enjoy it!

How to tell your co-workers that you don’t drink

As the writer of a recent Time article about our research writes, it’s not always easy to explain why you’re turning down a drink at work-related social functions. Time4ab

My research conducted with Dr. Lynsey Romo and colleagues and published in the Journal of Applied Communication Research, involved talking to working professionals who abstain from drinking about how they communicate with co-workers about their abstinence. Some participants reported being concerned about the negative impact of their alcohol abstinence.

So, how do you “spill the beans” to colleagues that you’re a non-drinker? How do you address it the heat of the moment at a social function where your colleagues are drinking and asking why you aren’t?

Well, our research revealed several ways that participants dealt with this.


First, avoiding the confrontation by “passing” as a drinker. As one participant reported, “I’ve held a beer bottle for hours, to the point where it’s warm.”

Being Forthright

Some participants came straight out with it about their non-drinking status, finding that it quickly settled the issue and prevented future conversations about the topic.

Using Excuses

Another option is to use vague excuses or explanations to diffuse the situation. First, choosing to emphasize abstinence from alcohol as a personal choice that applies only to you, not your judgement of others. Additionally, humor can be helpful here. One participant said she sometimes joked that she was allergic to alcohol when people questioned why she did not drink. Finally, as profiled in the Time article, health excuses are also an option:

  • “Not drinking is my secret to weight loss.” – Not drinking is the way you keep fit.
  • “It’s that pesky toe fungus again.” – Use of antibiotics prevents you from drinking.
  • “Sorry, I’ve got a marathon.” – Early mornings, training and physical prevent you from being able to drink.
  • “Ugh, migraines.” – Migraine medicine requires that you don’t drink.

Read more about our study, An Examination of How Professionals Who Abstain from Alcohol Communicatively Negotiate Their Non-drinking Identity, here.

Does workplace volunteering in groups improve employee relationships?

Image via Natesh Ramasamy

This is the general question I asked last spring when I undertook my first solo qualitative research paper. In fact, initial results from my study suggest yes, company-sanctioned group volunteer events fulfill the following relational functions for employees who volunteer together:

1. Create a positive experience together

Participants emphasized the positive nature of participating in company-sanctioned volunteer events with fellow employees. Volunteer events in the study often involved rituals to mark the occasion, such as wearing company t-shirts and photographing volunteer activities to share at the office. Brandy, an administrator at a hospital, said “I’ve yet to see a volunteer walk out [a volunteer session] with a frown on their face” upon participating in her company’s weekly reading tutoring volunteer program. Brandy said that her and other company volunteers have shared stories with one another about how the volunteer events serve as a “stress reducer,” adding that “if you’ve had that bad day, [after] going to [tutor], you’ll have a better day.”

2. Network to develop contacts in the company

Participants such as Robert, an engineer at a large company, discussed the social networking function of company volunteer events. Because his company employs more than 2,000 people at his location, Robert said he is “constantly seeing new faces” at the volunteer events he helps to organize. Robert added, “there are lots of examples of folks that I didn’t know before and now interact with at least personally… [Also] folks who I may have known who they were, didn’t know a whole lot about them, but had some tangential work connection before, and got to know them through volunteering. And then that connection was strengthened and we’ve ended up working in other ways together since then.”


3. Build deeper relationships with known colleagues

Other participants expressed how volunteering together helped to add layers of depth and understanding to relationships with colleagues. Brad, who works as a designer at a small firm, said that after employees at his company met family members of their colleagues at a company-sanctioned volunteer event that was open to family, they tended to “look out for each other more.” Brad said that after that experience, employees are more likely to help another employee who is swamped with work so that his or her family life doesn’t suffer. Brad added that volunteering “makes your work relationship better because you just realize, oh, they’re people just like you, they go home to the same stuff just like you do and they have the same responsibilities and the same things they care about.”

4. Leverage company impact in the community

Additionally, participants reported that they preferred to volunteer with their fellow employees rather than alone because they can accomplish more together and with the backing of the company. Robert reported that he sees volunteering with this colleagues as an opportunity to “make a much bigger impact.” He added that groups of employees “make a difference” through the 1,000 hours of service his company logged for a local food bank in addition to helping attract financial sponsorships on part of the company through employee advocacy for the food bank.

5. Collectively build company culture

Finally, participants reported that they took pride in helping to shape and encourage a culture of giving back in the company through volunteering with colleagues and increasing the visibility and participation in the volunteer program. Describing the volunteer recruitment process, Sue said “[Company name] people are really good people and so everybody will pitch in,” reflecting how volunteerism helps define the employee workforce at her company.

Given that each of these functions are only accomplished through volunteering within a group of other employees (as opposed to volunteering alone), the relational nature of these functions is revealed. Based upon these results and previous research, I propose that volunteering together at company-sanctioned volunteer events helps to cultivate social capital within internal relationships among employees of the company who volunteer together.

I’m considering expanding this project to include more data so stay tuned! Want to read more about the method of this research or see more? Click here to download a PDF of the initial results.

Note: To protect privacy of those who participated in the study, participants, organizations, and companies involved are all kept confidential and listed with pseudonyms where relevant.

Nondrinking at my first academic conference

Nondrinking at my first academic conference

Well, perhaps I did have a glass of wine or two while attending the International Communication Association (ICA) Groupconference in Seattle a few weeks ago. I use the word “nondrinking” with regard to a paper accepted to ICA which I co-authored with my colleagues (listed below!) entitled Neither Shaken Nor Stirred: How Professionals Who Abstain From Alcohol Communicatively Negotiate Their Nondrinking Identity.

This research helped uncover communication tools available to those who do not drink for managing their nondrinking identity and stigma they may face in the workplace. Additionally, this project helped me clarify my research interest in interpersonal communication about substance use/abuse and addiction. I will be exploring this further for my thesis, which I’m starting this summer.

ICA session screenshotAt ICA, I attended sessions about topics such as stigma and mental illness and top health communication papers, and met researchers from across the world who are researching similar to me. Overall,  my first academic conference was a success! Thanks to the NCSU Department of Communication for funding to attend the conference and to Dr. Lynsey Romo for the opportunity to work on the project.

Teaching Research

Teaching Portfolio Contents


How Novice Teachers Can Embrace the Paradox of Improvisation in the Classroom

Educational researchers established years ago that content knowledge alone in itself does not necessarily make an effective teacher (Sawyer, 2011). Scholars and researchers driven by the question, “what makes good teachers great?” have pursued the answer for decades. Novice teachers in particular are often willing to put in the time to plan and prepare for their teaching responsibilities. Is that enough to conduct an effective lesson that facilitates a high level of student learning? Literature about education has made clear that there are many things at play including student engagement, student motivation, relational dynamics, curriculum design, etc. Educational scholars have in recent years made a compelling case for the value of improvisation in the classroom as a pedagogical approach. However, teachers, as trained professionals who teach in settings that often demand strict student learning outcomes, can be hesitant to embrace improvisation. The “unspoken assumption… that while jazz musicians and actors may improvise, educators plan” that Donmoyer (1983) wrote about thirty years ago is still present today.

David Berliner (2011) asks teachers to consider the 2009 plane crash into the Hudson River after the engines failed. In this case, there was no protocol to follow. The only action available to Captain C.B. “Sully” Sullenberger was improvisation, which led him to land the plane in the river and save many lives. According to Sawyer, improvisation is a “characteristic of any human action that is not fully scripted and determined” (2011, p. 12), that is, it encompasses much of human interactions and actions. Further, the outcomes of a collaborative learning approach that is born through improvisational tactics are becoming important to policy leaders who want to ensure that students are developing “twenty-first-century skills” such as creative thinking and collaboration for the knowledge-based economy of the future (Sawyer, 2011). The 2005 United Kingdom government Qualifications and Curriculum Authority listed the following habits required of students after their schooling: questioning and challenging; making connections and seeing relationships; envisaging what might be; exploring ideas; keeping options open; and reflecting critically on ideas, actions, and outcomes” (Sawyer, 2011, p. 10). Teachers who are able to implement improvisation create more relevant, effective teaching and thus greater learning outcomes for students.

Roots of Classroom Improvisation as a Concept

In order to understand the somewhat abstract idea of improvisation in the classroom, one should understand its theoretical and philosophical underpinnings. The concept of improvisation in the classroom is rooted in the constructivist teaching theory, and therefore part of a movement in response to the historic emphasis on traditional teaching, or direct instruction. This approach emphasizes a scripted transmission of knowledge from teacher to student. A constructivist classroom, however, is one in which teachers and students both construct the learning experience, as opposed to the traditional approach which assumes a one-way channel from teacher to student, who is the passive receiver of teacher communication (Sawyer, 2004a).

The dominant teaching philosophy in public school as well as higher education for many years was the pedagogical approach (Milligan, 1995). The evolution toward constructivist approach is parallel to the evolution beyond the pedagogogical philosophy to androgogical philosophy, which encourages student participation and autonomy, particularly with regard to higher education (Gitterman, 2004). Beyond that, heutagogy is an off-shoot of androgogy that fully embraces the concept of self-directed learning. While a scripted teaching approach falls within pedagogical tendency to view the teacher as transmitting knowledge to the student, who merely receives it (Power, 2012), practicing improvisation in the classroom demonstrates the androgogcial and heutagogical teaching philosophies.

The notion of artistic improvisation or expression as a model for teaching has been around for decades. One of the leading scholars responsible for developing the concept of improvisation rooted in constructivist teaching is Keith Sawyer of Washington University. Sawyer brings together a variety of scholarship and research under the banner of creative teaching as an essential tool for teachers. The original concept of teacher as performer, which was popular for many years, Sawyer (2012) notes, was problematic because it downplayed the role of structured learning; it failed to account for any interplay between students and teachers; and it propagated the scripted notion of teaching which diminishes the importance of content knowledge and expertise (p. 6). Early research that specifically focused on improvisation in teaching from the 1970’s often explored the subject by pitting experienced teachers against novice teachers, the latter of which were assumed to exhibit low use of improvisation (Sawyer, 2012).

In Figure 1, I propose a diagram that maps out the theoretical, philosophical, strategic, and tactical approaches to improvisation in the classroom that are mentioned in this literature review.

 Improvisation Approaches Diagram

Approaches to Improvisation

What, then, is improvisation with regards to the constructivist classroom? Whereas many of the teaching philosophies and strategies listed above are a general, improvisation in the classroom can be used as is a specific tactic within the constructivist classroom during a given class session. Though scholars have taken various approaches to studying and applying improvisation to the classroom, many scholars have identified similar definitions and themes with regards to improvisation, namely the notion of paradoxical tension between structure and freedom required by teachers and which occurs during improvisational moments (Sawyer, 2011; Loveless, 2007).

Sawyer views improvisation as a tactic used to resolve the tension between structure and creative freedom that is necessary to optimize student learning (2012). He states that “disciplined improvisation provides us with a way to conceptualize creative teaching within curricular structures” (2004a, p. 16). Sawyer is, however, careful to counter the impression that “improvisation means anything goes” (2012, p. 12). Sawyer also concedes that though creative teaching is more effective, it is difficult to assess quantitatively (2004a). This is one of the greatest challenges to the concept of improvisation in the classroom given the heavy emphasis on assessing student outcomes through standardized testing on part of the government.

Naturally, various different scholars situate improvisation differently within teaching philosophy and models. Some scholars view improvisation as one element of an effective teaching model. Loveless (2007) identifies improvisation as vehicle for interdisciplinary value-ads to classroom discussion. She states,

Improvisation is not just related to experience and skill, and neither is it ‘content free’, but it is expressed within and between subject domains. Creative individuals in different knowledge domains demonstrate understanding of the underpinning concepts and traditions, while knowing how to ‘break the rules’ to present original combinations of ideas and outcomes (p. 513).

Loveless specifically proposes a framework (2007) that includes improvisation as one element of teacher knowledge. The framework integrates improvisation and open-mindedness with engagement of integrated co-teaching (ICT) and planned lesson designs using Didaktik analysis. Loveless situates improvisation within a larger framework as opposed to Sawyer’s singular focus on improvisation. However, their treatment is quite similar in that they both acknowledge the paradox of improvisation that involves contradicting elements: Loveless articulates both the art and science of teaching (2007, p. 520); Sawyer discusses structure and creative freedom (2011).

Artistic Improvisation as a Metaphor

Just as educational scholars looked to the arts as a model to develop the teacher as performer metaphor, scholars continue to build on this notion in the literature today. Contemporary scholars have sought to move beyond the static teacher as performer metaphor to a more complex metaphor that embraces constructivism (Sawyer, 2004b). They have integrated both the art and science of good teaching by acknowledging and embracing the tensions between planned structures and collaborative improvisation.

Though many scholars have compared teaching to artistic improvisation, Sawyer is most elegant and exhaustive in his writings about creative teaching. Jazz, for instance, requires a “deep knowledge of complex harmonic structures and profound familiarity with the large body of standards” (2011, p. 12) in addition to development of personal structuring strategies according to Sawyer. These are called “licks,” or go-to motifs that can be drawn upon in a wide variety of situations or songs. Just as jazz musicians decide in the moment when to utilize licks, teachers often do the same in the classroom. The jazz musician’s combination of deep knowledge of conventions as well as readiness to improvise using structures and tools is exactly the balance teachers must strike to create a collaborative, constructivist learning environment (2011).

Sawyer also compares constructivist teaching with improvisational theatre performance. He states, “constructivist teaching is fundamentally improvisational, because if the classroom is scripted and overly directed by the teacher, the students cannot co-construct their own knowledge (2004b, p. 190). Some features that share applications between both improvisational theatre and collaborating groups in classrooms include: interactional dynamics, the give-and-take nature of the interaction, and the common theme of properties emerging from the group as a consequence of individual actions (2004b, p. 190).

Collaborative Discussion: Improvisation in Action

Though Improvisation may be applied to a larger teaching philosophy which includes applications such as switching order of activities, swapping agenda items in class, dropping a specific item, etc., it is most often applied and viewed within the context of in-class collaborative discussion within the classroom. Many studies have demonstrated the value of collaborative discussion to student learning and engagement (Sawyer, 2004a; Wu, Nguyen-Jahiel, & Miller, 2013). Collaborative discussion takes place when teachers invite students to actively co-create the lesson through open dialogue. Collaborative discussion has been applied to many disciplines including math (Sawyer, 2004a), humanities (Wu, Nguyen-Jahiel, & Miller, 2013), and more through both qualitative case study methodologies as well as quantitative methodologies.

Until this point, this literature review has focused on teacher improvisation and facilitation of collaboration. Collaborative discussion in the constructivist classroom assumes that both teachers and students are improvisers. Sawyer states that this type of activity is both “emergent because the outcome cannot be predicted in advance, and… collaborative because no single participant can control what emerges” (2004a, p. 13). Study of collaborative discussion often draws on the work of neo-Piagetian social constructivists and Vygotskian socialculturalists, prioritizing the group rather than the individual (Sawyer 2004a). Collaborative discussion in the classroom is collective improvisation of meaning by teacher and students.

Drawing on the theatre metaphor, Sawyer identifies two principles of improvisational theatre that are required for collaborative discussion. First, the “Yes, and…” principle, in which fellow actors agree to metaphorically say yes by accepting the statement put forth and then adding something new to the improvisational string (2004b, p. 192). Teachers often “revoice” a student’s response by accepting the offering as valid and then elaborating to tie connect the response with another level of the material, just as actors do in improvisational theatre. Second, the “No denial” rule reinforces the negative role denial plays in a collaborative exchange and also notes that “the line between a subtle denial and a constructive revoicing is fuzzy and open to interpretation” (2004b, p. 193).

At the tactical level of implementation, the tension between teaching the prepared outline and the improvisational demand of collaborative learning is evident. Sawyer writes,

Even during free-flowing discussion, a teacher will naturally have the day’s lesson plan and curriculum goals in the back of his/her head. Yet, if the constructivist benefits of collaborative discussion are to be realized, the teacher must allow discussion to proceed without playwriting. Otherwise, socially-constructed insights do not naturally emerge from the students’ discussion. Students then perceive that the teacher is not interested in true discussion, but rather in using the students to further the teacher’s own hidden agenda—the scripted, preferred direction that it is hoped the students will move in.” (2004b, p. 195)

What’s Next?

The study of improvisation in the classroom is still somewhat in its adolescence. The literature includes a number of theoretical pieces about this approach to teaching. What is needed now is a bridge to implementation that explores the practical applications of this research. Some questions that remain are: What are some effective starting points for novice teachers to begin adopting this approach into their lessons? How is this approach applied practically other than in collaborative discussion? The current literature displays an impressive range of application. Ultimately, practical application of this strategy is going to vary by discipline and therefore, should be explored and applied individually in various disciplines now that the theoretical groundwork is completed.

In particular, much of the research highlights a divide between use of improvisation by novice teachers and expert teachers. Sawyer writes,

Beginning teachers are often so focused on their own lesson plan—what they want to cover, and what they want to come next in the class—that they find it difficult to truly listen to students’ responses. Improvisation requires close listening, and a teacher can only do this if he/she is willing to relinquish some amount of control over the follow of the class. (2004b, p. 199)

Additionally, according to Barker & Borko , novice teachers do not typically encounter these tensions which are inherent to the profession until they are already in front of a group of students and accountable for their students’ learning outcomes (2011, p. 292). Interestingly, research shows that expert teachers use more structures and yet they also improvise more (Sawyer, 2011). They do so by using go-to routines and activity structures, but they apply these routines in a creative, improvisational manner (2011, p. 2). Sawyer, however, provides encouragement for novice teachers: “improvisation is a conversational skill and, like other interactional skills, it can be taught” (2004b, p. 191).


To begin moving toward a bridge from theory to practice, I propose the following recommendations, which I hope are useful to most any teacher from the elementary school math teacher to the corporate training developer.

1. Reflect on opportunity for integration of improvisational strategies into your teaching. Some questions the scholars might ask you to consider include:

  • Is the constructivist approach to teaching a priority for me as a teacher?
  • How meaningful are Sawyer’s improvisational artistic expression metaphors (i.e. jazz, improvisational theatre) to my own practice as a teacher?

2. Begin putting it into practice. Use Gitterman’s (1995, p. 105) suggestions for incorporating interactive androgogy into the classroom:

(1) Ask questions in early classes which invite opinions and have no right or wrong answers; (2) direct students to talk to each other and build on their respective contributions; (3) deepen the conversation by using more discriminating questions which call for facts, inferences, explanations, and evaluative judgments as students comfort and confidence increases; (4) periodically pull together and summarize salient themes.

3. Attend or participate in an improvisational performance to observe improvisation in action. Try to discern or inquire about the structures in place to help performers in this setting to strike the balance that Sawyer (2011) describes between improvisational yet cohesive performance. Below are some resources for finding improvisational performances in your area:

4. Practice your listening skills. According to Sawyer, this poses the most difficulty for novice teachers (2004b) who seek to implement improvisational tactics in the classroom. Sawyer suggests practicing by playing some of improvisational theatre games that actors use to hone their skills in the craft (2004b). Read about theatre games here:

5. Identify opportunities in your class to incorporate improvisation and collaborative discussion. Implement it in small doses.  Take notes to evaluate the results and help refine your approach for the next opportunity.

Additional resources for professional development, adapted from Sawyer (2004b, p. 191):

In this paper, I have made the case for the importance of improvisational teaching that is rooted in the constructivist teaching. By looking first at the theoretical roots of improvisational teaching, then at the approaches to improvisational teaching, then reviewing the artistic metaphors used in conceptualizing improvisational teaching, and finally at how improvisation is enacted through collaborative discussion, I have explored the power of improvisational teaching. It not only creates more effective, relevant learning for students, but also facilitates learning outcomes that position students to build important skills such as collaboration for the knowledge economy of the future. Teachers of various stripes are encouraged to reflect about how improvisation fits into their teaching and consider the recommendations listed above.


Barker, L., & Borko, H. (2011). Conclusion: Presence and the art of improvisational teaching. In K. Sawyer (Ed.), Structure and Improvisation in Creative Teaching (pp. 279-319). Cambridge: Cambridge University Press.

Berliner, D. (2011). Foreword. In K. Sawyer (Ed.),Structure and Improvisation in Creative Teaching (pp. xiii-xvi). Cambridge: Cambridge University Press.

Donmoyer, R. (1983). Pedagogical improvisation. Educational Leadership,40(4), 39-43.

Gitterman, A. (2004). Interactive Andragogy: Principles, Methods, and Skills. Journal of Teaching in Social Work, 24(3-4), 95–112. doi:10.1300/J067v24n03_07

Lobman, C. (2011). Improvising within the system: Creating new teacher performances in inner-city schools. In K. Sawyer (Ed.), Structure and Improvisation in Creative Teaching (pp. 73-93). Cambridge: Cambridge University Press.

Loveless, A. (2007). Preparing to teach with ICT: subject knowledge, Didaktik and improvisation. Curriculum Journal, 18(4), 509–522. doi:10.1080/09585170701687951

Milligan, F. (1995). In defence of andragogy. Nurse Education Today, 15(1), 22–27.

Power, B. (2012). Enriching Students’ Intellectual Diet through Inquiry Based Learning. Libri, 62(4). doi:10.1515/libri-2012-0024

Sawyer, R. K. (2004a). Creative teaching: Collaborative discussion as disciplined improvisation. Educational researcher, 33(2), 12–20.

Sawyer, K. (2004b). Improvised lessons: Collaborative discussion in the constructivist classroom. Teaching Education15(2), 189-201.

Sawyer, K. (2011). What makes good teachers great? The artful balance of structure and improvisation. In K. Sawyer (Ed.), Structure and Improvisation in Creative Teaching (pp. 1-24). Cambridge: Cambridge University Press.

Volkert, D. (2012, August). Inquiry based learning. Nevada RNformation, p. 15.

Wu, X., Anderson, R. C., Nguyen-Jahiel, K., & Miller, B. (2013). Enhancing motivation and engagement through collaborative discussion. Journal of Educational Psychology, 105(3), 622–632. doi:10.1037/a0032792