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Western Journal of Communication
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The Role of “Active Listening” in
Informal Helping Conversations: Impact
on Perceptions of Listener Helpfulness,
Sensitivity, and Supportiveness and
Discloser Emotional Improvement
Graham D. Bodie
a
, Andrea J. Vickery
b
, Kaitlin Cannava
b
&
Susanne M. Jones
c
a
Department of Communication Studies , Louisiana State University
and Agricultural & Mechanical College and Visiting Associate
Professor in the School of Media and Communication, Korea
University , Seoul , South Korea
b
LSU A&M
c
Communication in the Department of Communication Studies ,
University of Minnesota , Twin Cities
Published online: 03 Jan 2015.
To cite this article: Graham D. Bodie , Andrea J. Vickery , Kaitlin Cannava & Susanne M. Jones (2015):
The Role of “Active Listening” in Informal Helping Conversations: Impact on Perceptions of Listener
Helpfulness, Sensitivity, and Supportiveness and Discloser Emotional Improvement, Western Journal of
Communication, DOI: 10.1080/10570314.2014.943429
To link to this article: http://dx.doi.org/10.1080/10570314.2014.943429
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The Role of ‘‘Active Listening’’ in
Informal Helping Conversations:
Impact on Perceptions of Listener
Helpfulness, Sensitivity, and
Supportiveness and Discloser
Emotional Improvement
Graham D. Bodie, Andrea J. Vickery,
Kaitlin Cannava, & Susanne M. Jones
Undergraduate students were randomly assigned to disclose a recent upsetting problem to
either a trained active listener (n ¼ 41) or an untrained listener (n ¼ 130). Active listen-
ers were trained to ask open questions, paraphrase content, reflect feelings, and use
assumption checking as well as be nonverbally immediate. Verbal and nonverbal active
listening behaviors were rated as signaling more emotional awareness and promoting a
greater degree of emotional improvement but did not affect perceptions of relational
assurance or problem-solving utility. On average, the set of verbal behaviors were more
important in the prediction of outcomes compared to the nonverbal behaviors. Results
Graham D. Bodie is Associate Professor in the Department of Communication Studies, Louisiana State University
and Agricultural & Mechanical College and Visiting Associate Professor in the School of Media and Communi-
cation, Korea University, Seoul, South Korea. Andrea J. Vickery and Kaitlin Cannava are doctoral candiates at
LSU A&M. Susanne M. Jones is Associate Professor and Donald V. Hawkins Professor of Communication in the
Department of Communication Studies, University of Minnesota, Twin Cities. Article preparation was assisted
by summer funding provided to Graham Bodie through the LSU A&M College of Humanities & Social Sciences.
A previous version of this article was presented at the 2014 meeting of the National Communication Associ-
ation, Chicago, IL. The authors would like to thank Michelle Pence, Jonathan Denham, Laura Hatcher, Trey
Gibson, Logan Sacco, McCade McDaniel, Elizabeth McKee, Daniel Chapman, Lori Castano, Amanda Legrand,
Nickole Hojnowski, Allison O’Neill, Dan Barberio, Billy Boland, and Kristin Carlson for their assistance with
various aspects of data collection and coding. Correspondence to: Graham D. Bodie, Department of Communi-
cation Studies, LSU A&M, 136 Coates Hall, Baton Rouge, LA 70803, USA. E-mail: gbodie@lsu.edu
Western Journal of Communication
Vol. 0, No. 0, pp. 1–23
ISSN 1057-0314 (print)/ISSN 1745-1027 (online) # 2015 Western States Communication Association
DOI: 10.1080/10570314.2014.943429
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contribute to the larger literature on enacted support, suggesting particular roles for
active listening techniques within troubles talk.
Keywords: Comforting; Emotional Support; Empathy; Stress; Supportive Listening
Disclosure of stress is a normative and important coping resource (Rime
´
, 2009).
When we engage in troubles talk with others, distress can be alleviated, relationships
strengthened, and physical and mental health improved. Unfortunately, the reverse
also is true: Discussing problems in certain ways is dysfunctional and can lead to a
range of negative outcomes from heightened distress to health complications (for
reviews see MacGeorge, Feng, & Burleson, 2011; Uchino, Carlisle, Birmingham, &
Vaughn, 2011). A key contributor to whether troubles talk is helpful or harmful is
the quality of enacted support—what is said and done in the service of talking about
problems (Goldsmith, 2004). Supportive communication scholars have spent con-
siderable effort documenting the behavioral features that distinguish more and less
helpful enacted support (MacGeorge et al., 2011), and there is mounting evidence
that specific behaviors have reliable impacts on important outcomes including indi-
vidual and relational health and well-being (Bodie, 2012; Jones & Guerrero, 2001;
Jones & Wirtz, 2006; Lepore, Ragan, & Jones, 2000; Priem & Solomon, 2009).
Although myriad behaviors contribute, perhaps no other behavior is more funda-
mental to enabling healthy troubles talk than ‘‘active listening.’’ Whether the reader
opens a scholarly journal or trade publication, textbook or handbook, flyer or
self-help manual, part of the advice relevant to being a good support provider will
include one or more skills like paraphrasing, asking questions, and reflecting feelings.
To date, although the active listening paradigm is a central component of supportive
communication scholarship, the impact of the constituent behaviors is largely
untested in the context of informal helping conversations. The purpose of this article
is to report an experimental study that tested the active listening paradigm in the
context of supportive conversations.
Active Listening in the Context of Troubles Talk
Interest in active listening as a therapeutic tool is generally traced to Carl Rogers
(1957, 1959), who proposed that effective counselors ought to demonstrate uncon-
ditional acceptance and unbiased reflection of client feelings and experiences. Indeed,
Rogers’s philosophy permeates the supportive communication literature. The work
on comforting by Burleson and colleagues, for instance, has shown that support
providers who have an increasing ‘‘awareness of and adaptation to the subjective,
affective, and relational reality’’ of the stressful situation and the person affected by
that situation (Burleson, 1987, p. 305) produce messages that are more likely to assist
in the comforting process (for review see Burleson, 2003). Traces of Rogers’s work
also are visible in a range of contexts including health care (Fassaert, van Dulmen,
Schellevis, & Bensing, 2007), social work (Nugent & Halvorson, 1995), and
2 G. D. Bodie et al.
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occupational health (Mishima, Kubota, & Nagata, 2000), from which scholars
studying the communication of support in less formal settings generate numerous
recommendations.
Although definitions of active listening vary widely across contexts (see
Armstrong, 1998; Weger, Bell, Minei, & Robinson, 2014; Weger, Castle, & Emmett,
2010), most treatments stress the importance of both nonverbal and verbal behaviors
that function to demonstrate attention, understanding, responsiveness, and empathy;
to encourage continued expression of thoughts and feelings; and to aid in relational
maintenance. In terms of nonverbal behaviors, active listening typically is cast as non-
verbal immediacy (NVI)—behaviors such as head nods, eye contact and forward
body lean that reflect the degree of psychological distance between (or closeness with)
others (Andersen & Andersen, 2005). In the context of troubles talk, these behaviors
communicate approach (vs. avoidance) (Jones & Wirtz, 2006) and signal involve-
ment, attentiveness, and awareness (Coker & Burgoon, 1987). Active listening is read-
ily operationalized with immediacy cues (for a recent example, see Fassaert et al.,
2007), and research on NVI in the context of troubles talk suggests a positive role
for many immediacy behaviors (Derlega, Barbee, & Winstead, 1994; Jones &
Guerrero, 2001; Miczo & Burgoon, 2008).
In addition to showing nonverbal warmth, active listeners also signal attentiveness
through a range of verbal behaviors, the most common of which are paraphrasing,
reflecting feelings, assumption checking, and asking questions. Paraphrasing and
reflecting feelings are both forms of formulation (Garfinkel & Sacks, 1970; Hak &
de Boer, 1996; Heritage & Watson, 1979; Korman, Bavelas, & De Jong, 2013; Phillips,
1999). While paraphrasing refers to the repetition of what was said in the listener’s
own words the way he or she understood it (Weger et al., 2014; Weger et al.,
2010), reflecting feelings refers to statements that demonstrate an accurate detection
of feelings that underlie certain statements and mirror these feelings to the discloser
(Hutchby, 2005). Both types of summaries often are prefaced with short introduc-
tions that indicate their speculative nature (e.g., It seems like; It appears; So the
way you see it ...). When active listeners engage in paraphrasing and reflecting feel-
ings, one strategy utilized to ensure the listener does not misrepresent the discloser is
assumption checking or asking short questions to ascertain the degree to which the
listener has accurately captured the meaning of the discloser’s response (e.g., Did I
hear you correctly? Does that fit for you?) (Baldwin, 1987). Finally, active listeners
also engage with questioning in the form of open questions (e.g., How did that make
you feel?) which help shift the conversation in particular directions (Healing &
Bavelas, 2011).
The benefits of various active listening strategies are well documented in formal
helping settings like therapy (Norcross, 2011), and these results are readily general-
ized and applied to how lay helpers should enact informal support (see Burleson,
1984, 2003; Jones, 2011; Stewart, 1983; for review see Weger et al., 2010). Others have
questioned the wholesale extrapolation of findings from formal helping situations to
day-to-day support settings (Armstrong, 1998; Cramer, 1987; Gelso & Karl, 1974;
Thomas & Levine, 1994), and to date there remains little critical examination of
Western Journal of Communication 3
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the impact of active listening techniques outside of formal helping relationships.
1
Evidence exists that skills such as paraphrasing and asking open questions can be
taught to informal helpers like spouses (Garland, 1981), supervisors (Kubota,
Mishima, & Nagata, 2004), parents (Graybill, 1986), and teachers (McNaughton,
Hamlin, McCarthy, Head-Reeves, & Schreiner, 2008), and there is strong evidence
that engaging in certain active listening responses affects the listener (Lewis &
Manusov, 2009; Notarius & Herrick, 1988; Perrine, 1993). Interestingly, although
informal helping situations constitute the majority of the enacted support we receive
in our daily lives (Cowen, 1982), there is little evidence that lay helpers should or do
enact strategies derived from the active listening paradigm.
Ultimately, we are left with the assumption that active listening is beneficial to
help seekers without compulsory empirical verification. If the active listening
techniques championed in the formal helping literature insufficiently explain key
outcomes of troubles talk conversations, then alternative models of supportive listen-
ing should be forwarded and explored. It seems, however, that the introduction of
any alternative model is necessarily limited due to the prevalence of active listening
in our lay and scholarly vernacular. Thus, a key contribution of this article is to pro-
vide an empirical test of the active listening paradigm in the context of troubles talk.
How Should Active Listening Be Beneficial in Troubles Talk?
Research on enacted support has been primarily concerned with two classes of effects.
First, supportive behaviors can influence message evaluations, or ‘‘the judgments
recipients make about the degree to which messages are helpful, supportive, and sensi-
tive’’ (Bodie, Burleson, & Jones, 2012, p. 3; emphasis added), with these three adjec-
tives reflecting the perceived instrumental, relational, and emotional benefits of any
given supportive behavior. Active listening is posited as evaluatively positive on each
of these three dimensions. Of the 40 themes Goldsmith, McDermott, and Alexander
(2000) derived from participant reports of their understanding of the terms helpful,
sensitive, and supportive, listening and three other closely related terms—
understanding, caring, and helps clarify ideas (see Bodie, St. Cyr, Pence, Rold, &
Honeycutt, 2012; Imhof & Janusik, 2006)—were the top four themes, constituting
nearly a third of the total responses. An additional 21% of the remaining themes
are related to lay notions of good listening.
2
It seems, therefore, that good support
is contingent on adequate listening (Bodie, Vickery, & Gearhart, 2013; Jones, 2011;
Jones & Bodie, 2014).
By paraphrasing and using tag questions while being nonverbally immediate, lis-
teners are likely to be seen as more sensitive or emotionally aware than listeners who
do not demonstrate recognition and involvement in these ways. In a similar manner,
these behaviors seem to signal an acknowledgment of how the partner is feeling.
Acknowledgement has been recognized as a desired macrolevel listening process in
close relationships (Pecchioni & Halone, 2000); having a listener who can ‘‘get the
meaning’’ or otherwise ‘‘summarize key points,’’ thus reflects relational loyalty and
assurance (Bodie, 2011). Finally, while engaged in supportive interactions,
4 G. D. Bodie et al.
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‘‘people’s capacity to overcome their own emotions in order to help others may be
limited’’ (Barbee, Rowatt, & Cunningham, 1998, p. 289). Thus, active listening
techniques that stress withholding the projection of one’s own emotions or view-
points also may be more helpful than techniques that insist on a particular viewpoint.
Indeed, exploration of thoughts and feelings is a hallmark of good support (Burleson
& Goldsmith, 1998). Combined, this logic leads us to our first hypothesis, that
perceived helpfulness, sensitivity, and supportiveness vary as a function of active
listening:
H1: Active listening techniques contribute significantly to evaluations of supportive
conversations as helpful, sensitive, and supportive.
The second primary class of supportive communication effects is message out-
comes, the ‘‘more distal effects of supportive [behaviors] ...[such as] the degree to
which [they] generate cognitive (e.g., appraisals), affective (e.g., emotions), and=or
behavioral (e.g., coping) change’’ (Bodie, Burleson, et al., 2012, p. 3). Although asses-
sing the degree to which active listening promotes perceptions of helpers and their
instrumental, relational, and emotional utility is important, ‘‘emotional support
is primarily about alleviating upset’’ (Jones & Wirtz, 2006, p. 217). Even more distal
outcomes such as physical health and mental well-being ‘‘are generally viewed as
influenced by affective change, which is why [affect change is regarded] as the critical
variable in studies of emotional support’’ (Burleson, 2010, p. 176). Curiously, how-
ever, affect change seems the least studied outcome in the supportive communication
literature; thus, testing the impact of active listening techniques on a distressed
other’s affect change is crucial.
Active listening should make people feel better for several reasons. First, the
relationship between message evaluations and message outcomes has been estab-
lished, suggesting that when people evaluate supportive behaviors positively there
is a concomitant positive change in affect (Bodie, Burleson, et al., 2012; High &
Dillard, 2012). Second, active listening is likely to encourage disclosers to express dif-
ficult feelings. Indeed, support providers who are more attentive and conversationally
responsive elicit more detailed disclosures from distressed others (Miller, Berg, &
Archer, 1983; Tokic & Pecnik, 2010) and are more likely to provide appropriate
responses to those disclosures (Clark, 1993). Related research demonstrated that
emotional disclosure assists in the coping process, especially when that disclosure
is met with a responsive interlocutor (Jones, 2004; Jones & Wirtz, 2006; Maisel &
Gable, 2009). Finally, active listening is proposed as helping to establish a warm
environment, a place where disclosers feel relaxed and able to talk about feelings
without fear of being judged negatively (Burleson & Goldsmith, 1998). Formally,
H2: Active listening techniques contribute significantly to reports of affect
improvement as the result of a supportive conversation.
Although active listening is posited to produce primarily positive effects during
troubles talk, active listening is not universally supportive as research finds active
listening responses can produce negative affect in disclosers (Nugent, 1992). Such
Western Journal of Communication 5
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findings led Nugent and Halvorson (1995) to speculate that the particular behaviors
which constitute active listening may have differential effects on outcomes. Research
exploring the contribution of particular verbal and nonverbal behaviors on troubles
talk outcomes showed that specific verbal behaviors (e.g., verbal person centeredness)
and specific nonverbal behaviors (e.g., eye contact) each contribute to positive
perceptions and affect change but to varying degrees (Winstead, Derlega, Lewis,
Sanchez-Hucles, & Clarke, 1992). For instance, while certain nonverbal behaviors
have consensually recognizable interpretations, others can engender various effects;
still other nonverbal behaviors such as touch clearly are inappropriate in particular
relational or communicative contexts (Burgoon, Buller, Hale, & deTurck, 1984;
Burgoon & Newton, 1991; Coker & Burgoon, 1987). Other work has shown instru-
mental responses to generate more positive change when compared to simple reflec-
tion of meaning and understanding (Barnett & Harris, 1984). Finally, verbal displays
of enacted support can be stronger predictors of message evaluations and outcomes
than nonverbal behaviors (Jones & Guerrero, 2001); a similar pattern of results also
has been found with individual reports of listening (Bodie, St. Cyr, et al., 2012). Thus,
it is possible that, as a gestalt, active listening techniques engender more positive
evaluations and outcomes, while certain active listening behaviors may not be con-
tributing to these outcomes. Based on the above logic, we propose the following
research question:
RQ1: What is the relative importance of specific active listening behaviors to the
evaluations of supporter helpfulness, sensitivity, and supportiveness, and
reported affect change after a supportive conversation?
Methods
Participants
In total, 301 undergraduate students (175 females, 116 males, 10 not reporting sex)
enrolled in Communication Studies courses at Louisiana State University A&M par-
ticipated in this study and voluntarily provided demographic information. Students
ranged in age from 18 to 52 (M ¼ 20, Mdn ¼ 20, SD ¼ 4.24, 21 missing) and most
frequently reported a Caucasian identity (n ¼ 215; 73.9%; 10 participants missing);
others reported African American (n ¼ 44; 15.1%), Asian (n ¼ 9; 3.1%), Hispanic
(n ¼ 8; 2.7%), and ‘‘other’’ (n ¼ 13). Participants reported majoring in all undergrad-
uate academic programs offered by the University and represented all class ranks:
freshmen (n ¼ 78), sophomores (n ¼ 93), juniors (n ¼ 65), and seniors (n ¼ 53). All
participants received a modest amount of research credit (3% of their total course
grade).
Trained Active Listeners
In order to e nsure adequat e variabilit y in the use of active listening techniques,
we employed eight (7 females, 1 male) masters’ students enrolled in the University’s
6 G. D. Bodie et al.
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Counseling Education program. All students were in the final y ear of the program
and had received classroom training in active listening, including listening in a way
that displays acceptance, congruence, and empathy by engaging in various nonver-
bal immediacy behaviors, and by asking open questions, paraphrasing, reflecting
feelings, and using check outs. In addition, at the time of data collection, each
active listener was employed t hrough the Program’s internship mechanism in a
job that required her or him t o engage in these behaviors on a daily basis. Prior
to running the study, each active listener was interviewed by the first author, briefed
on the study procedures, and allowe d a mple t ime to prepare for hi s or her confed-
erate role. Prior to each conversation, active listeners were provided a reminder
sheetthatdefinedandgaveexamplesofeach active listening behavior of interest
to this study.
Procedure
Undergraduate students were provided with a brief description of the study and then
signed up for a specific time slot using an electronic system. After signing up, the
undergraduate students received a confirmation e-mail containing a link to a survey.
The survey first displayed a human subjects statement to comply with University IRB
protocol; students then completed various measures, including self-report measures
not germane to the current study and the voluntary demographic information
summarized above.
Research assistants greeted participants at their scheduled lab time, ensured the
participants had not met previously, and provided all participants with a consent
form. They then briefly described the study (using a standard script) and instructed
participants to draw slips of paper to randomly assign the conversational roles of
problem discloser or listener. In conditions involving an active listener, confederates
were given the opportunity to draw first and had been instructed to select the role of
listener. Based on the role assignments, there were 130 untrained and 41 trained
listener–discloser dyads.
After assignment to condition, participants were separated to complete various
individual measures. Trained listeners were provided with a reminder sheet outlining
the active listening behaviors (see above). During this time, disclosers identified and
rated two recent distressing events, and a research assistant informed the discloser
which event to disclose (for similar procedures, see Jones & Guerrero, 2001). Prob-
lematic events included mainly everyday stressors common to college students (e.g.,
academic stressors, relationship spats and dissolution, roommate problems). Disclo-
sers then completed measures related to the event, after which they were reunited
with the listener to engage in a 5-minute conversation. Participants sat approximately
3 feet from each other in facing chairs. Research assistants gave all instructions for the
conversations at this point, then left the room and allowed participants to get
acquainted for 1 minute.
3
Participants were left alone for 5 minutes to converse,
and the entire conversation was video- and audio-recorded for later data analysis.
After the 5-minute conversation session, participants were separated for a final time
Western Journal of Communication 7
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and completed various evaluative measures of the conversation and partner. Only
relevant measures are outlined below.
Coding Interactions
The videotaped interactions were assessed by two sets of independent coders. For
both sets of coders, training consisted of a) a discussion of the relevant construct
(e.g., immediacy, paraphrasing, reflecting feelings); b) discussing and visually demon-
strating the level of each verbal and nonverbal cue; c) coding videotaped interactions;
and d) discussing and adjusting differences in coding. When training the coders, scale
endpoints were conceptualized to fit the specific cue. For example, a high level of eye
contact was conceptualized as exhibiting eye contact 80% or more of the time,
whereas a low level of eye contact was conceptualized as exhibiting eye contact only
20% of the time or less. Coders assessed the listener’s verbal and nonverbal cues
twice: once after the first half of the conversation and then again after the second half
of the conversation. Coders were allowed to stop, rewind, and fast-forward the videos
as much as they needed. Interitem correlations across Times 1 and 2 were quite
high (rs > .65) and homogeneous across all cues, suggesting that there were only
minor coder variations in the first and second half of the conversations. Cues for both
Times 1 and 2 were consequently collapsed within the verbal and nonverbal coding
rubrics.
Listeners’ nonverbal immediacy cues were coded with a modified version of
Andersen, Andersen, and Jensen’s (1979) nonverbal immediacy scale. Two research
assistants blind to the study’s purpose were trained by the fourth author for
approximately 4 hours over two meeting sessions. The modified immediacy scale
consisted of nine immediacy cues (e.g., ‘‘orient her=his body toward the other
person,’’ ‘‘smile when it’s appropriate’’) and one global immediacy evaluation. All
cues and the global assessment were prefaced with the stem ‘‘To what extent is=does
the person(’s) ...’’ and were evaluated with 7-point scales (1 ¼ not at all ;7¼ very
much). The average intraclass correlation, based on 40 dyads, was .81.
Listeners’ verbal behaviors were assessed by five coders who scored paraphrasing,
reflecting feelings, open questions, and check outs using 5-point scaling (0 ¼ Never;
4 ¼ Always). Three coders (different from those who coded NVI) scored interactions
featuring the untrained helpers (n ¼ 130), and an additional two coders scored
interactions featuring the trained listeners (n ¼ 41). Interrater reliability, calculated
with Krippendorff’s a on a subset of the data not used in training, was .68 for
untrained dyads and .78 for trained dyads.
Although hypothesis tests are not fully reliant on between-group differences (i.e.,
our predictions are concerned with techniques not listeners of particular classes, per
se), it is important to establish that active listening techniques were being employed
and that utilizing trained listeners was a beneficial strategy to elicit them. Evidence in
support of this claim comes from the fact that the variance in all five verbal behaviors
almost doubled with the inclusion of the active listener group (average ¼ .85) relative
to the untrained listeners (average ¼ .45); the same was not true of the nonverbal
8 G. D. Bodie et al.
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immediacy behaviors (.982 vs .963), suggesting that untrained listeners may naturally
exhibit some active listening behaviors.
To assess whether trained active listeners exhibited higher levels of nonverbal
immediacy than did untrained listeners, we inspected both the overall presence of
immediacy as well as each individual immediacy cue. For the combined scale, active
listeners (M ¼ 4.84, SD ¼ .36) were statistically different from their normal counter-
parts (M ¼ 4.66, SD ¼ .41), t (164) ¼ 2.56, p ¼ .01, though the effect was small,
r
2
¼ .05. This trend was not consistent across all behaviors. As seen in Table 1, trained
listeners were primarily more immediate with regard to eye contact, head nods, and
vocal pleasantness (as well as the overall rating), with eye contact and head nods
exhibiting moderate effect sizes. Untrained listeners were more immediate with regard
to forward lean and body orientation, although these effects were small; there were no
differences for smiling, facial pleasantness, open body orientation, and animation.
As a complementary analysis with the verbal behaviors, we inspected both the
overall presence of these behaviors as well as each individual behavior. Active listeners
(M ¼ 2.60, SD ¼ .72) were statistically more verbally active than their normal coun-
terparts (M ¼ 1.16, SD ¼ .53), t (163) ¼ 13.72, p < .001, and the effect of this differ-
ence was large, r
2
¼ .56. Each behavior also was in the correct direction, although
Table 1 Trained Coder Manipulation Check Analyses for Individual Nonverbal
Immediacy Behaviors
Nonverbal Behavior Condition MSD t df p r
2
Smiling Untrained – Student 4.64 1.35 1.32 164 .19 .01
Active – Confederate 4.31 1.39
Eye Contact Untrained – Student 5.12 1.01 5.51 162 .000 .27
Active – Confederate 6.01 .24
Head Nods Untrained – Student 4.38 1.33 7.35 164 .000 .39
Active – Confederate 5.94 .32
Facial Pleasantness Untrained – Student 5.18 .83 1.91 164 .06 .03
Active – Confederate 4.90 .80
Forward Lean Untrained – Student 4.06 .74 2.78 164 .01 .06
Active – Confederate 3.71 .58
Body Orientation Toward Person Untrained – Student 5.69 .42 2.67 164 .01 .06
Active – Confederate 5.49 .40
Open Body Orientation Untrained – Student 4.46 .81 .43 164 .67 .001
Active – Confederate 4.53 .80
Animation Untrained – Student 3.42 1.46 1.24 164 .22 .01
Active – Confederate 3.10 1.23
Vocal Pleasantness Untrained – Student 4.77 .72 3.71 164 .000 .11
Active – Confederate 5.23 .56
Global NVI Rating Untrained – Student 4.86 .72 2.97 164 .003 .08
Active – Confederate 5.23 .54
Western Journal of Communication 9
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there was no significant difference for open questions or check outs (see Table 2).
4
It appears that employing expert confederates for active listening is a reasonable
strategy to elicit some but not all active listening behaviors.
Dependent Variables
Message evaluation (ME)
Participants were asked to evaluate listeners on 11 semantic differential items
(7-point) (Goldsmith et al., 2000). The three-factor (helpful, sensitive, supportive)
model was adequate, v2 (51) ¼ 143.15, p < .001, CFI ¼ .92, RMSEA ¼ .10 (.08, .12),
ks > .53, as were the subscale reliabilities (problem solving utility a ¼ .80; relational
assurance a ¼ .82, emotional awareness a ¼ .84).
Message outcomes (MO)
Affect improvement was measured using four items from the Clark et al. (1998)
Comforting Response Scale, based on recommendations found in Jones (2004). Each
item reflected the affective state of the discloser as the result of the conversation (e.g.,
I feel better after talking with my conversational partner) and, thus, are appropriate
indicants of MO as opposed to ME. The fit was adequate, v2 (2) ¼ 4.91 p ¼ .09,
CFI ¼ .99, RMSEA ¼ .09 (.00, .20), ks > .73, as was internal consistency (a ¼ .88).
Correlations presented in Table 3 show that ME and MO are only moderately
correlated, suggesting that they are distinct judgments made of these behaviors.
Results
Tests of hypotheses and answers to research questions were assisted by multiple
regression techniques. With alpha set at .05, 171 total dyads, and 13 total predictors,
power to detect small effects (f
2
¼ .02) was .16, power to detect moderate effects
(f
2
¼ .15) was .92, and power to detect large effects (f
2
¼ .35) was above .99. For
thoroughness, bivariate correlations are presented in Table 3.
Table 2 Trained Coder Manipulation Check Analys es for Individual Verbal Response
Behaviors
Verbal Behavior Condition MSD t df p r
2
Open Questions Untrained – Student 1.04 .74 1.64 163 .10 .02
Active – Confederate 1.30 1.16
Paraphrasing Untrained – Student .99 .92 10.87 163 .000 .47
Active – Confederate 2.89 1.08
Reflecting Feelings Untrained – Student .51 .74 7.53 163 .000 .25
Active – Confederate 1.76 1.34
Check Outs Untrained – Student .02 .14 1.70 163 .09 .13
Active – Confederate .10 .50
Global Rating Untrained – Student 1.98 .69 9.92 163 .000 .47
Active – Confederate 3.17 .57
10 G. D. Bodie et al.
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Table 3 Bivariate Associations between All Study Variables
1 2 3 4 5 6 7 8 9 1011121314151617
1. Smiling 1
2. Eye Contact 0.08 1
3. Head Nods .18
.65
1
4. Facial
Pleasantness
.74
0.02 0.13 1
5. Forward Lean 0.09 0.31
.25
0.02 1
6. Body
Orientation
0.19
0.51
.45
0.05 .32
1
7. Open Body
Posture
0.13 0.09 0.12 .20
0.06 .16
1
8. Animation 0.06 .33
.20
0.12 .40
.32
.16
1
9. Vocal
Pleasantness
.20
.27
.35
.26
0.03 .20
0.12 0.03 1
10. Open
Questions
0.06 0.04 0.01 0.08 .19
0.11 .17
.24
0.09 1
11. Paraphrasing 0.14 .24
.31
0.14 0.12 0.14 0.11 0.07 .29
.27
1
12. Reflecting
Feelings
0.01 0.08 .27
0.08 0.04 0.04 0.01 0.06 .27
.31
.51
1
13. Check Outs 0.01 0.06 0.04 0.02 0.09 0.04 0.06 0.06 0.05 0.13 .21
0.11 1
14. ME - PSU 0.04 0 0.01 0.03 0.14 0.1 0.01 0.14 0.05 .21
.17
0.14 0.08 1
15. ME - RA 0.01 0.06 0.08 0.04 0.08 0.02 0.01 0.03 0.01 0.05 .17
0.08 0.09 .68
1
16. ME - EA 0.14 0.11 0.08 0.05 0.09 0.08 0.02 0.07 0.1 0.08 .31
.20
.02 .69
.79
1
17. Affect
Change
0.03 0.13 0.09 0.1 0.05 0.05 0.1 0.02 0.05 .20
.16
0.12 0.10 .40
.23
.17
1
Correlation is significant at the 0.05 level (2-tailed).
Correlation is significant at the 0.01 level (2-tailed).
11
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Preliminary Analyses
The problems disclosed in these interactions represented mild stressors common to
college students. Across both conditions, the average problem rating was 5.08
(SD ¼ 1.10; R ¼ 2–7) on a scale from 1 (‘‘not at all emotionally distressing’’) to 7
(‘‘very emotionally distressing’’). The average problem rating in the trained condition
(n ¼ 41; M ¼ 4.95, SD ¼ 1.24) was statistically similar to the average rating in the
untrained condition (n ¼ 130; M ¼ 5.12, SD ¼ 1.06), t (169) ¼ .87, p ¼ .39.
The types of problems disclosed represented seven general categories of personal
stressors, including academic problems, car problems, employment problems, family
problems, health problems, pet problems, relationship problems, and other stressors.
Half of the problems disclosed represented academic problems (n ¼ 86; 50.2%),
including problems in the classroom (e.g., failing tests) and other problems unique
to academic settings (e.g., applying to nursing school, switching majors); the category
percentages and example problems for the seven categories are summarized in
Table 4.
Tests of Hypotheses and Answers to Research Questions
The first two hypotheses predicted that active listening techniques contribute signifi-
cantly to evaluations of supportive conversations as helpful, sensitive, and supportive
(H1) and to reports of affect improvement after the conversations (H2). Each
hypothesis was tested by regressing each outcome measure on the set of nonverbal
immediacy and verbal responses. In support of H1, the overall model was significant
for emotional awareness (see Table 5), though models for problem-solving utility and
relational awareness did not receive support. In support of H2, the model for affect
improvement achieved statistical significance at the conventional level (see Table 5).
To answer RQ1, which asked about the relative importance of individual behaviors
for evaluations and affect improvement, individual relative importance statistics
were computed for the two statistically significant main effects models (Johnson &
LeBreton, 2004).
5
Judged by relative weights as a percentage of R
2
, there was
a different relative importance pattern for each dependent variable (see Table 5).
For Emotional Awareness, the only behaviors to contribute more than 10% to
model R
2
were paraphrasing and reflecting feelings. The former contributed almost
half of the total model R
2
suggesting that emotional awareness is primarily commu-
nicated through the use of paraphrasing discloser statements. Indeed, paraphrasing
was the only behavior to share more than 5% variance with emotional awareness;
all other behaviors shared less than 2%. On average, the verbal behaviors were more
important to the prediction of emotional awareness than the nonverbal behaviors.
For Affect Improvement, five behaviors contributed over 10% to model R
2
,
namely eye contact, facial expressions, open questions, paraphrasing, and check outs.
While the strongest predictor was open questions, the substantive contribution of
this behavior was only 3%, suggesting that any single behavior cannot account
fully for affect change resulting from the conversation. On average, the verbal
12 G. D. Bodie et al.
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Table 4 Categories and Descriptions of Problems Disclosed
Category and Overall
Percentage General Description Verbatim Examples
Active
(Confederate)
Untrained
(Student)
Academic Problems
(n ¼ 86; 50.2%)
(a) Problems relating to classroom performance ‘‘Taking calculus test’’ ‘‘a lot of tests coming up’’ n ¼ 17 n ¼ 46
(b) Problems relating to the larger
college experience
‘‘getting into nursing school’’ ‘‘6 am volleyball practices’’ n ¼ 3 n ¼ 20
Car Problems
(n ¼ 5; 2.9%)
Problems with transportation
or tickets
‘‘Car wreck (hit & run)’’ ‘‘I was on my way
going home & my car died’’
n ¼ 1 n ¼ 4
Employment
Problems
(n ¼ 9; 5.3%)
Problems with internships or
employment
‘‘Internship interviews’’ ‘‘Got laid off from
my job’’
n ¼ 3 n ¼ 6
Family Problems
(n ¼ 26; 15.2%)
Problems with family members ‘‘Death of a family member’’ ‘‘Sister moving
away’’
n ¼ 7 n ¼ 19
Health Problems
(n ¼ 5; 2.9%)
Problems with personal health ‘‘Knee surgery’’ ‘‘Surgery on my back for pole vaulting’’ n ¼ 0 n ¼ 5
Pet Problems
(n ¼ 5; 2.9%)
Problems with companion animals
‘‘Dog dying’’ ‘‘Raising a puppy’’ n ¼ 2 n ¼ 5
Relationship Problems
(n ¼ 28; 16.3%)
(a) Problems with intimate dating partners ‘‘Difficult breakup’’ ‘‘Long-distance relationship’’ n ¼ 0 n ¼ 5
(b) Problems with friends or
roommates
‘‘Best friend expressed ‘love’ feelings’’ ‘‘My
best friend and I had a fight’’
n ¼ 7 n ¼ 11
Other Problems
(n ¼ 7; 4.1%)
Problems unable to be categorized ‘‘Air force officer training school’’ ‘‘Squirrel
in my attic’’
n ¼ 1 n ¼ 9
13
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behaviors were stronger predictors of affect change than were nonverbal behaviors,
mirroring results from the model predicting emotional awareness.
Discussion
Although scholars and practitioners alike stress the importance of paraphrasing,
reflecting feelings, checking assumptions, asking open-ended questions, and being
nonverbally immediate, relatively little attention has been paid to the impact of these
behaviors outside of formal helping relationships. Thus, our study provides an
important empirical check for the claims that techniques found to work for therapists
and clinical social workers are appropriate for more mundane stressors. Textbooks
are replete with recommendations to engage in active listening behaviors such as
paraphrasing, especially when ‘‘listening to support others’’ (Wood, 2010, p. 162).
Descriptions of highly person-centered helpers from more scholarly outlets also stress
behaviors such as asking open-ended questions, paraphrasing, and reflective feelings
because they are thought to signal unconditional positive regard and a sincere will-
ingness to help. Although not explicitly labeled as such, Burleson (2003; see especially
Table 5 Relative Importance Analysis of Verbal and Nonverbal Listener Responses
for RQ1
Emotional Awareness Affect Change
Overall Model Statistics
F (13, 160) ¼ 1.99,
p ¼ .02, R
2
¼ .14
F (13, 160) ¼ 1.79,
p ¼ .05, R
2
¼ .13
Relative Importance of
Individual Behaviors
%R
2
(substantive
contribution %)
%R
2
(substantive
contribution %)
Smiling 9.2 (1.0) 2.2 (0.3)
Eye Contact 7.8 (1.0) 11.8 (1.5)
Head Nods 2.5 (0.4) 2.8 (0.4)
Face 2.1 (0.3) 10.2 (1.3)
Lean 6.9 (1.0) 2.4 (0.3)
Body Orientation 6.3 (0.9) 6.6 (0.9)
Open Body Posture 1.4 (0.3) 6.7 (0.9)
Animation 2.0 (0.3) 1.7 (0.2)
Voice 2.3 (0.3) 0.8 (0.1)
Total NVI 40.5 (5.5) 45.2 (5.9)
Average ¼ 4.5 (0.61) Average ¼ 5.02 (0.66)
Open Questions 1.2 (0.2) 23.1 (3.0)
Paraphrasing 44.5 (6.2) 13.2 (1.7)
Reflect Feelings 13.1 (1.8) 4.7 (0.6)
Check Outs 0.6 (0.01) 13.6 (1.8)
Total Verbal 59.4 (8.21) 54.6 (8.6)
Average ¼ 14.9 (2.05) Average ¼ 13.65 (2.15)
14 G. D. Bodie et al.
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p. 580) referred to the use of several active listening techniques when discussing the
behavioral strategies available to manifest a person-centered approach to comforting.
Indeed, the conceptualization of person-centered comforting, which is the most com-
monly used proxy for ‘‘good support,’’ was partially derived from the active listening
paradigm of Carl Rogers (see also Bodie & Jones, 2012; Bodie et al., 2013; Burleson &
Goldsmith, 1998; Jones, 2011; Jones & Bodie, 2014).
Overall, the results of our study suggest mixed support for the active listening
paradigm within the context of troubles talk, results that have larger theoretical
and practical payoffs to the research in supportive communication. First, although
as a group, the set of four verbal and nine nonverbal active listening behaviors con-
tributed to reports of emotional awareness and affect improvement, these same beha-
viors did not contribute to perceptions of problem-solving utility or relational
assurance. Goldsmith et al. (2000) suggested that judgments of emotional awareness
‘‘are associated with legitimating, elaborating, and acknowledging the feelings
another person is experiencing’’ (p. 373). The behaviors that formed the operationa-
lization of active listening in this study largely are posited to provide a sense of
acceptance and emotional recognition, and so this result seems to provide a type
of construct validity for these behaviors within informal helping conversations.
One reason these same behaviors did not influence relational assurance or the degree
to which they reflect ‘‘relational loyalty’’ may be methodological: Our sample of
participants were strangers; thus, similar work with friends and other types of
relationally close individuals is needed to assess the utility of active listening beha-
viors in those sorts of conversations. At the same time, however, we chose strangers
for valid reasons. First, by employing strangers we were able to compare the results of
our studies to past work exploring supportive communication, as the primary dyadic
pairing used is unacquainted individuals. Second, training relationally close partners
to engage in active listening behaviors introduces its own set of relevant challenges,
not the least of which is these close others’ ability to behave ‘‘naturally.’’ Future work
should attempt to solve these logistical concerns as the role of active listening within
close relationships is an important issue.
In terms of helpfulness ratings, perhaps the role of active listening behaviors is not
to provide problem-solving utility; that is, asking questions and paraphrasing
may provide little ‘‘informational and instrumental benefits’’ to a stressed other
(Goldsmith et al., 2000, p. 387). Importantly, however, these same behaviors did
influence reports of emotional improvement after the conversation. Given the nature
of the task asked of disclosers, perhaps they felt better in part because the active
listening behaviors did not attempt to solve a problem but instead created a sense
of emotional awareness. Future research should continue to explore the role of these
(and other) active listening behaviors, attempting to determine what judgments and
more distal outcomes they do (and do not) influence as well as exploring competing
theoretical models that explore various cognitive, physiological, and behavioral
mechanisms underlying these effects.
Second, the magnitude of effects was relatively small, suggesting that the enact-
ment of active listening behaviors is not a panacea. Our findings, however, are not
Western Journal of Communication 15
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all that discrepant from research exploring other forms of enacted support. For
instance, Jones and Guerrero (2001) reported that nonverbal immediacy and verbal
person centeredness accounted for just under 20% of the variance in comforting
quality
6
; Jones (2004) reported an even smaller effect for affect improvement at
7%, an effect of similar magnitude as that reported by Bodie (2012), who explored
how mean arterial pressure and heart rate varied as a function of receiving high
and low person-centered support (variance explained, 7–11%). Thus, it appears that
the behaviors highlighted in this study have a similarly small to moderate influence
on supportive conversation outcomes, perhaps due in part because they might con-
stitute person-centered speech in a supportive context (Jones & Bodie, 2014). Future
work is needed that attends to additional behaviors deemed important to ‘‘good’’ lis-
tening, such as interruptions, that are not directly implicated in existing models of
enacted support. Likewise, there is a need to explore how variability within behaviors
such as the types of open questions asked (e.g., Healing & Bavelas, 2011) or variations
in how to formulate another person’s event or feelings (e.g., Korman et al., 2013) can
affect outcomes in specific ways. Indeed, a primary contribution of supportive com-
munication scholarship to the more general social support literature is to document
patterns of variability of specific types of behavior and the degree to which these pat-
terns map onto important outcomes.
Our results also appear to replicate the finding from Jones and Guerrero (2001)
that verbal behaviors are more important to the prediction of supportive conver-
sation outcomes than their nonverbal counterparts. We are not convinced, however,
that the distinction between ‘‘verbal’’ and ‘‘nonverbal’’ is the best explanation. Per-
haps, instead, what we have replicated is the operation of generic and specific
responding (Bavelas & Gerwing, 2011). Very simply, generic responding includes
those familiar and ubiquitous utterances such as ‘‘hmm’’ or actions such as head
nods that can go anywhere in a narrative, while specific responding includes utter-
ances and actions that are tied to particular points of a story. Interestingly, all of
the verbal behaviors included in this study seem to map nicely onto specific respond-
ing, while the nonverbal actions seem to map nicely onto generic responding. Of
course, nonverbal behaviors can be used in very specific ways (and verbal in generic
ways); thus, experimental studies that attempt to manipulate these two orthogonal
constructs are warranted.
A complementary explanation comes from the work of Clark (1996), who suggested
(in a manner similar to what we find with implicit theories of listening; see Bodie, St.
Cyr, et al., 2012) that listening behaviors signal attending, understanding, and identifi-
cation. As part of a joint contribution to discourse, typical listening behaviors operate to
signal to disclosers that they are understood well enough for current purposes and that
there is a building of mutual knowledge between interlocutors. In initial viewings of our
videotaped data, our research team noted consistently that conversations with fewer
signals of listening do not flow as smoothly, stories are not told as coherently, and
disclosers are more likely to do things like repeat themselves and provide verbal indica-
tions that it is hard to think of what to say next, a finding we later recognized in the work
of Bavelas (Bavelas, Coates, & Johnson, 2000, 2002; Bavelas & Gerwing, 2011).
16 G. D. Bodie et al.
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But why the verbal-over-nonverbal pattern? Clark provided an explanation in his
chapter on grounding, in which he asserted that contributions to discourse are
achieved in two main phases, the presentation phase and the acceptance phase. As
part of the acceptance phase, listeners can engage in a range of behaviors, some of
which will provide more valid evidence of understanding. In particular, Clark laid
out four types of positive evidence of understanding with displays and exemplifica-
tions offering more explicit evidence of understanding than assertions and presuppo-
sitions. In this framework, listening is a joint construal problem—the listener and the
speaker are collaboratively settling on what the speaker is to be taken to mean. As
related to the verbal and nonverbal findings, we have instead an explicit versus
implicit uptake of a speaker’s proposition with some forms of listener behavior help-
ing the joint construal process more than others.
It is important to note that in addition to these theoretical musings, it is also true
that most listeners were highly immediate, regardless of whether they were trained or
untrained. In particular, fewer than 15% of listeners were coded below the midpoint
(4) on the global immediacy scale; for most of the behaviors the modal score was 6.
This may suggest that normative pressures for listeners to be immediate were strong
in these conversations, a finding that seems in line with speculation offered by Jones
and Guerrero (2001). Similarly, as the results from the manipulation check showed,
there was little difference between trained and untrained listeners with respect to
enacted immediacy behaviors. As a result of a lower amount of variability, NVI
may not have been fully able to capture variability in the dependent variables. At
the same time, even in the experimental work of Jones, in which both verbal and non-
verbal behaviors were manipulated along three levels (and all of these combinations
crossed), verbal behaviors were still much more important in the prediction of out-
comes. If future work replicates our data that untrained listeners tend to naturally
exhibit high levels of NVI, and that verbal behaviors are relatively more influential
to outcomes, one important practical implication is that training efforts should focus
more on verbal as opposed to nonverbal techniques, or at least a more limited subset
of the latter behaviors because they appear to occur naturally and have less of an
impact on outcomes.
Limitations and Future Research Directions
In order to investigate the verbal and nonverbal behaviors in these interactions, one
noted limitation is our decision to define, code, and investigate the broader instances
of behavior. There are certainly different ways in which listeners can paraphrase,
reflect feelings, ask questions, and check interpretations, but the current investigation
examined the general occurrence of these behaviors rather than focus on the variation
and differences within these particular behaviors. The inherent variability in these
verbal behaviors is grounds for future theoretical and empirical investigation,
accompanied with closer textual analyses in order to identify potential differences
in the construction and effectiveness of these verbal behaviors. In addition, seven
of the eight confederates were female, therefore disallowing a comparison of
Western Journal of Communication 17
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confederate sex in our analyses. Future work should seek to balance the enactment of
active listening by various types of support providers.
Additionally, bringing participants into the laboratory and having them engage in a
troubles talk conversation with a stranger, although allowing for experimental control
and a variety of other benefits, certainly has questionable ecological validity which
must be acknowledged due to the formal setting, timed conversation with an unfam-
iliar partner, and the presence of recording devices. However, with no manipulation of
listeners’ verbal and nonverbal behaviors, the observed behaviors represent natural-
istic behavior as opposed to behavior constrained by having to act in a manner pre-
determined by a researcher. Derlega et al. (1994) argued, ‘‘Despite the limitations of
the laboratory setting, the direct observation of social support is crucial in advancing
our understanding of this phenomenon’’ (p.149) as it provides a greater understand-
ing of how supportive communication helps another feel better after sharing an
emotional event. Examining supportive behaviors in conversation is important to bet-
ter understand supportive communication, active listening, and the coping process.
Funding
This study was supported by the Louisiana Board of Regents through the Board of
Regents Support Fund (Grant # LEQSF[2011-14]-RD-A-04).
Notes
[1] Perhaps the most sustained attention to active listening is within tests of marital enrichment
programs (Bowling, Hill, & Jencius, 2005). While many of these programs have produced
evidence of success, they are not without their critics (Gottman, Coan, Carrere, & Swanson,
1998; Hafen & Crane, 2002). Most relevant to our argument, these programs include active
listening as one of several components to marital therapy and do not tease out the effects of
active listening behaviors. Moreover, most of these programs are situated in the context of
marital conflict rather than providing beneficial support.
[2] Those themes were ‘‘being there’’ (n ¼ 40), ‘‘gives advice’’ (n ¼ 38), ‘‘perceptive’’ (n ¼ 30),
‘‘touch’’ (n ¼ 18), ‘‘asks questions’’ (n ¼ 14), ‘‘eye contact’’ (n ¼ 9), and ‘‘friendly’’
(n ¼ 7). See Bodie, St. Cyr, et al. (2012) for reference to how these themes align with lay
notions of good listening and Bodie et al. (2013) for similar results suggesting the terms sup-
portive person and supportive listener are reported as virtually isomorphic.
[3] Research assistants were trained to use a script to maintain consistent instructions to listen-
ers and disclosers. Disclosers were told by the research assistant to ‘‘talk about the event that
you and I identified. Talk about what happened and what made this particular event so dis-
tressing, how the event made you feel, and why it’s still painful=distressing now. Take your
time and make sure to provide your conversational partner, (Listener name) with as much
information as is necessary and as you feel comfortable disclosing.’’ Listeners were told to
‘‘respond as you normally would respond in a conversation about emotionally distressing
events with your friends. So this is just a regular conversation meaning that, (Listener name),
you talk too; it is just that we focus on (discloser’s name) topic.’’ The full script is available
from the first author upon request.
[4] We additionally conducted a discriminant function analysis to predict group membership
from the coded nonverbal immediacy and verbal active listening responses. Using the aggre-
gate data for each behavior group, 87.5% of original grouped cases were correctly classified.
18 G. D. Bodie et al.
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Using the individual behaviors, 93% of the original grouped cases were correctly classified.
Thus, listener behaviors (verbal and nonverbal) seem to discriminate between trained and
untrained listeners (i.e., trained and untrained listeners are enacting support differently).
Details of these analyses are available from the first author upon request.
[5] This method defines relative importance as ‘‘[the] proportionate contribution each predictor
makes to R
2
, considering both its direct effect (i.e., its correlation with the criterion) and its
effect when combined with the other variables in the regression equation’’ (p. 240). Their
relative importance analysis consists of (a) transforming the original predictors to their
‘‘maximally related orthogonal counterparts’’ (p. 249); these counterparts are (b) ‘‘then used
to predict the criterion’’ (p. 249). The formula for the raw relative weight (e
j
) is the sum of
all the products of (c), the relative contribution of the original criterion to each orthogonal
criterion, and (d), the relative importance of the transformed criterion variables to the
dependent variable. When these weights are ‘‘rescaled by dividing them by the model R
2
and multiplying by 100, they may be interpreted as the percentage of the model R
2
associated
with each predictor’’ (p. 251).
[6] In their study, Jones and Guerrero (2001) used 14 bipolar adjective pairs to assess comforting
quality. These items included those more appropriately classified as assessing only one of the
three ratings assessed in this study.
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