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The comfort in touch: Immediate and lasting effects of handholding on emotional pain


Abstract and Figures

Consoling touch is a powerful form of social support that has been repeatedly demonstrated to reduce the experience of physical pain. However, it remains unknown whether touch reduces emotional pain in the same way that it reduces physical pain. The present research sought to understand how handholding with a romantic partner shapes experiences of emotional pain and comfort during emotional recollection, as well as how it shapes lasting emotional pain associated with emotional experiences. Participants recalled emotionally painful memories or neutral memories with their partners, while holding their partner’s hand or holding a squeeze-ball. They additionally completed a follow-up survey to report how much emotional pain they associated with the emotional experiences after recalling them in the lab with their partners. Although consoling touch did not reduce emotional pain during the task, consoling touch increased feelings of comfort. Moreover, participants later recalled emotional memories that were paired with touch as being less emotionally painful than those that were not paired with touch. These findings suggest that touch does not decrease the immediate experience of emotional pain and may instead support adaptive processing of emotional experiences over time.
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The comfort in touch: Immediate and lasting
effects of handholding on emotional pain
Razia S. SahiID
*, Macrina C. Dieffenbach
, Siyan Gan
, Maya LeeID
, Laura I. HazlettID
Shannon M. Burns
, Matthew D. Lieberman
, Simone G. Shamay-Tsoory
, Naomi
I. Eisenberger
1Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of
America, 2School of Education and Psychology, Pepperdine University, Malibu, CA, United States of
America, 3Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, United
States of America, 4Department of Psychology, University of Haifa, Haifa, Israel
Consoling touch is a powerful form of social support that has been repeatedly demonstrated
to reduce the experience of physical pain. However, it remains unknown whether touch
reduces emotional pain in the same way that it reduces physical pain. The present research
sought to understand how handholding with a romantic partner shapes experiences of emo-
tional pain and comfort during emotional recollection, as well as how it shapes lasting emo-
tional pain associated with emotional experiences. Participants recalled emotionally painful
memories or neutral memories with their partners, while holding their partner’s hand or hold-
ing a squeeze-ball. They additionally completed a follow-up survey to report how much emo-
tional pain they associated with the emotional experiences after recalling them in the lab
with their partners. Although consoling touch did not reduce emotional pain during the task,
consoling touch increased feelings of comfort. Moreover, participants later recalled emo-
tional memories that were paired with touch as being less emotionally painful than those
that were not paired with touch. These findings suggest that touch does not decrease the
immediate experience of emotional pain and may instead support adaptive processing of
emotional experiences over time.
Three out of four people report that their most painful life experience was emotional in nature,
rather than physically painful [1]. Emotional pain, defined as an unpleasant feeling (or suffer-
ing) associated with a psychological, non-physical origin, often stemming from thwarted psy-
chological needs [2], undergirds a range of psychiatric issues, including depression, anxiety,
borderline personality disorder, and suicidal ideation [3,4]. Given the prevalence of emotional
pain, and the negative outcomes associated with such pain, it is crucial to examine how indi-
viduals effectively cope with and process it.
When we experience negative events or hardships, support from others can mitigate the
harmful effects of those experiences and buffer us from trauma or prolonged distress [5]. For
example, talking through our problems or finding a welcome distraction during a tough time
PLOS ONE | February 9, 2021 1 / 15
Citation: Sahi RS, Dieffenbach MC, Gan S, Lee M,
Hazlett LI, Burns SM, et al. (2021) The comfort in
touch: Immediate and lasting effects of
handholding on emotional pain. PLoS ONE 16(2):
Editor: Hedwig Eisenbarth, Victoria University of
Wellington, NEW ZEALAND
Received: August 14, 2020
Accepted: January 26, 2021
Published: February 9, 2021
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
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editorial history of this article is available here:
Copyright: ©2021 Sahi et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: Data cannot be
shared publicly because our IRB states that data
may be shared only with principle investigators
with verifiable credentials at an academic research
can be valuable in helping us to regulate our emotions [6]. But there are also powerful forms of
social support that more implicitly communicate understanding and concern, such as when a
loved one holds our hand [7,8]. This type of physical support, often referred to as consoling
touch, is observed across species and across cultures [9], and has been shown to reliably reduce
the experience of physical pain [1012]. Notably, however, research has yet to experimentally
assess whether touch reduces the subjective experience of emotional pain in the same way that
it reduces the subjective experience of physical pain.
Extensive research has documented the importance of physical touch in emotional wellbe-
ing. From a developmental perspective, touch plays a vital role in infants’ physical develop-
ment, neurodevelopment, stress relief, and the development of attachment [1315]. From a
therapeutic perspective, touch is thought to provide comfort and facilitate healing [1619].
While research suggests that touch can increase positive feelings like security, and decrease
negative feelings like stress [19], the majority of research on the pain-relieving effects of touch
have focused on how consoling touch affects individuals experiencing physical pain, such as
treatment-related pain, or painful shocks administered in experimental settings. This work
suggests that handholding, especially with a romantic partner, attenuates subjective distress
associated with physical pain, as well as activation in neural regions associated with threat
responses [1012,20,21].
A body of research suggests that physical pain and emotional pain are processed in overlap-
ping neural regions [2224], although the extent of this overlap is still debated [25]. While
physical pain and emotional pain differ insofar as physical pain has a sensory component (e.g.
stinging, burning) [26] and emotional pain stems from psychological events rather than physi-
cal stimulation [2], they both involve an affective component (e.g. unpleasantness, distress).
Prior research suggests that consoling touch reduces the affective component of physical pain
[27], suggesting that consoling touch also has the potential to reduce the subjective unpleasant-
ness associated with emotional pain.
A recent study suggests that consoling touch can increase subjective feelings of comfort and
decrease responsivity in affective-pain related neural regions such as the anterior cingulate cor-
tex and anterior insula during negative emotional experiences [28]. However, it remains an
open question whether consoling touch reduces subjective feelings of emotional pain, such as
the pain of social rejection, in the same way that it reduces subjective feelings of physical pain,
like the pain of receiving a physical shock. One (though not the only) notable difference
between emotional and physical pain is that physical pain is often temporally bound (i.e.
restricted to a certain amount of time), whereas emotional pain is often more enduring. Thus,
it is possible that physical and emotional pain differ in terms of how consoling touch shapes
their immediate and lasting experience.
The current investigation
This study applied a novel approach to understanding the emotional benefits of touch by
examining how handholding with a romantic partner, one form of consoling touch, shapes
experiences of emotional pain and comfort during emotional recollection, as well as how it
shapes lasting emotional pain associated with emotional experiences. Participants recalled
emotionally painful memories or neutral memories with their partners, while either holding
their partner’s hand or holding a squeeze-ball. Building on extensive research demonstrating
the role of consoling touch in reducing physical pain, we hypothesized that handholding dur-
ing the emotionally painful memories would result in lower feelings of emotional pain and
greater feelings of comfort from their romantic partner as compared to holding a squeeze-ball.
Since relationship satisfaction often moderates the effect of social support on wellbeing
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PLOS ONE | February 9, 2021 2 / 15
institution. Data access queries can also be sent to
the IRB at Our
data and analysis materials are also hosted on the
Open Science Framework for researchers who
meet the criteria for access to confidential data:
Funding: This work was supported by grant
funding from the United States – Israel Binational
Science Foundation awarded to Drs. Naomi
Eisenberger (N.I.E.) and Simone Shamay-Tsoory
(S.S.) (grant number 2015068).
Competing interests: The authors have declared
that no competing interests exist.
outcomes [2931], including the effect of handholding on the experience of physical pain [10],
we additionally hypothesized that relationship satisfaction would play a moderating role in the
effect of touch on emotional pain and comfort, such that greater relationship satisfaction
would enhance the soothing effects of touch. Finally, participants completed an exploratory
follow-up survey to assess whether there were any lasting effects of handholding on the experi-
ence of emotional pain. In other words, we aimed to test whether emotional memories paired
with handholding in the lab would later be recalled with less emotional pain than those that
were paired with holding a squeeze-ball. Given the exploratory nature of this follow-up study,
this data is considered preliminary in elucidating how consoling touch potentially shapes the
lasting experience of emotional pain.
The University of California Los Angeles (UCLA) Institutional Review Board (IRB) has
approved this study (IRB#17–001474). UCLA’s Federal-Wide Assurance (FWA) with Depart-
ment of Health and Human Services is FWA00004642. Informed written consent was obtained
for all participants.
We recruited 60 male-female romantic couples (N= 120 individuals) from the UCLA campus
and surrounding community through flyers and emails. All couples were in relationships for
at least 6 months (mean relationship length = 7.37 months). All interested participants sepa-
rately completed an email interview to assess eligibility for participation; prospective partici-
pants who reported having any psychiatric or neurological disorder, or any serious physical
illness, were not enrolled in the study. As part of this study, we also measured neural changes
in participants using functional near infrared spectroscopy. These neural data were designed
to serve as exploratory pilot data for a future neuroimaging study. However, because of this
component of the study, all participants were required to be right-handed. The final sample
(mean age = 21.81 years) included approximately 30% White, 32% Asian/Asian American,
11% Latino/a, 2% Filipino/a, 2% Black, and 11% multiracial participants. The remaining par-
ticipants chose another identity or preferred not to answer.
Sample size rationale
The rationale for our sample size derives from recently published work on affective touch [12,
32,33]. Since these studies found effects of touch on pain with samples of 16–43 dyads, we
aimed to obtain a sample of 60 dyads for our within-subjects design.
Session 1. This study included two sessions. At session 1, which took approximately 1
hour, we assigned each person within the couple to be either the “storyteller” (i.e., the person
experiencing emotional pain) or the “listener” (i.e., the comforting partner). The storyteller in
this study is the person who would ultimately receive support, and the listener is the person
who would give support. Half of the male participants were assigned to be the person receiving
support and the other half were assigned to be the person giving support so that we could
examine potential gender differences in our outcome variables. Both participants completed
questionnaires, and then the listener, i.e. the support giver, left the lab.
Then, the person assigned to receive support recounted stories about past experiences. For
these stories, participants began by completing a form that allowed us to select which negative
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stories they would recount based on: (a) whether the experience was emotionally painful at the
time of the event and (b) whether they were comfortable discussing the experience on camera.
This form is available on our OSF repository (titled: “Story Selection”). After selecting which
stories they would share, participants recounted a total of 4–5 unrehearsed stories, each lasting
about 3 minutes, as we video recorded them. Two stories were about neutral experiences, such
as walking around their current residence or campus. Another 2–3 stories were about negative
social experiences, such as betrayal, loneliness, loss, or rejection. We specifically asked partici-
pants not to discuss experiences that involved a former romantic partner so that they would
not feel discomfort at later watching these recordings with their current romantic partner.
Participants were asked to focus their stories on how they felt at the time of the event, how
they dealt with their feelings, and how they feel about the event now. To clarify, participants
were not imagining emotional pain. Rather, they were being asked to reflect on and relive their
own personal emotionally painful experiences by describing negative events from their past
and the feelings those memories brought up in detail [34,35]. This method for manipulating
emotion is consistent with countless studies that have used writing or talking about past emo-
tional experiences to evoke an emotional response [36,37], as opposed to using impersonal
standardized stimuli to induce negative affect.
During each of the recordings, the experimenter waited outside of the experiment room so
that participants could recount their stories in privacy. The camera was continuously rolling
throughout the session. Reminders for each prompt were presented via Qualtrics. Once the
participant was ready to tell their story, they would flip a 3-minute hourglass to help them
keep track of time and speak towards the camera. After each story, they responded to questions
on Qualtrics about how they felt while sharing the stories (i.e. “emotional pain at first recall”,
see Measures for more details). At the end of the session, participants were reminded not to
discuss the content of these videos with their partners until after session 2, which was approxi-
mately 1 week after session 1.
Before session 2, two experimenters independently watched the set of videos to ensure par-
ticipants appropriately followed the study instructions. As they watched each video, they were
asked to provide an overall rating on a scale of 1–10, 10 being the highest, based on the follow-
ing question: “To what extent did the participant experience emotional pain in the video?” For
videos to be considered similar enough for our experimental manipulation in session 2, ratings
had to be within at least two points of each other (e.g. 9 and 7). Each rater selected the two vid-
eos that they rated as most similar based on the above question. Videos additionally had to be
approximately the same length (within 18 s, about 10 seconds of the total video length). If the
two raters agreed on which two videos were most similar, those videos were prepared for use
in session 2. If the raters disagreed (approximately 22% of the time), a third rater was asked to
provide a rating. If no consensus was reached, or no two videos approximately matched on
emotionality and length, the couple was excluded from participating in session 2 (see Exclu-
sion Criteria for details).
Session 2. At session 2, which took approximately 1.5 hours, the romantic couples
returned to the lab together to watch 2 neutral and 2 negative videos recorded at session 1.
Prior to each video, they were cued via PsychoPy to either hold hands or hold a squeeze ball
such that participants underwent four conditions in a randomized order: (a) hand-holding
during a negative video (i.e. consoling touch condition); (b) hand-holding during a neutral
video (i.e. touch only control condition); (c) holding a squeeze ball during a negative video
(emotional pain only control condition); and (d) holding a squeeze ball during a neutral video
(full control condition).
After each video, participants underwent a minute of “rest” which involved closing their
eyes as they continued to hold their partner’s hand or hold the squeeze ball. After the rest, they
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heard a beep that cued them to turn their attention to their laptops to answer questions via
Qualtrics about their feelings, including “how much pain”, “how hurt”, “how sad”, “how
angry”, “how much stress or anxiety”, “how emotional”, and “how comforted by their partner”
they felt on a Likert scale of 1 to 10. The first six items were used to measure “emotional pain
during the task”, whereas the last item measured “comfort during the task” (see Measures for
more detail). Following these questions, participants completed a shape match task for 1 min-
ute to distract them from the previous video in preparation for watching the next video.
Throughout the task, participants sat on opposite sides of a curtain from each other to pre-
vent them from communicating verbally or through other non-verbal cues (e.g. body language,
facial expressions). Both participants could hear and see the videos on a single screen on the
wall across from them, such that the support receiver and support giver experienced the sti-
muli simultaneously. During the two handholding conditions, they held hands through the
curtain. Thus, participants were aware of the presence of their partner in all four conditions,
but their contact was limited to the two conditions that included touch. Experimenters waited
outside of the testing room to allow participants some privacy, but monitored the session
using Google Hangouts (with participants’ permission) to ensure that the task ran smoothly
and that participants followed instructions. At the end of all four story-videos, participants
completed a brief end-of-study questionnaire.
Exclusion criteria. Participants were not invited to return to the lab for session 2 if the
videos they recorded at session 1 were unusable, either because of technological issues with the
recordings or because they did not follow the video prompt instructions. Ten couples were not
eligible for session 2 for this reason. Two additional couples dropped out of the study after ses-
sion 1 due to scheduling issues. One additional couple was removed from analyses due to tech-
nological issues during session 2, leaving a total of 47 couples in the sample.
Follow-up survey. To examine potential lasting effects of consoling touch on emotional
pain, participants who received support completed a brief exploratory follow-up survey. These
surveys were sent out electronically after we completed in-lab data collection for all of our
dyads. Thus, participants completed the survey between 1.28 and 7.82 months after session 2
(M= 4.01 months). Because we decided to add this follow-up assessment to our investigation
while data collection was ongoing, this portion of the project was an exploratory addition to
the original research plan. These surveys included personalized cues to remind participants of
the emotional stories they shared (e.g. “When you participated in our study you recorded a
video about the loss of your grandmother.”), followed by questions about how much emotional
pain they associated with those memories, including how much pain they experienced at the
time of the event, and how much pain they experience when thinking about the event now (i.e.
lasting emotional pain, see Measures for more detail). We received responses from 79% of our
couples (N= 31).
Emotional pain at first recall. To account for the fact that different memories can elicit
differing amounts of emotional pain, we asked participants to rate the extent to which they felt
different negative emotions on a scale of 1 to 10 during each video recording at session 1.
These negative emotion ratings included “how much pain”, “how hurt”, “how sad”, “how
angry”, “how much stress or anxiety”, and “how emotional” they felt. Cronbach’s alpha for
these items on conditions involving emotional content (negative video 1: α= 0.90; negative
video 2: α= 0.91) indicated a high degree of covariance between the six individual items. Thus,
the items were averaged into a single “emotional pain at first recall” composite for each of the
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stories that we used to control for differences in the relative painfulness of reliving the different
Emotional pain and comfort during the task. To assess how participants felt when
recalling the memories with their partner, and either holding hands or holding a squeeze-ball,
we asked them the same set of negative emotion questions used to create the “emotional pain
at first recall” composite described above. Once again, Cronbach’s alpha indicated a high
degree of covariance between the six individual negative affect items (consoling touch condi-
tion: α= 0.92; emotional pain only condition: α= 0.92). Thus, the items were averaged into a
single “emotional pain during the task” composite for each condition.
Meanwhile, “comfort during the task” was assessed with a single item asking participants
how comforted they felt by their romantic partners as they recalled each memory on a scale of
1 to 10. To test the association between participants’ emotional pain and comfort, we exam-
ined the correlation between these variables in each condition. These variables were correlated
during the consoling touch condition, r= 0.47, p<0.01, and the emotional pain only condi-
tion, r= 0.30, p= 0.04, but not during the touch only condition (i.e. holding hands during a
neutral video), r= 0.14, p= 0.37, or the full control condition (i.e. holding a squeeze-ball dur-
ing a neutral video), r= 0.03, p= 0.83. Since emotional pain and comfort represent related but
distinct concepts, they were maintained as separate outcome variables.
Lasting emotional pain. To assess whether touch shaped the lasting experience of emo-
tional pain, we asked participants the following questions in a follow-up survey on a Likert scale
of 1 to 10: (a) “How much pain did you experience at the time of the event that you described in
that video?” and (b) “When you think about this experience now, how much pain do you expe-
rience?” The first question would serve as a baseline assessment of how participants recalled
feeling at the time that the event originally occurred, and the second question would indicate
how much emotional pain they currently associated with the event (i.e. lasting emotional pain).
Relationship satisfaction. As a measure of relationship satisfaction, participants com-
pleted the 32-item version of the Couples Satisfaction Index (CSI), which includes items such
as “I have a warm and comfortable relationship with my partner” and “I really feel like part of
a team with my partner” [38]. The full scale can be accessed through our OSF repository.
Statistical analyses
For our analyses, we used the statistical package R (Version 1.2.1335) to create linear mixed
models (LMMs, i.e. multilevel regression) with participant ID as the group level variable, fixed
effects, and random intercepts. We used the “lmer” package in R, which by default uses the Sat-
terthwaite degrees of freedom method and bases confidence intervals and p-values on the t-
distribution. This analytic approach allowed us to account for non-independence of errors due
to our repeated-measures design, which would result in underestimated standard errors and
inflated risk of type I error, while also providing more modeling flexibility than repeated-mea-
sures ANOVA. Since repeated-measures ANOVA only uses list-wise deletion, multilevel
regression is additionally better at accounting for missing data, and therefore has greater statis-
tical power than repeated-measures ANOVA. Data and analysis materials can be accessed
through Open Science Framework upon request to the first author.
As a first step, we conducted exploratory analyses to investigate potential gender differences
in our primary outcome variables (i.e. emotional pain, comfort) by running LMMs with
valence of the videos, touch, gender, and interactions between them as predictor variables.
There were no significant main effects or interactions with gender on any of the outcome vari-
ables (p’s >0.05). Thus, gender was not included in any subsequent models. A full report of
these analyses is included in our S1 File.
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To test how touch shaped emotional outcomes for participants as they recalled the memo-
ries with their partners, we ran two separate LMMs with emotional pain during the task and
how comforted they felt by their partner as the outcome variables. These models included
valence of the videos (negative vs. neutral), touch (hand vs. ball), and the interaction between
them as predictors. To account for potential differences in the emotional intensity of the differ-
ent memories being recalled, we included the measure of emotional pain at first recall
(assessed at session 1) as a covariate in these analyses.
To follow-up on these analyses, we conducted tukey-adjusted pairwise comparisons with a
focus on the contrast between the consoling touch condition and the emotional pain only con-
trol condition (i.e. holding a squeeze-ball during a negative video) to examine the following
hypotheses: (1) participants’ emotional pain will be significantly lower during consoling touch
than emotional pain only, and (2) participants’ comfort will be significantly higher during con-
soling touch than emotional pain only.
Both of these models (assessing the effect of consoling touch on participants’ emotional
pain and comfort) were then re-run with participants’ relationship satisfaction (i.e. CSI) as a
possible moderator of the association between consoling touch and emotional pain/comfort.
These models included valence, touch, relationship satisfaction, and interactions between
them as predictors, and emotional pain at first recall as a covariate. We followed up on signifi-
cant interaction terms that included relationship satisfaction by obtaining estimated marginal
means for our model using the “emmeans” package. This method uses the given model to
approximate the outcome variable at different levels of a continuous moderator, adjusting for
other variables in a model [39].
To analyze the results of our follow-up survey probing potential lasting effects of consoling
touch, we ran a separate LMM with touch as the predictor and participants’ current emotional
pain when thinking about the event as the outcome variable. To clarify, valence was not
included in this model because the follow-up survey only asked about the two negative emo-
tional memories, not the two neutral memories. To account for potential differences in the
emotional intensity of the different memories being recalled, we included how participants
recalled feeling at the time of the event (assessed at follow-up) as a covariate in this analysis.
We then ran this analysis with relationship satisfaction as a possible moderator of the effect of
touch on current emotional pain. To assess whether the amount of time between the in-lab ses-
sion and the follow-up survey affected the results, we also ran the model with time as an addi-
tional control variable. Finally, since this follow-up study involved a smaller subset of
participants than our primary analyses, we re-ran our primary analyses using this smaller sub-
set of participants to ensure consistency in our results (see S1 File for a full report of these anal-
yses and accompanying figures).
Does consoling touch decrease emotional pain?
Controlling for potential differences in the emotional intensity of the different memories
being recalled (i.e. emotional pain at first recall), b= 0.49, t(175.83) = 9.96, p<.001, 95% CI =
[0.39, 0.59], there was a significant main effect of valence, b= -1.18, t(170.47) = -4.47, p<.001,
95% CI = [-1.69, -0.66], no main effect of touch, b= -0.05, t(136.18) = -0.28, p= 0.78, 95% CI =
[-0.44, 0.33], and no interaction between valence and touch, b= 0.05, t(135.50) = 0.16,
p= 0.87, 95% CI = [-0.50, 0.59], on how much emotional pain participants felt. Participants
felt significantly more emotional pain during the negative videos (M= 4.17, SD = 1.82) than
the neutral videos (M= 1.23, SD = 0.35) (Fig 1A). Contrary to our hypothesis, pairwise com-
parisons indicated no significant difference between how much emotional pain participants
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felt during the consoling touch condition versus the emotional pain only condition, t(136) =
0.28, p= 0.99, 95% CI = [-0.46, 0.57]. When including participants’ relationship satisfaction
scores in the model as a potential moderator, we found that relationship satisfaction did not
moderate the effects of touch, b= 0.01, t(132.48) = 1.17, p= 0.24, 95% CI = [-0.01, 0.04],
valence, b= 0.00, t(132.48) = 0.37, p= 0.71, 95% CI = [-0.02, 0.03], or the interaction between
touch and valence on participants’ emotional pain, b= -0.02, t(132.45) = -1.03, p= 0.31, 95%
CI = [-0.05, 0.01].
Does consoling touch increase feelings of comfort from one’s partner?
Controlling for potential differences in the emotional intensity of the different memories
being recalled (i.e. emotional pain at first recall), b= 0.22, t(177) = 2.09, p= 0.04, 95% CI =
[0.01, 0.44], there was no main effect of valence, b= 0.12, t(160.71) = 0.22, p= 0.83, 95% CI =
[-0.98, 1.23], a significant main effect of touch, b= 2.80, t(131.95) = 6.74, p<.001, 95% CI =
[1.99, 3.61], and no interaction between valence and touch, b= -0.84, t(131.35) = -1.43,
p= 0.15, 95% CI = [-1.98, 0.30], on how comforted participants felt by their partner. Partici-
pants felt more comforted by holding their partners’ hand (M= 5.2, SD = 2.82) than by holding
a squeeze ball (M= 2.77, SD = 2.16) (Fig 1B). Consistent with our hypothesis, pairwise com-
parisons indicated that participants felt significantly more comforted during the consoling
touch condition (M= 5.98, SD = 2.59) than the emotional pain only condition (M= 3.11,
SD = 2.01), t(133) = -6.74, p<.001, 95% CI = [-3.88, -1.72].
When including participants’ relationship satisfaction scores in the model as a potential
moderator, we found that relationship satisfaction did not moderate the association between
valence by touch and comfort, b= -0.05, t(128.22) = -1.42, p= 0.16, 95% CI = [-0.11, 0.02], or
the association between valence and comfort, b= 0.00, t(128.23) = 0.16, p= 0.88, 95% CI =
[-0.04, 0.05], but did significantly moderate the association between touch and comfort,
b= 0.07, t(128.27) = 2.96, p= .004, 95% CI = [0.02, 0.11]. While relationship satisfaction did
not enhance comfort during the squeeze-ball conditions, b= 0.02, t(74.4) = 0.04, p= 0.97, it
did enhance comfort during handholding such that those with high relationship satisfaction
Fig 1. Handholding does not decrease emotional pain, but does increase comfort. Participants’ feelings of
emotional pain (A) and comfort (B) plotted by touch and valence conditions. Participants felt more emotional pain
during the negative videos than the neutral videos, and felt more comforted whenhandholding during the negative
video (i.e. consoling touch) than holding a squeeze-ball during the negative video.
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reported greater comfort during handholding (EMM = 5.97) as compared to those with low
relationship satisfaction (EMM = 4.39), b= 1.59, t(74.6) = 2.82, p= .006 (Fig 2).
Is there a lasting effect of consoling touch on how emotionally painful
events are recalled?
When controlling for emotional pain at the time of the original emotional event (“How much
pain did you experience at the time of the event that you described in that video?”), b= 0.50, t
(54.03) = 5.37, p<.001, 95% CI = [0.32, 0.69], touch significantly predicted current pain about
the emotional memory (“When you think about this experience now, how much pain do you
experience?”), b= -0.58, t(29.02) = -2.24, p= 0.03, 95% CI = [-1.09, -0.07]. Specifically, partici-
pants’ current pain when recalling the past event was lower for the emotionally painful mem-
ory that was previously paired with handholding (M= 3.74, SD = 2.08) as opposed to the
emotionally painful memory that was previously paired with holding a squeeze ball (M= 4.26,
SD = 1.88) (Fig 3). When including relationship satisfaction as a moderator in the model, we
did not find a significant interaction between touch and relationship satisfaction, b= -0.02, t
(28.06) = -0.75, p= 0.46, 95% CI = [-0.06, 0.02].
In addition, when controlling for emotional pain at the time of the original emotional
event, b= 0.50, t(53.38) = 5.33, p<.001, 95% CI = [0.32, 0.69], and the amount of time that
passed between the in-lab manipulation and the completion of the follow-up survey, b= -0.00,
t(28.35) = -0.78, p= 0.44, 95% CI = [-0.01, 0.00], we still found a significant effect of touch on
current emotional pain, b= -0.58, t(29.05) = -2.24, p= 0.03, 95% CI = [-1.09, -0.07]. Further-
more, when using our measure of emotional intensity from the in-lab portion of the study (i.e.
emotional pain at first recall), b= 0.44, t(57.32) = 3.81, p<.001, 95% CI = [0.21, 0.66], instead
of participants’ self-reported emotional pain at the time of the original event assessed at fol-
low-up, we still found a significant effect of touch on current emotional pain, b= -0.59, t
(29.76) = -2.15, p= 0.04 95% CI = [-1.12, -0.05].
A robust body of work demonstrates that consoling touch can reduce the affective experience
of physical pain [1012], and that physical pain and emotional pain share a common neural
system [22–24, c.f. 25]. Intuitively, then, we may assume that consoling touch reduces subjec-
tive reports of emotional pain. Surprisingly, however, our results indicate that consoling touch
does not decrease the immediate subjective experience of emotional pain relative to holding a
squeeze ball in the presence of one’s romantic partner. But, it does lead individuals to feel
more comforted by their partner than holding a squeeze ball, particularly when they have
greater relationship satisfaction with their partner. This finding is in line with other work sug-
gesting that consoling touch increases subjective feelings of comfort during emotional pain
[28], and that relationship satisfaction plays an important role in how we feel during consoling
touch [10]. We found no effect of gender on our outcome variables. Given that the majority of
touch studies have only examined female participants [10,12,21], with some work finding
gender differences during the experience of physical pain [20], further research is needed to
clarify how gender shapes the outcome of consoling touch.
A somewhat surprising finding was that participants’ feelings of emotional pain and com-
fort were positively correlated in the emotional conditions, particularly during consoling
touch. Intuitively, comfort and emotional pain seem to be opposite experiences, such that feel-
ing comforted by a social support figure should result in lower subjective emotional pain.
However, participants in our study reported feeling more comfort from their partners as they
experienced greater emotional pain, suggesting that emotional pain may be to some extent
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Fig 2. Relationship satisfaction moderates the effect of handholding on feelings of comfort. While relationship satisfaction did not enhance comfort
during the squeeze-ball conditions, it did enhance comfort during handholding such that those with high relationship satisfaction had greater comfort
during handholding as compared to those with low relationship satisfaction.
Fig 3. Negative memories that are associated with handholding in the lab are later recalled with lower emotional
pain. Emotional pain when recalling a negative emotional memory at follow-up plotted by touch condition (hand or
ball). Participants felt significantly less pain recalling an emotional memory after that memory was paired in the lab
with handholding as compared to holding a squeeze ball.
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necessary to feel comforted. In other words, people may feel the most comforted when such
comfort is needed (i.e. there is something to comfort them about). This finding is interesting
to consider in terms of how negative emotional experiences are socially regulated, and whether
feelings of comfort simply provide a source of positive affect during a negative emotional expe-
rience, as opposed to decreasing the negative affect associated with that experience.
This set of findings suggests a potentially important difference between emotional pain and
physical pain in terms of how negative experiences are regulated in these two contexts. During
physical pain, it may be adaptive to down-regulate immediate distress, particularly in a lab setting
where the pain is not necessarily helpful in recognizing and escaping some sort of threat. How-
ever, during emotional pain, down-regulating immediate distress may not always be adaptive
since such distress may be stemming from personally meaningful events that need to be processed
and reflected on over time. Indeed, research suggests that individuals often feel motivated to expe-
rience negative emotional states because they are helpful in navigating certain experiences (e.g.
anger when preparing for a conflict, sadness in coping with a loss), even if those emotional states
feel unpleasant [4042]. Thus, subjective distress may be necessary to some extent to process emo-
tional memories in a way that supports adaptive long-term outcomes and resolution. This idea is
consistent with research demonstrating that exposure to negative emotional stimuli (e.g. spiders
for phobic patients) can be instrumental in reflecting on and changing harmful cognitions associ-
ated with those stimuli over time [43,44]. In other words, we may need to feel certain emotions
in order to process and learn from them, allowing us to heal and regulate over time.
Although preliminary, a particularly interesting finding is that emotional memories that
were paired with touch were later recalled with less emotional pain than those paired with
holding a squeeze-ball. While this finding is novel with regards to the effect of touch on emo-
tional memories, it is interesting in light of other research showing that close others can acti-
vate feelings of safety, which can have lasting effects on fear-learning processes [45,46]. Thus,
it is possible that consoling touch promotes a feeling of safety while recalling emotionally pain-
ful memories, facilitating a form of counter-conditioning that diminishes the negative affect
associated with the painful memory [47].
Ultimately, this study indicates an interesting distinction between the social regulation of
physical and emotional pain via touch, and suggests that while consoling touch can be helpful
in both contexts, it may be helpful in different ways. Although this study sheds light on the
potential benefits of consoling touch in emotional contexts, it is only a preliminary step in
understanding how consoling touch supports emotional well-being. The potential lasting effect
of consoling touch on the experience of emotional memories particularly warrants future
investigation, and boundaries on this effect should be explored in terms of when and how
changes in emotional pain take place, and whether the experience of such emotional memories
is related to other measures of well-being. Additionally, future work can build on these find-
ings to more specifically target certain mechanisms that might predict the magnitude of these
effects, and explain possible pathways through which consoling touch shapes the immediate
and lasting experience of emotional pain.
Supporting information
S1 File.
We are thankful for thoughtful feedback on study design and results from members of the
UCLA Social and Affective Neuroscience Lab and UCLA Social Cognitive Neuroscience Lab.
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Author Contributions
Conceptualization: Razia S. Sahi, Macrina C. Dieffenbach, Shannon M. Burns, Matthew D.
Lieberman, Naomi I. Eisenberger.
Data curation: Razia S. Sahi, Macrina C. Dieffenbach, Siyan Gan, Maya Lee, Laura I. Hazlett.
Formal analysis: Razia S. Sahi, Macrina C. Dieffenbach.
Funding acquisition: Simone G. Shamay-Tsoory, Naomi I. Eisenberger.
Investigation: Razia S. Sahi, Naomi I. Eisenberger.
Methodology: Razia S. Sahi, Naomi I. Eisenberger.
Project administration: Siyan Gan, Maya Lee.
Resources: Shannon M. Burns, Matthew D. Lieberman, Naomi I. Eisenberger.
Software: Shannon M. Burns.
Supervision: Macrina C. Dieffenbach, Naomi I. Eisenberger.
Writing – original draft: Razia S. Sahi, Naomi I. Eisenberger.
Writing – review & editing: Razia S. Sahi, Macrina C. Dieffenbach, Shannon M. Burns, Mat-
thew D. Lieberman, Simone G. Shamay-Tsoory, Naomi I. Eisenberger.
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... Even in adult life, as postulated by Morrison (2016), pleasant touch can serve as an important stress buffer, as it might promote bodily allostasis by activating some of the key brain nodes involved in stress regulation. Finally, pleasant touch has recently been shown to improve wellbeing during stressful situations such as COVID (Von Mohr et al., 2021), emotional pain (Sahi et al., 2021), and physiological stress (Triscoli et al., 2017). ...
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This mini-review covers recent works on the study of pleasant touch in patients with chronic pain (CP) and its potential use as a treatment. While experiments have demonstrated that pleasant touch, through the activation of CT-afferents and the brain regions involved in its affective value, might reduce the unpleasantness and intensity of induced pain, the interaction between pleasant touch and CP remains under-examined. Some experiments show that CP might disrupt the positive aspects of receiving pleasant touch, while in other studies the perception of pleasantness is preserved. Moreover, only a few attempts have been made to test whether touch can have a modulatory effect on CP, but these results also remain inconclusive. Indeed, while one recent study demonstrated that CT-touch can diminish CP after a short stimulation, another study suggested that pleasant touch might not be sufficient. Future studies should further investigate the psychological and neural interplay between pleasant touch and CP. In the conclusion of this mini-review, we propose a new tool we have recently developed using immersive virtual reality (IVR).
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Partners play an important role in both the general well-being and the care needs of patients. The dynamic between brain tumor treatment and patients’ families is a complex bidirectional relationship. Cancer diagnosis and treatments which leave patients compromised impact the nature and quality of their relationships, and these in turn impact the ability of their partners to care for them. This paper will review the nature of the impact of diagnosis and treatment on relationships and how couples and families respond to the disruption of cancer treatments. The impact of how emotional and social pain effect their relationships and their ability to engage in care will be addressed.
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Interpersonal touch and social support can influence physical health, mental well-being, and pain. However, the mechanisms by which supportive touch promotes analgesia are not well understood. In Study 1, we tested how three kinds of social support from a romantic partner (passive presence, gentle stroking, and handholding) affect pain ratings and skin conductance responses (SCRs). Overall, support reduced pain ratings in women, but not men, relative to baseline. Support decreased pain-related SCRs in both women and men. Though there were no significant differences across the three support conditions, effects were largest during handholding. Handholding also reduced SCRs in the supportive partner. Additionally, synchronicity in couples' SCR was correlated with reductions in self-reported pain, and individual differences in synchrony were correlated with the partner's trait empathy. In Study 2, we re-analyzed an existing dataset to explore fMRI activity related to individual differences in handholding analgesia effects in women. Increased activity in a distributed set of brain regions, including valuation-encoding frontostriatal areas, was correlated with lower pain ratings. These results may suggest that social support can reduce pain by changing the value of nociceptive signals. This reduction may be moderated by interpersonal synchrony and relationship dynamics.
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Social touch may modulate emotions, but the neurobehavioral correlates are poorly understood. Here, we investigated neural responses to a picture of a deceased close person and if neural activity and connectivity are modulated by social touch from one's romantic partner. Using functional magnetic resonance imaging (fMRI) we found altered reactivity in several brain areas including the anterior cingulate cortex (ACC) and the anterior insula in response to the personal picture compared to a picture of an unfamiliar person. Hand holding with the romantic partner, compared to being alone, reduced reactivity in the ACC and cerebellum and provided subjective comfort. To separate physical touch from the emotional effect of partner presence, we evaluated hand holding with the partner relative to a stranger, and found reduced reactivity in the anterior insula. Connectivity between the anterior insula and the ACC was reduced during partner touch, and the connectivity strength were negatively related to attachment security, with higher reported partner security associated with weaker connectivity. Overall, holding hands with one's partner attenuates reactivity in emotional brain areas and reduces between-region connectivity.
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People often recruit social resources to manage their emotions, a phenomenon known as interpersonal emotion regulation (IER). Despite its importance, IER’s psychological structure remains poorly understood. We propose that two key dimensions describe IER: (1) individuals’ tendency to pursue IER in response to emotional events, and (2) the efficacy with which they perceive IER improves their emotional lives. To probe these dimensions, we developed the Interpersonal Regulation Questionnaire (IRQ), a valid and reliable measure of individual differences in IER. Factor analyses of participants’ responses confirmed tendency and efficacy as independent dimensions of IER (Study 1; N = 285), and demonstrated independence between how individuals engage with IER in response to negative, versus positive, emotion. In Study 2 (N = 347), we found that individuals high in IER tendency and efficacy are more emotionally expressive, empathetic, and socially connected. Two subsequent studies highlighted behavioral consequences of IER dimensions: people high in IER tendency sought out others more often following experimentally-induced emotion (Study 3; N = 400), and individuals high in IER efficacy benefitted more from social support after real-world emotional events (Study 4; N = 787). Finally, a field study of social networks in freshman dormitories revealed that individuals high in IER tendency and efficacy developed more supportive relationships during the first year of college (Study 5; N = 193). These data (i) identify distinct dimensions underlying IER, (ii) demonstrate that these dimensions can be stably measured and separated from related constructs, and (iii) reveal their implications for relationships and well-being.
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The human ability to synchronize with other individuals is critical for the development of social behavior. Recent research has shown that physiological inter-personal synchronization may underlie behavioral synchrony. Nevertheless, the factors that modulate physiological coupling are still largely unknown. Here we suggest that social touch and empathy for pain may enhance interpersonal physiological coupling. Twenty-two romantic couples were assigned the roles of target (pain receiver) and observer (pain observer) under pain/no-pain and touch/no-touch conditions, and their ECG and respiration rates were recorded. The results indicate that the partner touch increased interpersonal respiration coupling under both pain and no-pain conditions and increased heart rate coupling under pain conditions. In addition, physiological coupling was diminished by pain in the absence of the partner’s touch. Critically, we found that high partner’s empathy and high levels of analgesia enhanced coupling during the partner’s touch. Collectively, the evidence indicates that social touch increases interpersonal physiological coupling during pain. Furthermore, the effects of touch on cardio-respiratory inter-partner coupling may contribute to the analgesic effects of touch via the autonomic nervous system.
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Unlabelled: Previous studies have provided evidence for pain-alleviating effects of segmental tactile stimulation, yet the effect of social touch and its underlying mechanism is still unexplored. Considering that the soma affects the way we think, feel, and interact with others, it has been proposed that touch may communicate emotions, including empathy, interacting with the identity of the toucher. Thus, the goal of the current study was to examine the analgesic effects of social touch, and to test the moderating role of the toucher's empathy in analgesia using an ecological paradigm. Tonic heat stimuli were administered to women. Concurrently, their partners either watched or touched their hands, a stranger touched their hands, or no one interacted with them. The results revealed diminished levels of pain during partners' touch compared with all other control conditions. Furthermore, taking into account the dyadic interaction, only during the touch condition we found 1) a significant relationship between the partners' pain ratings, and 2) a significant negative relationship between the male touchers' empathy and the pain experience of their female partners. The findings highlight the powerful analgesic effect of social touch and suggest that empathy between romantic partners may explain the pain-alleviating effects of social touch. Perspective: Pain research mostly concentrates on different factors around a single pain target, without taking into account various social interactions with the observers. Our findings support the idea that pain perception models should be extended, taking into account some psychological characteristics of observers. Our conclusions are on the basis of advanced statistical methods.
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Although social and physical pain recruit overlapping neural activity in regions associated with the affective component of pain, the two pains can diverge in their phenomenology. Most notably, feelings of social pain can be re-experienced or "relived," even when the painful episode has long passed, whereas feelings of physical pain cannot be easily relived once the painful episode subsides. Here, we observed that reliving social (vs. physical) pain led to greater self-reported re-experienced pain and greater activity in affective pain regions (dorsal anterior cingulate cortex and anterior insula). Moreover, the degree of relived pain correlated positively with affective pain system activity. In contrast, reliving physical (vs. social) pain led to greater activity in the sensory-discriminative pain system (primary and secondary somatosensory cortex and posterior insula), which did not correlate with relived pain. Preferential engagement of these different pain mechanisms may reflect the use of different top-down neurocognitive pathways to elicit the pain. Social pain reliving recruited dorsomedial prefrontal cortex, often associated with mental state processing, which functionally correlated with affective pain system responses. In contrast, physical pain reliving recruited inferior frontal gyrus, known to be involved in body state processing, which functionally correlated with activation in the sensory pain system. These results update the physical-social pain overlap hypothesis: while overlapping mechanisms support live social and physical pain, distinct mechanisms guide internally-generated pain.
Objectives: Contextual factors can transform how we experience pain, particularly if pain is associated with other positive outcomes. Here we test a novel meaning-based intervention: Participants were given the opportunity to choose to receive pain on behalf of their romantic partners, situating pain experience in a positive, prosocial meaning context. We predicted that the ventromedial prefrontal cortex (vmPFC), a key structure for pain regulation and generation of affective meaning, would mediate the transformation of pain experience by this prosocial interpersonal context. Methods: We studied fMRI activity and behavioral responses in 29 heterosexual female participants during (1) a baseline pain challenge and (2) a task in which participants decided to accept a self-selected number of additional pain trials in order to reduce pain in their male romantic partners ("Accept Partner-Pain" condition). Results: Enduring extra pain for the benefit of the romantic partner reduced pain-related unpleasantness (t=-2.54,p=.016) but not intensity, and increased positive thoughts (t=3.60,p=.001) and pleasant feelings (t=5.39,p<.0005). Greater willingness to accept one's partner pain predicted greater unpleasantness reductions (t=3.94,p=.001) and increases in positive thoughts (r=.457,p=.013). The vmPFC showed significant increases (q<.05 FDR-corrected) in activation during Accept-Partner-Pain, especially for women with greater willingness to relieve their partner's pain (t=2.63, p=.014). Reductions in brain regions processing pain and aversive emotion significantly mediated reductions in pain unpleasantness (q<.05 FDR-corrected). Conclusions: The vmPFC has a key role in transforming the meaning of pain, which is associated with a cascade of positive psychological and brain effects, including changes in affective meaning, value, and pain-specific neural circuits.
Although fear-conditioning research has demonstrated that certain survival-threatening stimuli, namely prepared fear stimuli, are readily associated with fearful events, little research has explored whether a parallel category exists for safety stimuli. We examined whether social-support figures, who have typically benefited survival, can serve as prepared safety stimuli, a category that has not been explored previously. Across three experiments, we uncovered three key findings. First, social-support figures were less readily associated with fear than were strangers or neutral stimuli (in a retardation-of-acquisition test). Second, social-support stimuli inhibited conditional fear responses to other cues (in a summation test), and this inhibition continued even after the support stimulus was removed. Finally, these effects were not simply due to familiarity or reward because both familiar and rewarding stimuli were readily associated with fear, whereas social-support stimuli were not. These findings suggest that social-support figures are one category of prepared safety stimuli that may have long-lasting effects on fear-learning processes.