Optimizing stress in breaking bad news: a randomized controlled trial on the psychophysiological effects of stress arousal reappraisal and worked-example interventions among medical students

Breaking bad news (BBN) is among the most distressing communication tasks in the medical field, wherein physicians disclose serious diagnoses to their patients. Under stress, physicians may resort to maladaptive communication behaviors, potentially affecting patient’s health in the long-term. Therefore, it is essential to support medical professionals in effectively managing their stress responses early in their careers. Using the biopsychosocial model of challenge and threat as theoretical framework, we employed a 2 x 2 study design to examine the effects of stress arousal reappraisal (SAR; i.e., reinterpretation of bodily changes as functional coping resources) and worked example (WE; i.e., step-by-step demonstration of how to BBN) interventions on demand and resource appraisals and cardiovascular responses of 229 medical students engaged in simulated BBN encounters. Participants who prepared with WE reported more coping resources relative to demands after the BBN encounter than participants not preparing with WE. Participants receiving SAR instructions exhibited improved cardiovascular responses during the BBN task, indicated by increased cardiac output and decreased total peripheral resistance, than participants not receiving SAR instructions. These findings align with the notion that both interventions facilitate a shift from a threat to a challenge state, supporting their potential for integration into BBN training.