Table 1 Definitions and examples of patients’ expressions of emotional distress

Concern

'A clear and unambiguous expression of an unpleasant emotion which was explicitly verbalized.'

Emotional issue is recent or current

"It was a huge worry for me."

Importance of the issue may or may not be stated

"I was concerned by that."

Cue

'A verbal or non-verbal hint which suggests underlying unpleasant emotions require clarification."

(A) Vague or unspecified words or phrases used to describe one's emotions which would require clarification

"I just try to cope with it every day."

(B) Non-explicit verbal hints towards one's hidden concerns

"I hope it is only going to be temporary."

(C) Verbal expressions emphasizing negative emotional states regarding cognitive or physiological states

"I'll lie there and I'll have the alarm going off an hour before I get up."

(D) Expressions referring to negative life events or conditions using neutral content which emphasizes emotional importance of issues and standards out from the narrative background

"I would say it's difficult, sometimes I just don't know what I'm doing half the time."

(E) Repeated expressions of previously neutral emotions

“It has changed in the last fortnight, but then maybe, because of the medication…”

(F) Non-verbal expressions of negative or unpleasant emotions

"I don't know... [Sobs]... it's hard."

(G) Clear and unambiguous negative emotional expression in reference to the past (more than a month) or an unspecified time-frame

"Being down, I've never been down, you know, depressed, in my life like that."