VR-CoDES – Network of Sequence Analysis

The Verona Network on Sequence Analysis, met in 2003 and 2004 to study critical health provider–patient communication sequences in which patients signal or express emotional distress. The lack of a common ground in defining cues and concerns led to the decision to launch a consensus process on the definition of cues and concerns and, subsequently, on the definition of health provider responses to such expressions. With the purpose to facilitate comparative research on the basis of a shared language, the process gave rise to the Verona Coding Definitions of Emotional Sequences (VR-CoDES) consisting of two manuals, one for cues and concerns expressed by patients and one for health provider responses.




The VR-CoDES coding manual has instructions on how to carry out the division into units of analysis and to calculate reliability indices, and a coding exercise book for rater training.

Members  If you are a member of EACH, you may download the manual free of charge by completing the form. Manuals are available in English, German, Italian, Portuguese and Chinese.  Please click the button.

Non Members  Non members may purchase the manual for £25 by completing the registration form.  Please click the button.


There has been little consensus in definitions among coding systems of how to code emotional talk and the theoretical background of other coding systems varies considerably. The VR-CoDES represents the result of a shared effort in finding a general consensus among different experts in health communication research. The work includes conceptual and procedural outcomes of the “Verona Network on Sequence Analysis” which has reached on evaluating health provider’s behaviour in response to emotional talking by the patient as described in the VR-CoDES system for patient cues and concerns.

The VR-CoDES allows researchers to adopt sequence analysis techniques. Sequence analysis allows an understanding of the temporal relationship between events focusing on interactions in terms of what communication behaviour precedes and what follows a target behaviour. The impact of provider responses to cues and concerns can be investigated through interaction analysis systems which can describe the consultation process realistically and accurately, reflecting the dynamics of true interaction.  Even if sequential analysis presents challenging methodological and conceptual problems it permits to study the natural course of events and thus provides a more valid picture of communication processes. The SIG provides an excellent forum for the development of these approaches.


  1. To facilitate, develop and consolidate the VR-CoDES system as a means to both qualitatively and quantitatively identify episodes and sequences of emotional interaction and health provider responses.
  2. To organise and sustain the Verona Sequence Analysis Group meetings (since 2003 annual event held in February/March)
  3. To strengthen research activity and improve understanding of emotional communication in health care interactions

Proposed Activity

  1. Cataloguing of peer review papers
  2. SIG meetings at conferences and special meetings
  3. Language versions of VR-CoDES developed and posted onto SIG page
  4. Advisory documentation for use of VR-CoDES e.g. Summary instructions for conversion of original Observer data file into usable computer statistical package (e.g. SPSS, STATA)
  5. Extension  of  VR-CoDES application to different settings (triadic conversations, veterinary, dentistry, psychiatry, psychotherapy…)

2017 Annual Report

  • During last 12 months a subgroup of the network met in Verona twice (10-11 February and 27-29 June 2017) to write a conceptual paper on the VR-CoDES which has been now published in PEC (Del Piccolo, L., Finset, A., Mellblom, A.V., Figueiredo-Braga, M., Korsvold, L., Zhou, Y., Zimmermann, C., Humphris, G. (2017) Verona Coding Definitions of Emotional Sequences (VR-CoDES): Conceptual framework and future directions. Patient Education and Counseling 100, 2303–2311)
  • The Vr-CoDES has been translated into Italian and Portuguese. Both translations are available on EACH website.
  • The following papers have been published with reference to the VR-CoDES:

Do doctors’ attachment styles and emotional intelligence influence patients’ emotional expressions in primary care consultations? An exploratory study using multilevel analysis. Cherry MG, Fletcher I, Berridge D, O’Sullivan H. Patient Educ Couns. 2017 Oct 26. doi: 10.1016/j.pec.2017.10.017. [Epub ahead of print]

Towards objective and reproducible study of patient-doctor interaction: Automatic text analysis based VR-CoDES annotation of consultation transcripts. Birkett C, Arandjelovic O, Humphris G. Conf Proc IEEE Eng Med Biol Soc. 2017 Jul;2017:2638-2641. doi: 10.1109/EMBC.2017.8037399.

Is patient behavior during consultation associated with shared decision-making? A study of patients’ questions, cues and concerns in relation to observed shared decision-making in a cancer outpatient clinic. Amundsen A, Nordøy T, Lingen KE, Sørlie T, Bergvik S. Patient Educ Couns. 2017 Oct 12. doi: 10.1016/j.pec.2017.10.001. [Epub ahead of print]

Exploring physicians’ verbal and nonverbal responses to cues/concerns: Learning from incongruent communication. Gorawara-Bhat R, Hafskjold L, Gulbrandsen P, Eide H. Patient Educ Couns. 2017 Nov;100(11):1979-1989. doi: 10.1016/j.pec.2017.06.027. Epub 2017 Jun 27.

Verona Coding Definitions of Emotional Sequences (VR-CoDES): Conceptual framework and future directions. Del Piccolo L, Finset A, Mellblom AV, Figueiredo-Braga M, Korsvold L, Zhou Y, Zimmermann C, Humphris G. Patient Educ Couns. 2017 Dec;100(12):2303-2311. doi: 10.1016/j.pec.2017.06.026. Epub 2017 Jun 21.

Do negative emotions expressed during follow-up consultations with adolescent survivors of childhood cancer reflect late effects? Mellblom AV, Ruud E, Loge JH, Lie HC. Patient Educ Couns. 2017 Nov;100(11):2098-2101. doi: 10.1016/j.pec.2017.06.008. Epub 2017 Jun 19.

Emotional communication in support groups for siblings of children with disabilities. Vatne TM, Zahl E. Patient Educ Couns. 2017 Nov;100(11):2106-2108. doi: 10.1016/j.pec.2017.05.021. Epub 2017 Jun 19.

VR-CoDES and patient-centeredness. The intersection points between a measure and a concept. Del Piccolo L. Patient Educ Couns. 2017 Nov;100(11):2135-2137. doi: 10.1016/j.pec.2017.05.007. Epub 2017 May 5.

Registered Nurses’ and nurse assistants’ responses to older persons’ expressions of emotional needs in home care. Höglander J, Eklund JH, Eide H, Holmström IK, Sundler AJ. J Adv Nurs. 2017 Dec;73(12):2923-2932. doi: 10.1111/jan.13356. Epub 2017 Jul 5.

How family physicians respond to unpleasant emotions of ethnic minority patients. Aelbrecht K, De Maesschalck S, Willems S, Deveugele M, Pype P. Patient Educ Couns. 2017 Oct;100(10):1867-1873. doi: 10.1016/j.pec.2017.04.001. Epub 2017 Apr 2.

A content analysis of emotional concerns expressed at the time of receiving a cancer diagnosis: An observational study of consultations with adolescent and young adult patients and their family members. Korsvold L, Mellblom AV, Finset A, Ruud E, Lie HC. Eur J Oncol Nurs. 2017 Feb;26:1-8. doi: 10.1016/j.ejon.2016.10.005. Epub 2016 Nov 16.

Analysing how negative emotions emerge and are addressed in veterinary consultations, using the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Vijfhuizen M, Bok H, Matthew SM, Del Piccolo L, McArthur M. Patient Educ Couns. 2017 Apr;100(4):682-689. doi: 10.1016/j.pec.2016.11.001. Epub 2016 Nov 3.

Older persons’ expressions of emotional cues and concerns during home care visits. Application of the Verona coding definitions of emotional sequences (VR-CoDES) in home care. Sundler AJ, Höglander J, Eklund JH, Eide H, Holmström IK. Patient Educ Couns. 2017 Feb;100(2):276-282. doi: 10.1016/j.pec.2016.09.009. Epub 2016 Sep 20.

Applying the Verona coding definitions of emotional sequences (VR-CoDES) to code medical students’ written responses to written case scenarios: Some methodological and practical considerations. Ortwein H, Benz A, Carl P, Huwendiek S, Pander T, Kiessling C. Patient Educ Couns. 2017 Feb;100(2):305-312. doi: 10.1016/j.pec.2016.08.026. Epub 2016 Aug 27.

  • In May 2017, an invitational workshop has been conducted in China with 20 participants by prof. Lidia Del Piccolo and prof. Arnstein Finset.

Three year plan

  1. To continue cataloguing of peer review papers
  2. SIG meetings at conferences and special meetings
  3. New language versions of VR-CoDES developed and posted onto SIG page
  4. Advisory documentation for use of VR-CoDES e.g. Summary instructions for conversion of original Observer data file into usable computer statistical package (e.g. SPSS, STATA)
  5. Extension of VR-CoDES application to different settings (triadic conversations, veterinary, dentirstry, psychiatry, psychotherapy…)


Completed projects:

  • To publish on EACH website the first revision of the VR-CoDES together with the translated version into Italian and Portuguese
  • To write a conceptual paper to sustain theoretically the system.
  • To present the at the first Congress of the young Portuguese Society of Clinical Communication in Healthcare (named in Portuguese Sociedade Portuguesa de Comunicação Clínica em Cuidados de Saúde – SP3SC) the Portuguese version of VR-CoDES Manual. The Manual is now accessible to all the members of the Society.

Current projects:

  • Organization of a new meeting of the network in April 6th and 7th
  • The VR-CoDES is going to be translated into German and Chinse
  • The VR-CoDES system is being utilised in one of the projects of the University of S.Andrews called “Digital Health”. The data collected from the coding system are matched to many parameters in the audio recording of the interaction to help identify codes using Artificial Intelligence.
  • The VR-CoDES continues to be used at the Edinburgh Cancer Centre.

Future planned projects:

  • Extension of VR-CoDES application to different settings (triadic conversations, veterinary, dentirstry, psychiatry, psychotherapy…)
  • New projects applying VR-CoDES as teaching tool at the Faculty of Medicine at the University of Porto, Portugal.


  • To enhance the application of the Vr-CoDES by implementing automatic text analysis and data statistical analysis.
  • how to propagate (and made accessible) this tools, in particular in lower income countries, newly formed teams, etc.

How can EACH help?

  • By facilitating the downloading of the system and by helping in the organization of workshops on the use of the system


Lidia Del Piccolo
Associate Professor in Clinical Psychology
Department of Neurosciences, Biomedicine and Movement Sciences
University of Verona
Section of Clinical Psychology
Policlinico G.B. Rossi
Piazzale L.A. Scuro 10, 37134 Verona, Italy.
Email: lidia.delpiccolo@univr.it
Tel: +39 045 8124692
Arnstein Finset
Professor – Dept of Behavioural Sciences in Medicine
Institute of Basic Medical Sciences
Medical School
University of Oslo
Postboks 1111 Blindern 0317 OSLO
Email: arnstein.finset@medisin.uio.no
Tel: +47 22851435
Gerry Humphris
Professor – Health Psychology
Medical School
University of St Andrews
North Haugh
St Andrews, Fife, KY16 9TF, UK
Email: gmh4@st-andrews.ac.uk
Tel:+44 (0)1334 463565
Margarida Figueiredo-Braga
Professor – Dep Clinical Neurosciences and Mental Health
Medical Psychology Unit
Faculty of Medicine
University of Porto
Email: mmfb@med.up.pt
Tel: +35 122 5513672