Can something as simple as a curved doorway or undulating roof line on the exterior of a healthcare facility trigger a fear response in patients?

Debajyoti Pati, Rockwell Endowment Professor, Department of Design, Texas Tech University (Lubbock, Texas), and Upali Nanda, Vice President and Director of Research, HKS Inc. (Dallas), joined colleagues from Texas Tech and American Art Resources (Houston) to explore the potential influence of design aspects in the physical environment—specifically, contours—on amygdala activation, the brain region associated with fear response.

Extending previous studies in neuropsychology, which found sharp objects were associated with significantly higher activation, the Texas Tech study, which was funded by American Art Resources and the Rockwell Endowment, exposed 36 subjects to curved and sharp contours typically used in healthcare settings, such as furniture.

Similar to past tests, people associated fear with sharp contours in landscapes (parks and gardens) and objects. However, images of curves in building exteriors and interiors also made people more fearful.

“That’s a finding of substantial importance to healthcare design,” Pati says. “Perhaps amygdala response to contours will vary depending on the context. High-stress environments like hospitals, courthouses, or prisons may demonstrate different intensity of amygdala response as compared to entertaining or thrill-seeking environments, such as theme parks, museums, or shopping malls.”

The research team says future studies will explore this and other questions to help designers understand how different architectural forms may affect patients and their overall experience.

In the meantime, key findings and a discussion of the recent study will be presented at the 2014 Healthcare Design Conference (San Diego, Nov. 15-18) in the session “Do Curves Matter? An fMRI Examination of Neural Reactions to Formal Attributes of Healthcare Environments.” For more information, visit