Embodied emotion: the influence of manipulated facial and bodily states on emotive responses

Soft electrodes for simultaneous bio-potential and bio-impedance study of the face

The human body's vascular system is a finely regulated network: blood vessels can change in shape (i.e. constrict, or dilate), their elastic response may shift and they may undergo temporary and partial blockages due to pressure applied by skeletal muscles in their immediate vicinity. Simultaneous measurement of muscle activation and the corresponding changes in vessel diameter, in particular at anatomical regions such as the face, is challenging, and how muscle activation constricts blood vessels has been experimentally largely overlooked. Here we report on a new electronic skin technology for facial investigations to address this challenge. The technology consists of screen-printed dry carbon electrodes on soft polyurethane substrate. Two dry electrode arrays were placed on the face: One array for bio-potential measurements to capture muscle activity and a second array for bio-impedance. For the bio-potential signals, independent component analysis (ICA) was used to differentiate different muscle activations. Four-contact bio-impedance measurements were used to extract changes (related to artery volume change), as well as beats per minute (BPM). We performed concurrent bio-potential and bio-impedance measurements in the face. From the simultaneous measurements we successfully captured fluctuations in the superficial temporal artery diameter in response to facial muscle activity, which ultimately changes blood flow. The observed changes in the face, following muscle activation, were consistent with measurements in the forearm and were found to be notably more intricate. Both at the arm and the face, a clear increase in the baseline impedance was recorded during muscle activation (artery narrowing), while the impedance changes signifying the pulse had a clear repetitive trend only at the forearm. These results reveal the direct connection between muscle activation and the blood vessels in their vicinity and start to unveil the complex mechanisms through which facial muscles might modulate blood flow and possibly affect human physiology.

Effects of various sitting and standing postures on arousal and valence

According to research on the effects of posture on psychological states, high-power poses-with the body spread wide open-lead to high-arousal positive emotions, whereas low-power poses-with the body slumped and constricted-lead to low-arousal negative emotions. However, postures that lead to both high-arousal negative and low-arousal positive emotions have not been investigated yet. Although relative comparisons between postures have been made, the positioning of postures on the two-dimensional coordinates created by arousal and valence has not been clarified. Therefore, the purpose of this study was to explore and clarify which postures lead to the four types of emotions: high-arousal negative, high-arousal positive, low-arousal negative, and low-arousal positive. In Experiment 1, 29 participants (13 men and 16 women) adopted 12 sitting postures for 1 minute each. In Experiment 2, 25 participants (13 men and 12 women) adopted six sitting and six standing postures for 1 minute each. Arousal and valence were measured after each posture, and heart rate was measured during posture maintenance. Arousal and valence after adopting the postures were compared with the neutral arousal and valence. As a result, postures leading to high-arousal negative and low-arousal positive emotions were identified. In addition, postures leading to high-arousal positive emotions, which are the high-power poses, were identified. There were no differences in the magnitude of psychological effects between sitting and standing postures.

Facial expression and emotion

Human facial expressions are unique in their ability to express our emotions and communicate them to others. The mimic expression of basic emotions is very similar across different cultures and has also many features in common with other mammals. This suggests a common genetic origin of the association between facial expressions and emotion. However, recent studies also show cultural influences and differences. The recognition of emotions from facial expressions, as well as the process of expressing one's emotions facially, occurs within an extremely complex cerebral network. Due to the complexity of the cerebral processing system, there are a variety of neurological and psychiatric disorders that can significantly disrupt the coupling of facial expressions and emotions. Wearing masks also limits our ability to convey and recognize emotions through facial expressions. Through facial expressions, however, not only "real" emotions can be expressed, but also acted ones. Thus, facial expressions open up the possibility of faking socially desired expressions and also of consciously faking emotions. However, these pretenses are mostly imperfect and can be accompanied by short-term facial movements that indicate the emotions that are actually present (microexpressions). These microexpressions are of very short duration and often barely perceptible by humans, but they are the ideal application area for computer-aided analysis. This automatic identification of microexpressions has not only received scientific attention in recent years, but its use is also being tested in security-related areas. This article summarizes the current state of knowledge of facial expressions and emotions.

Implicit IAT Measures and Neurophysiological fNIRS Markers in Response to High-Engagement Advertising

Self-report measures partially explain consumers' purchasing choices, which are inextricably linked to cognitive, affective processes and implicit drives. These aspects, which occur outside of awareness and tacitly affect the way consumers make decisions, could be explored by exploiting neuroscientific technology. The study investigates implicit behavioural and neurovascular responses to emotionally arousing and high-engagement advertisements (COVID-19 content). High-engagement advertisements and control stimuli were shown in two experimental sessions that were counterbalanced across participants. During each session, hemodynamic variations were recorded with functional Near-Infrared Spectroscopy (fNIRS) of the prefrontal cortex (PFC), a neurophysiological marker for emotional processing. The implicit association task (IAT) was administered to investigate the implicit attitude. An increase in the concentration of oxygenated haemoglobin (O2Hb) was found for the high-engagement advertising when this category of stimuli was seen first. Specular results were found for deoxygenated haemoglobin (HHb) data. The IAT reported higher values for highly engaging stimuli. Increased activity within the PFC suggests that highly engaging content may be effective in generating emotional arousal and increasing attention when presented before other stimuli, which is consistent with the higher IAT scores, indicating more favourable implicit attitudes. This evidence suggests that the effectiveness of highly engaging advertising-related messages may be constrained by the order of advertisement administration.

Bodily feedback: expansive and upward posture facilitates the experience of positive affect

Most emotion theories recognise the importance of the body in expressing and constructing emotions. Focusing beyond the face, the present research adds needed empirical data on the effect of static full body postures on positive/negative affect. In Studies 1 (N = 110) and 2 (N = 79), using a bodily feedback paradigm, we manipulated postures to test causal effects on affective and physiological responses to emotionally ambiguous music. Across both studies among U.S. participants, we find the strongest support for an effect of bodily postures that are expansive and oriented upward on positive affect. In addition, an expansive and upward pose also led to greater cardiac vagal reactivity but these changes in parasympathetic activity were not related to affective changes (Study 2). In line with embodied theories, these results provide additional support for the role of postural input in constructing affect. Discussion highlights the relevance of these findings for the study of religious practices during which the postures studied are often adopted.

Real-Time Ultrasound Imaging of the Tear Trough: Lessons Learned From Functional Anatomy

BACKGROUND

The tear trough is one of the most challenging facial regions for soft-tissue filler injections. A thorough understanding of the underlying facial, muscular, and vascular anatomy is crucial to perform safe and effective tear trough injectable treatments.

OBJECTIVES

The authors sought to evaluate the location and function of the angular vein in the tear trough in 3 different facial expressions: repose, smiling, and max. orbicularis oculi contraction.

METHODS

Twenty study participants with a mean age of 48.3 years and mean BMI of 24.5 kg/m2 were investigated via functional ultrasound imaging. The diameter of the angular vein and the velocity and direction of venous blood flow were analyzed in repose, smiling, and during max. orbicularis oculi contraction.

RESULTS

The angular vein was identified in 100% of the cases to travel inside the orbicularis oculi muscle (intra-muscular course) within the tear trough, whereas the angular artery was not identified in this location. The distance between the angular vein and the inferior orbital rim was (lateral to medial): 4.6 mm, 4.5 mm, 3.9 mm, and 3.8 mm. The caudally directed blood flow was in repose 10.2 cm/s and was 7.3 cm/s at max. orbicularis oculi muscle contraction; however, no blood flow was detectable during smiling.

CONCLUSIONS

The diameter and the venous blood flow of the angular vein varied between the 3 tested facial expressions. Based on these anatomical findings, the deep injection approach to the tear trough is recommended due to the intramuscular course of the angular vein.

The neural underpinnings of facial emotion recognition in ischemic stroke patients

Deficits in facial emotion recognition occur frequently after stroke, with adverse social and behavioural consequences. The aim of this study was to investigate the neural underpinnings of the recognition of emotional expressions, in particular of the distinct basic emotions (anger, disgust, fear, happiness, sadness and surprise). A group of 110 ischaemic stroke patients with lesions in (sub)cortical areas of the cerebrum was included. Emotion recognition was assessed with the Ekman 60 Faces Test of the FEEST. Patient data were compared to data of 162 matched healthy controls (HC's). For the patients, whole brain voxel-based lesion-symptom mapping (VLSM) on 3-Tesla MRI images was performed. Results showed that patients performed significantly worse than HC's on both overall recognition of emotions, and specifically of disgust, fear, sadness and surprise. VLSM showed significant lesion-symptom associations for FEEST total in the right fronto-temporal region. Additionally, VLSM for the distinct emotions showed, apart from overlapping brain regions (insula, putamen and Rolandic operculum), also regions related to specific emotions. These were: middle and superior temporal gyrus (anger); caudate nucleus (disgust); superior corona radiate white matter tract, superior longitudinal fasciculus and middle frontal gyrus (happiness) and inferior frontal gyrus (sadness). Our findings help in understanding how lesions in specific brain regions can selectively affect the recognition of the basic emotions.

Efficacy of Facial Exercises in Facial Expression Categorization in Schizophrenia

Embodied cognition theories suggest that observation of facial expression induces the same pattern of muscle activation, and that this contributes to emotion recognition. Consequently, the inability to form facial expressions would affect emotional understanding. Patients with schizophrenia show a reduced ability to express and perceive facial emotions. We assumed that a physical training specifically developed to mobilize facial muscles could improve the ability to perform facial movements, and, consequently, spontaneous mimicry and facial expression recognition. Twenty-four inpatient participants with schizophrenia were randomly assigned to the experimental and control group. At the beginning and at the end of the study, both groups were submitted to a facial expression categorization test and their data compared. The experimental group underwent a training period during which the lip muscles, and the muscles around the eyes were mobilized through the execution of transitive actions. Participants were trained three times a week for five weeks. Results showed a positive impact of the physical training in the recognition of others’ facial emotions, specifically for the responses of “fear”, the emotion for which the recognition deficit in the test is most severe. This evidence suggests that a specific deficit of the sensorimotor system may result in a specific cognitive deficit.

Cosmetic appreciation and emotional processing in patients with a peripheral facial palsy: A systematic review

Background; The goal of this review is 1) to summarize the studies assessing PFP by casual observers, patients themselves and the cosmetic appreciation of the PFP and 2) to summarize the studies assessing whether there is a difference in emotional recognition/processing of facial emotions and/or cognitive tasks in patients with a PFP. Materials and Methods; A multi-database systematic literature search was performed using the following databases: Pubmed, Embase, Medline, and The Cochrane Library from the earliest date of each database up to December 2019. Population of interest consisted of patients with a PFP and studies that investigated cosmetic appreciation and/or emotional recognition and/or emotional processing in these patients. Two authors rated the methodological quality of the included studies independently using the 'Newcastle - Ottawa Quality Assessment Scale' for nonrandomised studies' (NOS). Two authors extracted the outcome data regarding cosmetic appreciation and/or emotional recognition/processing from the included studies. Results; Twelve hundred and thirty-two studies were found of which eleven studies met the inclusion criteria. Most studies were assessed to be of 'fair' to 'good' methodological quality. The Cohen's kappa (between author RL and SP) was 0.68. Two studies investigated emotional processing and/or emotional recognition. Nine studies investigated cosmetic appreciation in both patients and casual observers. Important findings of this systematic review are that there is a correlation between the perceived severity of the PFP of the patients and the ratings by casual observers. Secondly there seems to be a laterality difference in cosmetic appreciation and thirdly there might to be a decreased emotional recognition and processing in patients with a PFP. Conclusion; Emotional recognition and cosmetic appreciation in patients with a PFP is an under investigated area, in which further studies are needed to substantiate the findings in current literature.

Interactive Motion-Assisted Exposure Therapy for Veterans with Treatment-Resistant Posttraumatic Stress Disorder: A Randomized Controlled Trial

BACKGROUND

Veterans with posttraumatic stress disorder (PTSD) tend to benefit less from evidence-based treatments than other PTSD populations. A novel virtual reality and motion-assisted exposure therapy, called 3MDR, provides treatment in an immersive, personalized and activating context.

OBJECTIVE

To study the efficacy of 3MDR for veterans with treatment-resistant PTSD.

METHOD

In a randomized controlled trial (n = 43) 3MDR was compared to a non-specific treatment component control group. Primary outcome was clinician-rated PTSD symptoms at baseline, after 3MDR, and at the 12-week and 16-week follow-up (primary end point). Intention-to-treat analyses of covariance and mixed models were applied to study differences between groups at the end point and over the course of intervention, controlling for baseline scores.

RESULTS

The decrease in PTSD symptom severity from baseline to end point was significantly greater for 3MDR as compared to the control group, with a large effect size (F[1, 37] = 6.43, p = 0.016, d = 0.83). No significant between-group difference was detected in the course of PTSD symptoms during treatment when including all time points. The dropout rate was low (7%), and 45% of the patients in the 3MDR group improved clinically. The number needed to treat was 2.86.

CONCLUSIONS

In this trial, 3MDR significantly decreased PTSD symptoms in veterans with, on average, a history of 4 unsuccessful treatments. The low dropout rate may be indicative of high engagement. However, a lack of significant differences on secondary outcomes limits conclusions that can be drawn on its efficacy and underlines the need for larger phase III trials. These data show emerging evidence for 3MDR and its potential to progress PTSD treatment for veterans (Dutch Trial Register Identifier: NL5126).

Embodiment of sleep-related words: Evidence from event-related potentials

Our thoughts can influence sleep, but the underlying mechanisms are unknown. According to the theory of "embodied cognition," the semantic content of cognitive processes is represented by multimodal networks in the brain, which include body-related functions. Such multimodal representations could offer a mechanism, which explains mutual influences between cognition and sleep. Here we tested whether sleep-related words are represented in multimodal networks by examining the effect of congruent versus incongruent body positions on word processing during wakefulness. We experimentally manipulated the body position of 66 subjects (19-40 years old) between standing upright and lying down. Sleep- and activity-related words were presented around the individual speech recognition threshold. Our results show that word processing was facilitated in congruent body positions (sleep words: lying down and activity words: standing upright) compared with incongruent body positions, as indicated by a reduced N400 in the congruent condition with the lowest volume. In addition, early sensory components of the ERP (N180 and P280) were enhanced, suggesting that words were also acoustically better understood in a congruent body position. However, the difference in ERPs did not translate to differences on a behavioral level. Our results support the prediction of embodied processing of sleep- and activity-related words. Body position potentially induces a pre-activation of multimodal networks, thereby enhancing access to the semantic concepts of words related to current body position. The link between semantic meaning and body-related function could be a key element in explaining the influences of cognitive processing on sleep.

Impairments in Emotion Recognition and Risk-Taking Behavior After Isolated, Cerebellar Stroke

An increasing amount of research has shown a cerebellar involvement in higher order cognitive functions, including emotional processing and decision-making. However, it has not been investigated whether impairments in facial emotion recognition, which could be a marker of impaired emotional experiences, are related to risky decision-making in these patients. Therefore, we aimed to investigate facial emotion recognition and risky decision-making in these patients as well as to investigate a relationship between these constructs. Thirteen patients with a discrete, isolated, cerebellar lesion as a consequence of a stroke were included in the study. Emotion recognition was assessed with the Facial Expressions of Emotions—Stimuli and Test (FEEST). Risk-taking behavior was assessed with the Action Selection Test (AST). Furthermore, 106 matched healthy controls performed the FEEST and 20 matched healthy controls performed the AST. Compared with healthy controls, patients were significantly worse in the recognition of emotional expressions and they took significantly more risks. In addition, a worse ability to recognize fearful facial expressions was strongly related to an increase in risky decisions in the AST. Therefore, we suggest that tests of emotion recognition should be incorporated into the neuropsychological assessment after cerebellar stroke to boost detection and treatment of these impairments in these patients.

The self’s choice: Priming attentional focus on bodily self promotes loss frequency bias

When attention is focused on self representation(s), the ability to evaluate one’s internal sensations is enhanced, according to previous research by Ainley and colleagues (Consciousness and Cognition, 22(4), 1231–1238, 2013). Self-representations are usually distinguished between bodily and narrative. Both bodily and narrative representations improve decision-making processes, in that the consideration of alternatives is informed by sensations experienced deep inside the body (e.g., anxiety) as suggest by the literature (Noël, Brevers & Bechara in Frontiers in Psychiatry, 4, 179,  2013). The objective of the present study is to analyze the decision-making process in multiple conditions of stimulated self-representations. Participants played the Iowa Gambling Task three times (a baseline without stimuli and two randomly ordered stimulations to prime bodily and narrative self-representations). While no significant differences emerged regarding advantageous choices, participants showed loss frequency bias in the condition with bodily-self representation priming. Two interpretations are proposed: bodily-self focus acted as a distractor diminishing participants’ commitment to long term outcomes or enhanced interoception promoted aversion to losses. Directions are given for future research and clinical implications.

Protective effects of elevated anandamide on stress and fear-related behaviors: translational evidence from humans and mice

Post-traumatic stress disorder (PTSD) is a common, debilitating condition with limited treatment options. Extinction of fear memories through prolonged exposure therapy, the primary evidence-based behavioral treatment for PTSD, has only partial efficacy. In mice, pharmacological inhibition of fatty acid amide hydrolase (FAAH) produces elevated levels of anandamide (AEA) and promotes fear extinction, suggesting that FAAH inhibitors may aid fear extinction-based treatments. A human FAAH 385C->A substitution encodes an FAAH enzyme with reduced catabolic efficacy. Individuals homozygous for the FAAH 385A allele may therefore offer a genetic model to evaluate the impact of elevations in AEA signaling in humans, helping to inform whether FAAH inhibitors have the potential to facilitate fear extinction therapy for PTSD. To overcome the challenge posed by low frequency of the AA genotype (appr. 5%), we prospectively genotyped 423 individuals to examine the balanced groups of CC, AC, and AA individuals (n = 25/group). Consistent with its loss-of-function nature, the A allele was dose dependently associated with elevated basal AEA levels, facilitated fear extinction, and enhanced the extinction recall. Moreover, the A-allele homozygotes were protected against stress-induced decreases in AEA and negative emotional consequences of stress. In a humanized mouse model, AA homozygous mice were similarly protected against stress-induced decreases in AEA, both in the periphery, and also in the amygdala and prefrontal cortex, brain structures critically involved in fear extinction and regulation of stress responses. Collectively, these data suggest that AEA signaling can temper aspects of the stress response and that FAAH inhibition may aid the treatment for stress-related psychiatric disorders, such as PTSD.

The role of oxytocin in the facial mimicry of affiliative vs. non-affiliative emotions

The present paper builds upon a growing body of work documenting oxytocin's role in social functioning, to test whether this hormone facilitates spontaneous mimicry of others' emotional expressions. In a double-blind, randomized trial, adult Caucasian males (n = 145) received a nasal spray of either oxytocin or placebo before completing a facial mimicry task. Facial expressions were coded using automated face analysis. Oxytocin increased mimicry of facial features of sadness (lips and chin, but not areas around the eyes), an affiliative reaction that facilitates social bonding. Oxytocin also increased mimicry of happiness, but only for individuals who expressed low levels of happiness in response to neutral faces. Overall, participants did not reliably mimic expressions of fear and anger, echoing recent theoretical accounts of emotional mimicry as dependent on the social context. In sum, our findings suggest that oxytocin facilitates emotional mimicry in ways that are conducive to affiliation, pointing to a possible pathway through which oxytocin promotes social bonding.

Does Blocking Facial Feedback Via Botulinum Toxin Injections Decrease Depression? A Critical Review and Meta-Analysis

Researchers have proposed that blocking facial feedback via glabellar-region botulinum toxin injections (GBTX) can reduce depression. Random-effects meta-analyses of studies that administered GBTX to individuals with depression indicate that, 6 weeks postintervention, GBTX groups were significantly less depressed compared to placebo groups ( d = 0.83) and pretreatment levels ( d = 1.57). However, we noted the following concerns: (a) effect sizes were extraordinarily large, (b) authors failed to provide information to compute 51% of relevant effect sizes, (c) 96% of effect sizes came from studies conducted by investigators with conflicts of interest, (d) there is some evidence of publication bias, and (e) studies used ineffective blinding procedures. These considerations suggest that confidence in GBTX as a treatment for depression is premature.

Do Not Neglect the Body and Action: The Emergence of Embodiment Approaches to Understanding Human Development

It is becoming clear that to truly understand what it is to be human, focusing scientific efforts on the mind alone is insufficient. We are embodied minds, living and acting in a world full of meaningful things. In this article, we discuss how science has been informed by important research insights into the close relationship between the body, the mind, and the world. These interactions can be translated into embodied perspectives of human development. We provide evidence that perception, cognition, emotion, human relations, and behavior are grounded in our bodies from the beginning of our lives. From this perspective, the body cannot be assumed to be simply an effector for cognition or an instrument for collecting information for the brain. This comprehensive review and debate of embodied-related literature is accompanied by the identification of theoretical challenges and practical applications that will shape research for years to come.

A False Trail to Follow: Differential Effects of the Facial Feedback Signals From the Upper and Lower Face on the Recognition of Micro-Expressions

Micro-expressions, as fleeting facial expressions, are very important for judging people’s true emotions, thus can provide an essential behavioral clue for lie and dangerous demeanor detection. From embodied accounts of cognition, we derived a novel hypothesis that facial feedback from upper and lower facial regions has differential effects on micro-expression recognition. This hypothesis was tested and supported across three studies. Specifically, the results of Study 1 showed that people became better judges of intense micro-expressions with a duration of 450 ms when the facial feedback from upper face was enhanced via a restricting gel. Additional results of Study 2 showed that the recognition accuracy of subtle micro-expressions was significantly impaired under all duration conditions (50, 150, 333, and 450 ms) when facial feedback from lower face was enhanced. In addition, the results of Study 3 also revealed that blocking the facial feedback of lower face, significantly boosted the recognition accuracy of subtle and intense micro-expressions under all duration conditions (150 and 450 ms). Together, these results highlight the role of facial feedback in judging the subtle movements of micro-expressions.

Biopsychosocial Assessment of Pain with Thermal Imaging of Emotional Facial Expression in Breast Cancer Survivors

Background: Recent research has evaluated psychological and biological characteristics associated with pain in survivors of breast cancer (BC). Few studies consider their relationship with inflammatory activity. Voluntary facial expressions modify the autonomic activity and this may be useful in the hospital environment for clinical biopsychosocial assessment of pain. Methods: This research compared a BC survivors group under integral treatment (Oncology, Psychology, Nutrition) with a control group to assess the intensity of pain, behavioral interference, anxiety, depression, temperament-expression, anger control, social isolation, emotional regulation, and alexithymia and inflammatory activity, with salivary interleukin 6 (IL-6). Then, a psychophysiological evaluation through repeated measures of facial infrared thermal imaging (IRT) and hands in baseline—positive facial expression (joy)—negative facial expression (pain)—relaxation (diaphragmatic breathing). Results: The results showed changes in the IRT (p < 0.05) during the execution of facial expressions in the chin, perinasal, periorbital, frontal, nose, and fingers areas in both groups. No differences were found in the IL-6 level among the aforementioned groups, but an association with baseline nasal temperature (p < 0.001) was observable. The BC group had higher alexithymia score (p < 0.01) but lower social isolation (p < 0.05), in comparison to the control group. Conclusions: In the low- and medium-concentration groups of IL-6, the psychophysiological intervention proposed in this study has a greater effect than on the high concentration group of IL-6. This will be considered in the design of psychological and psychosocial interventions for the treatment of pain.

Embodied Cognition and the Direct Induction of Affect as a Compliment to Cognitive Behavioural Therapy

We make the case for the possible integration of affect experience induced via embodiment techniques with CBT for the treatment of emotional disorders in clinical settings. Theoretically we propose a possible integration of cognitive behavioural theory, neuroscience, embodied cognition and important processes of client change outcomes such as the therapeutic alliance to enhance client outcomes. We draw from evidence of bidirectional effects between embodiment modes of bottom-up (sensory-motor simulations giving rise to important basis of knowledge) and top-down (abstract mental representations of knowledge) processes such as CBT in psychotherapy. The paper first describes the dominance and success of CBT for the treatment of a wide range of clinical disorders. Some limitations of CBT, particularly for depression are also outlined. There is a growing body of evidence for the added value of experiential affect-focused interventions combined with CBT. Evidence for the embodied model of cognition and emotion is reviewed. Advantages of embodiment is highlighted as a complimentary process model to deepen the intensity and valence of affective experience. It is suggested that an integrated embodiment approach with CBT enhances outcomes across a wide range of emotional disorders. A description of our embodiment method integrated with CBT for inducing affective experience, emotional regulation, acceptance of unwanted emotions and emotional mastery is given. Finally, the paper highlights the importance of the therapeutic alliance as a critical component of the change process. The paper ends with a case study highlighting some clinical strategies that may aid the therapist to integrate embodiment techniques in CBT that can further explore in future research on affective experience in CBT for a wider range of clinical disorders.

An Innovative Framework for Delivering Psychotherapy to Patients With Treatment-Resistant Posttraumatic Stress Disorder: Rationale for Interactive Motion-Assisted Therapy

Despite an array of evidence-based psychological treatments for patients with a posttraumatic stress disorder (PTSD), a majority of patients do not fully benefit from the potential of these therapies. In veterans with PTSD, up to two-thirds retain their diagnosis after psychotherapy and often their disorder is treatment-resistant, which calls for improvement of therapeutic approaches for this population. One of the factors hypothesized to underlie low response in PTSD treatment is high behavioral and cognitive avoidance to traumatic reminders. In the current paper we explore if a combination of personalized virtual reality, multi-sensory input, and walking during exposure can enhance treatment engagement, overcome avoidance, and thereby optimize treatment effectiveness. Virtual reality holds potential to increase presence and in-session attention and to facilitate memory retrieval. Multi-sensory input such as pictures and music can personalize this experience. Evidence for the positive effect of physical activity on fear extinction and associative thinking, as well as embodied cognition theories, provide a rationale for decreased avoidance by literally approaching cues of the traumatic memories. A dual-attention task further facilitates new learning and reconsolidation. These strategies have been combined in an innovative framework for trauma-focused psychotherapy, named Multi-modular Motion-assisted Memory Desensitization and Reconsolidation (3MDR). In this innovative treatment the therapeutic setting is changed from the face-to-face sedentary position to a side-by-side activating context in which patients walk toward trauma-related images in a virtual environment. The framework of 3MDR has been designed as a boost for patients with treatment-resistant PTSD, which is illustrated by three case examples. The intervention is discussed in context of other advancements in treatment for treatment-resistant PTSD. Novel elements of this approach are activation, personalization and empowerment. While developed for veterans with PTSD who do not optimally respond to standardized treatments, this innovative framework holds potential to also be used for other patient populations and earlier stages of treatment for patients with PTSD.

Age invariance in rapid facial affective reactions to emotionally valenced stimuli

It has been suggested that an age-related positivity effect may only occur in the context of explicit information processing, but it is unclear whether this bias extends to the processing of rapid facial reactions. In addition, most studies that have looked for evidence of age-related implicit positivity have used attentional (as opposed to sensory) unawareness paradigms, or used broad-based indicators of attentional awareness that do not speak to the nature of the affective response. In the present study, younger and older adults were therefore asked to view non-facial images presented supraliminally (i.e., consciously) as well as outside of sensory awareness (i.e., subliminally) while their facial reactions were indexed using electromyography. The results indicated that both younger and older adults exhibited rapid facial reactions congruent with the emotional valence of non-facial images in both supraliminal and subliminal conditions. Relative to young, older adults did not respond with greater zygomaticus (cheek) activity to positive stimuli or reduced corrugator (brow) activity to negative stimuli in either condition. These data show that rapid facial reactions to emotional stimuli are intact in late adulthood, even in response to stimuli that activate more automatic and implicit forms of emotion processing. However, there is no evidence for any age-related positivity bias in these behavioral responses.

Incidental retrieval of prior emotion mimicry

When observing emotional expressions, similar sensorimotor states are activated in the observer, often resulting in physical mimicry. For example, when observing a smile, the zygomaticus muscles associated with smiling are activated in the observer, and when observing a frown, the corrugator brow muscles. We show that the consistency of an individual’s facial emotion, whether they always frown or smile, can be encoded into memory. When the individuals are viewed at a later time expressing no emotion, muscle mimicry of the prior state can be detected, even when the emotion itself is task irrelevant. The results support simulation accounts of memory, where prior embodiments of other’s states during encoding are reactivated when re-encountering a person.

Fashioning the Face: Sensorimotor Simulation Contributes to Facial Expression Recognition

When we observe a facial expression of emotion, we often mimic it. This automatic mimicry reflects underlying sensorimotor simulation that supports accurate emotion recognition. Why this is so is becoming more obvious: emotions are patterns of expressive, behavioral, physiological, and subjective feeling responses. Activation of one component can therefore automatically activate other components. When people simulate a perceived facial expression, they partially activate the corresponding emotional state in themselves, which provides a basis for inferring the underlying emotion of the expresser. We integrate recent evidence in favor of a role for sensorimotor simulation in emotion recognition. We then connect this account to a domain-general understanding of how sensory information from multiple modalities is integrated to generate perceptual predictions in the brain.