The influence of attention and arousal on emotion perception in adults with severe traumatic brain injury

Physiological reactivity at rest and in response to social or emotional stimuli after a traumatic brain injury: A systematic review

Numerous studies have shown that alterations in physiological reactivity (PR) after traumatic brain injury (TBI) are possibly associated with emotional deficits. We conducted a systematic review of these studies that evaluated PR in adults with moderate-to-severe TBI, either at rest or in response to emotional, stressful, or social stimuli. We focused on the most common measures of physiological response, including heart rate (HR), heart rate variability (HRV), respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), salivary cortisol, facial electromyography (EMG), and blink reflex.

Methods

A systematic literature search was conducted across six databases (PsycINFO, Psycarticles, SciencDirect, Cochrane Library, PubMed, and Scopus). The search returned 286 articles and 18 studies met the inclusion criteria.

Results

Discrepancies were observed according to the type of physiological measure. Reduced physiological responses in patients with TBI have been reported in most EDA studies, which were also overrepresented in the review. In terms of facial EMG, patients with TBI appear to exhibit reduced activity of the corrugator muscle and diminished blink reflex, while in most studies, zygomaticus contraction did not show significant differences between TBI and controls. Interestingly, most studies measuring cardiac activity did not find significant differences between TBI and controls. Finally, one study measured salivary cortisol levels and reported no difference between patients with TBI and controls.

Conclusion

Although disturbed EDA responses were frequently reported in patients with TBI, other measures did not consistently indicate an impairment in PR. These discrepancies could be due to the lesion pattern resulting from TBI, which could affect the PR to aversive stimuli. In addition, methodological differences concerning the measurements and their standardization as well as the characteristics of the patients may also be involved in these discrepancies. We propose methodological recommendations for the use of multiple and simultaneous PR measurements and standardization. Future research should converge toward a common methodology in terms of physiological data analysis to improve inter-study comparisons.

Knowledge and Perception of Risk in Pregnancy and Childbirth among Women in Low-Income Communities in Accra

Perception and knowledge of risk factors for pregnancy influence health behaviors during pregnancy and childbirth. We used a descriptive qualitative study to examine the perception and knowledge of risk factors in pregnancy and childbirth in low-income urban women in Ghana. Over the course of three-months, 12 focus group discussions and six individual interviews were conducted with 90 participants selected from six communities in the study area. Data were analyzed using inductive-thematic content analysis. Findings revealed that participants had knowledge of some risk factors, although some had superstitious beliefs. Participants viewed pregnancy as an exciting and unique experience, but also challenging, with a host of medical and psychological risks. Pre-existing medical conditions (e.g., diabetes), lack of physical activity, poverty, poor nutrition, and lack of social support were identified as conditions that could lead to negative pregnancy outcomes. Superstitious beliefs such as exposure to “evil eye” during pregnancy, as well as curses and spells, were also identified as risk factors for pregnancy complications. This research has implications for policies and programs to improve pregnancy outcomes for low-income women in Ghana. Thus, we recommend social and economic support programs as well as health education to change misperceptions about pregnancy risk and to support other efforts being made to improve maternal health outcomes.

The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood

This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.

tDCS effects on task-related activation and working memory performance in traumatic brain injury: A within group randomized controlled trial

Non-invasive transcranial direct current stimulation (tDCS) has been reported to facilitate working memory in normal adults. There is some evidence in people with Traumatic Brain Injury (TBI) but overall evidence is mixed. This study aimed to address shortcomings of prior study designs in TBI to examine whether a single dose of tDCS would lead to benefits in working memory. Thirty people with severe, chronic TBI were administered a single session of either anodal tDCS (2 mA for 20 min) or sham tDCS (2 mA for 30 s), in a counterbalanced order, over the left parietal cortex while performing 1-back and 2-back working memory tasks. Skin conductance levels were examined as a measure of task activated arousal, a possible functional analogue of cortical excitability. We found that tDCS led to no improvements in accuracy on the working memory tasks. A slight increase in variability and reaction time with tDCS was related to decreased task activated arousal. Overall, this study yielded no evidence that a single session of tDCS can facilitate working memory for people with TBI.

Functional neural correlates of facial affect recognition impairment following TBI

Facial affect recognition deficits following traumatic brain injury (TBI) have been well documented, as has their relationship with impairment in several other cognitive domains. However, little is known about the neurobiological mechanisms underlying affect recognition deficits, in particular mechanisms underlying different aspects of facial affect recognition (e.g., perceptual and interpretive processes). In the current study, 33 adults with moderate-to-severe TBI and 24 demographically matched healthy comparison (HC) participants completed an fMRI facial affect recognition study. While in the scanner, participants were asked to match the affect of a target face to either (a) one of two faces differing in affect (perceptual condition) or (b) one of two written affect labels (interpretative condition). In both groups we found activations in regions typically involved in affect recognition. Our results revealed that in the perceptual condition individuals with TBI tended to activate the left dorsolateral prefrontal cortex less than HCs, and within the HC group individuals with higher perceptual affect recognition scores showed higher levels of activation in the same brain region. Individuals with TBI who were specifically impaired at interpretative affect recognition showed less activation than HCs in the right fusiform gyrus. Moreover, in the labeling condition individuals with TBI tended to de-activate medial prefrontal regions less than HCs. A region of interest analysis revealed that individuals with TBI showed significantly less activation than HCs in the FFA for all the contrasts of interest. Our results suggest involvement of several brain regions in facial affect recognition impairment post TBI, and provide neurobiological support for the notion that distinct aspects of facial affect recognition can be differentially impaired following TBI.

Emotions Are Rising: The Growing Field of Affect Neuropsychology

Thirty years ago, the neuropsychology of emotion started to emerge as a mainstream topic. Careful examination of individual patients showed that emotion, like memory, language, and so on, could be differentially affected by brain disorders, especially in the right hemisphere. Since then, there has been accelerating interest in uncovering the neural architecture of emotion, and the major steps in this process of discovery over the past 3 decades are detailed in this review. In the 1990s, magnetic resonance imaging (MRI) scans provided precise delineation of lesions in the amygdala, medial prefrontal cortex, insula and somatosensory cortex as underpinning emotion disorders. At the same time, functional MRI revealed activation that was bilateral and also lateralized according to task demands. In the 2000s, converging evidence suggested at least two routes to emotional responses: subcortical, automatic and autonomic responses and slower, cortical responses mediating cognitive processing. The discovery of mirror neurons in the 1990s reinvigorated older views that simulation was the means to recognize emotions and empathize with others. More recently, psychophysiological research, revisiting older Russian paradigms, has contributed new insights into how autonomic and other physiological indices contribute to decision making (the somatic marker theory), emotional simulation, and social cognition. Finally, this review considers the extent to which these seismic changes in understanding emotional processes in clinical disorders have been reflected in neuropsychological practice. (JINS, 2017, 23, 719-731).

Social Cognition Deficits: Current Position and Future Directions for Neuropsychological Interventions in Cerebrovascular Disease

Neuropsychological assessments of cognitive dysfunction in cerebrovascular illness commonly target basic cognitive functions involving aspects of memory, attention, language, praxis, and number processing. Here, I highlight the clinical importance of often-neglected social cognition functions. These functions recruit a widely distributed neural network, making them vulnerable in most cerebrovascular diseases. Sociocognitive deficits underlie most of the problematic social conduct observed in patients and are associated with more negative clinical outcomes (compared to nonsocial cognitive deficits). In clinical settings, social cognition deficits are normally gleaned from collateral information from caregivers or from indirect inferences made from patients' performance on standard nonsocial cognitive tests. Information from these sources is however inadequate. I discuss key social cognition functions, focusing initially on deficits in emotion perception and theory of mind, two areas that have gained sizeable attention in neuroscientific research, and then extend the discussion into relatively new, less covered but crucial functions involving empathic behaviour, social awareness, social judgements, and social decision making. These functions are frequently impaired following neurological change. At present, a wide range of psychometrically robust social cognition tests is available, and this review also makes the case for their inclusion in neuropsychological assessments.

Ostracism and physiological arousal following traumatic brain injury

PRIMARY OBJECTIVE

This study aimed to examine the psychological and physiological effects of ostracism in adults with traumatic brain injury (TBI).

RESEARCH DESIGN

A within-subject, counterbalanced design was used. The two conditions, inclusion and ostracism, were examined across two groups (between subjects).

METHODS AND PROCEDURES

A group of 21 adults with TBI and 17 matched controls participated in the Cyberball paradigm. This task is a computerised task that exposes participants to a game of catch and throw. In the inclusion condition they are included fairly in the game, while in the ostracism condition they are excluded from the game following the first few throws. Skin conductance levels (SCLs) were measured throughout the game as a proxy for social stress.

MAIN OUTCOMES

Results showed that people with TBI were cognitively aware of when they are being ostracised, but that their self-reported emotional experience to social exclusion was different to that of the control group. Differences in SCLs between groups and between conditions did not reach significance nor did they correlate with behavioural responses.

CONCLUSIONS

These findings are discussed in terms of the consequences of dissociation between psychological and physiological responses and the implications for motivating behaviours associated with re-inclusion.

Social Cognition Interventions in Neuro-Rehabilitation: An Overview

This article provides an overview of interventions developed and trialled in the embryonic field of social cognition neuro-rehabilitation. Interventions are categories under the headings of explicit skills training, embodied/relational interventions, and relational approaches. The assessment and treatment of social neuropsychological impairments have received comparably less attention and development than other domains of cognition. These include difficulties in representing the intentions and perspectives of others (mentalising), recognising emotions, inferring nuanced social communications such as sarcasm and deceit, accessing social knowledge, and emotion-based decision-making. Founded on distributed neuroanatomical substrates, impairments of these functions have been found to be present and enduring across major sub-groups of acquired brain injury (for review see [1]). The theoretical richness of the social neuroscience revolution has not been matched by the translation of concepts and findings into rehabilitation practice. This article will review the embryonic field of social cognition rehabilitation, categorised into three intervention clusters: a) explicit skills training, b) embodied and affective interventions and c) relational approaches.

Impairments in social cognition following severe traumatic brain injury

Severe traumatic brain injury (TBI) leads to physical, neuropsychological, and emotional deficits that interfere with the individual’s capacity to return to his or her former lifestyle. This review focuses on social cognition, that is, the capacity to attend to, recognize and interpret interpersonal cues that guide social behavior. Social cognition entails ‘‘hot’’ processes, that is, emotion perception and emotional empathy and ‘‘cold’’ processes, that is, the ability to infer the beliefs, feelings, and intentions of others (theory of mind: ToM) to see their point of view (cognitive empathy) and what they mean when communicating (pragmatic inference). This review critically examines research attesting to deficits in each of these domains and also examines evidence for theorized mechanisms including specific neural networks, the role of simulation, and non-social cognition. Current research is hampered by small, heterogeneous samples and the inherent complexity of TBI pathology. Nevertheless, there is evidence that facets of social cognition are impaired in this population. New assessment tools to measure social cognition following TBI are required that predict everyday social functioning. In addition, research into remediation needs to be guided by the growing empirical base for understanding social cognition that may yet reveal how deficits dissociate following TBI.

Emotion Perception and Alexithymia in People With Severe Traumatic Brain Injury: One Disorder or Two? A Preliminary Investigation

Primary objective:Recent research studies attest to the presence of deficits in emotion perception following severe traumatic brain injury (TBI). Additionally, a growing number of studies report significant levels of alexithymia (disorder of emotional cognition) following TBI. This research aimed to examine the relation between the two, while assessing the influence of posttraumatic stress disorder (PTSD).Design:Cross-sectional study examining levels of alexithymia, emotion perception disorders and PTSD and their association, in 20 people with severe, chronic TBI and 20 adults without brain injuries.Methods:Participants were assessed on the Toronto Alexithymia — 20 Scale, the Posttraumatic Diagnostic Scale and on two emotion perception tasks: matching and labelling of photos depicting the 6 basic emotions.Results:The group with TBI were impaired relative to controls when matching facial expressions. Their performance on ‘fear’ was especially poor. Performance on labelling was similar in pattern, although failed to reach significance. There was no association between poor performance on fear, or other negative expressions, and either PTSD or alexithymia symptoms in the TBI group.Conclusions:Alexithymia, as assessed by the TAS-20, taps a constellation of difficulties that do not appear to include difficulties with emotion perception in people with traumatic brain injuries.

All alone with sweaty palms--physiological arousal and ostracism

Social exclusion, or ostracism, is universally perceived as a negative emotional experience and often leads to poor social outcomes for individuals and society. Although the experience of distress associated with being ostracized is innate, there has been very little investigation of the effects on the autonomic nervous system. This study provides objective evidence for the effects of ostracism on arousal (examined with skin conductance levels) while participants played an internet ball-tossing game (Cyberball). Forty-two healthy undergraduate students participated in both inclusion and ostracism conditions. When participants were included, there was a marked decrement in arousal over the course of the task, whereas there was no evidence of habituation when participants were ostracized. The implications of these results are discussed in terms of the potential of differential autonomic activity to predict the coping strategies that people engage in following ostracism.