A review on sex differences in processing emotional signals. Neuropsychologia. 2012;50:1211-1221. [PMID: 22245006 DOI: 10.1016/j.neuropsychologia.2011.12.022]

Sex differences in neural responses to emotional facial expressions are associated with lifetime depression and mania risk

INTRODUCTION

No studies systematically examined sex differences in neural mechanisms underlying depression and mania/hypomania risk.

METHOD

80 females and 35 males, n = 115(age21.6±1.90) were scanned using 3TfMRI during an implicit emotional-faces task. We examined neural activation to all emotional faces versus baseline, using an anatomical region-of-interest mask comprising regions supporting emotion and salience processing. Sex was a covariate. Extracted parameter estimates(FWE < 0.05,k > 15), age, IQ and their sex interactions were independent variables(IV) in two penalized regression models: dependent variable either MOODS-SR-lifetime, depressive or manic domain score as measures of mania and depression risk. Subsequent Poisson regression models included the non-zero variables identified in the penalized regression models. We tested each model in 2 independent samples. Test sample-I,n = 108(21.6 ± 2.09 years,males/females = 33/75); Test sample-II,n = 93(23.7 ± 2.9 years,males/females = 31/62).

RESULTS

Poisson regression models yielded significant relationships with depression and mania risk: Positive correlations were found between right fusiform activity and depression(beta = 0.610) and mania(beta = 0.690) risk. There was a significant interaction between sex and right fusiform activity(beta = -0.609) related to depression risk, where females had a positive relationship than; and a significant interaction(beta = 0.743) between sex and left precuneus activity related to mania risk, with a more negative relationship in females than males. All findings were replicated in the test samples(qs < 0.05,FDR).

LIMITATIONS

No longitudinal follow-up.

CONCLUSION

Greater visual attention to emotional faces might underlie greater depression and mania risk, and confer greater vulnerability to depression in females, because of heightened visual attention to emotional faces. Females have a more negative relationship between mania risk and left precuneus activity, suggesting heightened empathy might be associated with reduced mania/hypomania risk in females more than males.

Reduced spatial frequency differentiation and sex-related specificities in fearful face detection in autism: Insights from EEG and the predictive brain model

Face processing relies on predictive processes driven by low spatial frequencies (LSF) that convey coarse information prior to fine information conveyed by high spatial frequencies. However, autistic individuals might have atypical predictive processes, contributing to facial processing difficulties. This may be more normalized in autistic females, who often exhibit better socio-communicational abilities than males. We hypothesized that autistic females would display a more typical coarse-to-fine processing for socio-emotional stimuli compared to autistic males. To test this hypothesis, we asked adult participants (44 autistic, 51 non-autistic) to detect fearful faces among neutral faces, filtered in two orders: from coarse-to-fine (CtF) and from fine-to-coarse (FtC). Results show lower d' values and longer reaction times for fearful detection in autism compared to non-autistic (NA) individuals, regardless of the filtering order. Both groups presented shorter P100 latency after CtF compared to FtC, and larger amplitude for N170 after FtC compared to CtF. However, autistic participants presented a reduced difference in source activity between CtF and FtC in the fusiform. There was also a more spatially spread activation pattern in autistic females compared to NA females. Finally, females had faster P100 and N170 latencies, as well as larger occipital activation for FtC sequences than males, irrespective of the group. Overall, the results do not suggest impaired predictive processes from LSF in autism despite behavioral differences in fear detection. However, they do indicate reduced brain modulation by spatial frequency in autism. In addition, the findings highlight sex differences that warrant consideration in understanding autistic females.

Social Class, Sex, and the Ability to Recognize Emotions: The Main Effect is in the Interaction

Previous research has demonstrated an inverse relation between subjective social class (SSC) and performance on emotion recognition tasks. Study 1 (N = 418) involved a preregistered replication of this effect using the Reading the Mind in the Eyes Task and the Cambridge Mindreading Face-Voice Battery. The inverse relation replicated; however, exploratory analyses revealed a significant interaction between sex and SSC in predicting emotion recognition, indicating that the effect was driven by males. In Study 2 (N = 745), we preregistered and tested the interaction on a separate archival dataset. The interaction replicated; the association between SSC and emotion recognition again occurred only in males. Exploratory analyses (Study 3; N = 381) examined the generalizability of the interaction to incidental face memory. Our results underscore the need to reevaluate previous research establishing the main effects of social class and sex on emotion recognition abilities, as these effects apparently moderate each other.

The role of the age and gender, and the complexity of the syntactic unit in the perception of affective emotions in voice

PURPOSE

The study aimed to identify (1) whether the age and gender of listeners and the length of vocal stimuli affect emotion discrimination accuracy in voice; and (2) whether the determined level of expression of perceived affective emotions is age and gender-dependent.

METHODS

Thirty-two age-matched listeners listened to 270 semantically neutral voice samples produced in neutral, happy, and angry intonation by ten professional actors. The participants were required to categorize the auditory stimulus based on three options and judge the intensity of emotional expression in the sample using a customized tablet web interface.

RESULTS

The discrimination accuracy of happy and angry emotions decreased with age, while accuracy in discriminating neutral emotions increased with age. Females rated the intensity level of perceived affective emotions higher than males across all linguistic units. These were: for angry emotions in words (z = -3.599, p < .001), phrases (z = -3.218, p = .001), and texts (z = -2.272, p = .023), for happy emotions in words (z = -5.799, p < .001), phrases (z = -4.706, p < .001), and texts (z = -2.699, p = .007).

CONCLUSION

Accuracy in perceiving vocal expressions of emotions varies according to age and gender. Young adults are better at distinguishing happy and angry emotions than middle-aged adults, while middle-aged adults tend to categorize perceived affective emotions as neutral. Gender also plays a role, with females rating expressions of affective emotions in voices higher than males. Additionally, the length of voice stimuli impacts emotion discrimination accuracy.

Gender effect in affective processing: Alpha EEG source analysis on emotional slides and film-clips

Past research on gender-related brain asymmetries in emotions was limited and not univocal. The present study analyzed EEG alpha activity (indexing cortical de-activation) from 64 scalp sites in 20 women and 20 men during a counterbalanced block presentation of emotional slides and short video-clips. Stimuli consisted of 45 brief clips of 13 s, divided into 15 erotic (pleasant), 15 neutral and 15 fear (unpleasant) contents. Slides consisted in 45 photo shots (presented for 13 s each) extracted from the videos. As expected, women perceived fear stimuli as more arousing and more unpleasant compared to men. Alpha EEG source analysis revealed gender effects depending on stimulus. Emotional film-clips elicited in both groups a pattern of greater right than left occipital activation. Instead, emotional pictures activated opposite occipital regions, as women showed greater activation in the left, men in the right hemisphere. Men also showed greater activation to Erotic compared to Fear stimuli (i.e., pictures/clips) in the posterior parietal complex. Results point to the relevance of emotional stimulus type to reveal gender effects: clips are ecological, dynamic and engaging, and forced a unified pattern of emotional responses that reset individual differences. Emotional pictures, less engaging, allowed individual differences to emerge and interact with the stimulus category.

Functional lateralization in social-emotional processing: The influence of sexual orientation and gender identity on cradling preferences

The left-cradling bias (i.e., the motor asymmetry for cradling infants on the left side) has often been associated to the right-hemispheric social-emotional specialization, and it has often been reported to be stronger in females than in males. In this study we explored the effects of sexual orientation and gender identity on this lateral bias by means of a web-based investigation in a sample of adults (485 biological females and 196 biological males) recruited through LGBTQIA+ networks and general university forums. We exploited a cradling imagery task to assess participants' cradling-side preference, and standardized questionnaires to assess participants' homosexuality (Klein Sexual Orientation Grid) and gender nonconformity (Gender Identity/Gender Dysphoria Questionnaire for Adults and Adolescents). Results confirmed the expected left-cradling bias across all sexual orientation groups except for heterosexual males. Importantly, higher homosexuality scores were associated with higher proportions of left cradling in males. These results suggest that sexual orientation can influence cradling preference in males, indicating a complex interaction between biological and psychological factors in the laterality of social-emotional processing. Finally, the left-cradling bias seems to confirm its role as a behavioral proxy of social-emotional functional lateralization in humans.

Mapping the emotional homunculus with fMRI

Emotions are commonly associated with bodily sensations, e.g., boiling with anger when overwhelmed with rage. Studies have shown that emotions are related to specific body parts, suggesting that somatotopically organized cortical regions that commonly respond to somatosensory and motor experiences might be involved in the generation of emotions. We used functional magnetic resonance imaging to investigate whether the subjective feelings of emotion are accompanied by the activation of somatotopically defined sensorimotor brain regions, thus aiming to reconstruct an "emotional homunculus." By defining the convergence of the brain activation patterns evoked by self-generated emotions during scanning onto a sensorimotor map created on participants' tactile and motor brain activity, we showed that all the evoked emotions activated parts of this sensorimotor map, yet with considerable overlap among different emotions. Although we could not find a highly specific segmentation of discrete emotions over sensorimotor regions, our results support an embodied experience of emotions.

Ensemble Coding of Crowd with Cross-Category Facial Expressions

Ensemble coding allows observers to form an average to represent a set of elements. However, it is unclear whether observers can extract an average from a cross-category set. Previous investigations on this issue using low-level stimuli yielded contradictory results. The current study addressed this issue by presenting high-level stimuli (i.e., a crowd of facial expressions) simultaneously (Experiment 1) or sequentially (Experiment 2), and asked participants to complete a member judgment task. The results showed that participants could extract average information from a group of cross-category facial expressions with a short perceptual distance. These findings demonstrate cross-category ensemble coding of high-level stimuli, contributing to the understanding of ensemble coding and providing inspiration for future research.

Ingestible pills reveal gastric correlates of emotions

Although it is generally held that gastrointestinal (GI) signals are related to emotions, direct evidence for such a link is currently lacking. One of the reasons why the internal milieu of the GI system is poorly investigated is because visceral organs are difficult to access and monitor. To directly measure the influence of endoluminal markers of GI activity on the emotional experience, we asked a group of healthy male participants to ingest a pill that measured pH, pressure, and temperature of their GI tract while they watched video clips that consistently induced disgust, fear, happiness, sadness, or a control neutral state. In addition to the objective physiological markers of GI activity, subjective ratings of perceived emotions and visceral (i.e. gastric, respiratory and cardiac) sensations were recorded, as well as changes in heart rate (HR), heart rate variability (HRV) and spontaneous eyes blinks as non-gastric behavioral and autonomic markers of the emotional experience. We found that when participants observed fearful and disgusting video clips, they reported to perceive not only cardiac and respiratory sensations but also gastric sensations, such as nausea. Moreover, we found that there was a clear relation between the physiology of the stomach and the perceived emotions. Specifically, when disgusting video clips were displayed, the more acidic the pH, the more participants reported feelings of disgust and fear; the less acidic the pH, the more they reported happiness. Complementing the results found in the deep gastric realm, we found that disgusting stimuli induced a significant increase in HRV compared to the neutral scenarios, and together with fearful video clips a decrease in HR. Our findings suggest that gastric signals contribute to unique emotional states and that ingestible pills may open new avenues for exploring the deep-body physiology of emotions.

The Interrelationships Between Cognitive Biases for Pain: An Experimental Study

Contemporary pain models highlight cognitive-processing biases (ie, attention bias [AB], interpretation bias [IB], and memory bias [MB]) as key processes that contribute to poor pain outcomes. However, existing research has yielded inconsistent findings regarding the presence and impact of these biases on pain outcomes. Recognizing the need to explore these biases simultaneously, contemporary pain models suggest that cognitive biases (CBs) are interrelated, and may have a combined impact upon pain problems. The current study aims to investigate the interrelationships between CBs using the PainAIM paradigm, a novel approach enabling simultaneous evaluation of pain-related AB, IB, and MB using cues signaling actual pain rather than symbolic information. We hypothesized the presence and positive associations of biases for pain-related cues and the predictive value of combined AB and IB for poor pain outcomes. Eighty-four healthy participants completed the PainAIM paradigm, followed by a cold pressor task probing pain experience and pain-related task interference. The results indicated an inverse relationship between AB and IB for ambiguous pain cues. In addition, there was a positive association between participants' AB for ambiguous pain and their MB for the same cues. Contrary to our hypotheses, CB indices did not predict experimental pain outcomes. These findings provide support for the interrelationships between pain-related CBs. However, future research on the temporal order of CBs and their combined impact on pain outcomes is needed. By overcoming the limitations associated with traditional paradigms, the PainAIM paradigm offers a promising research tool for the further study of combined CBs in the context of pain. PERSPECTIVE: The current study provides insight into the associations between pain-related CBs (AB, IB, and MB) using ecologically valid (ambiguous) pain cues. The results indicated an inverse association between pain-related AB and IB, while a positive association was found between AB and MB. CBs did however not predict experimental pain outcomes.

Self-Rated Confidence in Vocal Emotion Recognition Ability: The Role of Gender

PURPOSE

We studied the role of gender in metacognition of voice emotion recognition ability (ERA), reflected by self-rated confidence (SRC). To this end, we guided our study in two approaches: first, by examining the role of gender in voice ERA and SRC independently and second, by looking for gender effects on the ERA association with SRC.

METHOD

We asked 100 participants (50 men, 50 women) to interpret a set of vocal expressions portrayed by 30 actors (16 men, 14 women) as defined by their emotional meaning. Targets were 180 repetitive lexical sentences articulated in congruent emotional voices (anger, sadness, surprise, happiness, fear) and neutral expressions. Trial by trial, the participants were assigned retrospective SRC based on their emotional recognition performance.

RESULTS

A binomial generalized linear mixed model (GLMM) estimating ERA accuracy revealed a significant gender effect, with women encoders (speakers) yielding higher accuracy levels than men. There was no significant effect of the decoder's (listener's) gender. A second GLMM estimating SRC found a significant effect of encoder and decoder genders, with women outperforming men. Gamma correlations were significantly greater than zero for women and men decoders.

CONCLUSIONS

In spite of varying interpretations of gender in each independent rating (ERA and SRC), our results suggest that both men and women decoders were accurate in their metacognition regarding voice emotion recognition. Further research is needed to study how individuals of both genders use metacognitive knowledge in their emotional recognition and whether and how such knowledge contributes to effective social communication.

Multilevel analysis of positive emotional induction: Which is the role of gender and valence on cognitive control processes?

How emotions are processed affects people's cognition and behavior. One of the most used measures to study the physiological component of emotions is heart rate (HR), where greater HR variation (range) implies greater emotional processing. Several investigations established the importance of gender modulation of these processes due to the different cultural treatment given to emotions among genders. However, very heterogeneous results are reported today, and few studies incorporated these parameters when investigating emotion modulation of cognitive processes according to individual factors. The present work consists of two studies. In a pilot study, 97 young adults, through the Self-Assessment Manikin (SAM), ranged the valence and arousal to select two positive and neutral videos. The second study analyses the role of gender and valence in the variation of subjective (SAM) and physiological (HR) indicators of emotional processing associated with performance in two cognitive tasks (Stroop and Tower of London) under two different emotional conditions. Participants were 60 adults, who were randomly assigned to positive or neutral video visualization, and their HR was registered. There was a tendency for women to have higher HR during positive videos than in neutral. While the subjective reports indicated variances in the appraisal of the videos, the heart rate did not exhibit differences across the experimental conditions. Few studies integrate emotional and cognitive components, and include physiological and subjective measures of emotional processing. These findings illustrate the importance of including various measures of emotional and cognitive processing.

The association between youth violence and mental health outcomes in Colombia: A cross sectional analysis

BACKGROUND

Violence against children and youth poses public health risks regarding mental health symptoms and substance use. Less studied is the relationship between violence and mental health/substance abuse in the Latin American context. This study explored sex-stratified relationships between violence and mental health/substance use among Colombian youth.

METHODS

We analyzed the 2018 Colombian Violence Against Children and Youth Survey, which collected cross-sectional data from Colombian youth (13-24 years) (n = 2705). Exposure variables were (i) binary sexual, emotional, and physical victimization and (ii) poly-victimization. The outcomes were binary suicidal thoughts, self-harm, past-month psychological distress, binge drinking, smoking, and drug use. Sex-stratified, logistic regressions were adjusted for age, primary school, parental presence, relationship status, and witnessing community violence.

RESULTS

For females, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts, self-harm, and psychological distress and (ii) sexual violence was associated with suicidal thoughts and self-harm. For males, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts and psychological distress, but not self-harm and (ii) sexual violence exposure was associated with suicidal thoughts and self-harm. Physical violence was generally not associated with internalized mental health outcomes for females/males, when emotional and sexual violence were held constant. Poly-victimization was consistently and positively associated with internalized mental health symptoms among females, and to a lesser degree for males. Substance use outcomes for males or females were not associated with violence.

CONCLUSIONS

Findings highlight the internalized mental health burden of emotional and sexual violence.

Perception and memory-based representations of facial emotions: Associations with personality functioning, affective states and recognition abilities

Personality traits and affective states are associated with biases in facial emotion perception. However, the precise personality impairments and affective states that underlie these biases remain largely unknown. To investigate how relevant factors influence facial emotion perception and recollection, Experiment 1 employed an image reconstruction approach in which community-dwelling adults (N = 89) rated the similarity of pairs of facial expressions, including those recalled from memory. Subsequently, perception- and memory-based expression representations derived from such ratings were assessed across participants and related to measures of personality impairment, state affect, and visual recognition abilities. Impairment in self-direction and level of positive affect accounted for the largest components of individual variability in perception and memory representations, respectively. Additionally, individual differences in these representations were impacted by face recognition ability. In Experiment 2, adult participants (N = 81) rated facial image reconstructions derived in Experiment 1, revealing that individual variability was associated with specific visual face properties, such as expressiveness, representation accuracy, and positivity/negativity. These findings highlight and clarify the influence of personality, affective state, and recognition abilities on individual differences in the perception and recollection of facial expressions.

Social cognition abilities in patients with primary and secondary chronic pain

Previous evidence suggested that chronic pain is characterized by cognitive deficits, particularly in the social cognition domain. Recently, a new chronic pain classification has been proposed distinguishing chronic primary pain (CPP), in which pain is the primary cause of patients' disease, and chronic secondary pain (CSP), in which pain is secondary to an underlying illness. The present study aimed at investigating social cognition profiles in the two disorders. We included 38 CPP, 43 CSP patients, and 41 healthy controls (HC). Social cognition was assessed with the Ekman-60 faces test (Ekman-60F) and the Story-Based Empathy Task (SET), whereas global cognitive functioning was measured with the Montreal Cognitive Assessment (MoCA). Pain and mood symptoms, coping strategies, and alexithymia were also evaluated. Correlations among clinical pain-related measures, cognitive performance, and psychopathological features were investigated. Results suggested that CSP patients were impaired compared to CPP and HC in social cognition abilities, while CPP and HC performance was not statistically different. Pain intensity and illness duration did not correlate with cognitive performance or psychopathological measures. These findings confirmed the presence of social cognition deficits in chronic pain patients, suggesting for the first time that such impairment mainly affects CSP patients, but not CPP. We also highlighted the importance of measuring global cognitive functioning when targeting chronic pain disorders. Future research should further investigate the cognitive and psychopathological profile of CPP and CSP patients to clarify whether present findings can be generalized as disorder characteristics.

Sex differences in the effects of individual anxiety state on regional responses to negative emotional scenes

BACKGROUND

Men and women are known to show differences in the incidence and clinical manifestations of mood and anxiety disorders. Many imaging studies have investigated the neural correlates of sex differences in emotion processing. However, it remains unclear how anxiety might impact emotion processing differently in men and women.

METHOD

We recruited 119 healthy adults and assessed their levels of anxiety using State-Trait Anxiety Inventory (STAI) State score. With functional magnetic resonance imaging (fMRI), we examined regional responses to negative vs. neutral (Neg-Neu) picture matching in the Hariri task. Behavioral data were analyzed using regression and repeated-measures analysis of covariance with age as a covariate, and fMRI data were analyzed using a full-factorial model with sex as a factor and age as a covariate.

RESULTS

Men and women did not differ in STAI score, or accuracy rate or reaction time (RT) (Neg-Neu). However, STAI scores correlated positively with RT (Neg-Neu) in women but not in men. Additionally, in women, STAI score correlated positively with lingual gyrus (LG) and negatively with medial prefrontal cortex (mPFC) and superior frontal gyrus (SFG) activity during Neg vs. Neu trials. The parameter estimates (βs) of mPFC also correlated with RT (Neg-Neu) in women but not in men. Generalized psychophysiological interaction (gPPI) analysis in women revealed mPFC connectivity with the right inferior frontal gyrus, right SFG, and left parahippocampal gyrus during Neg vs. Neu trials in positive correlation with both STAI score and RT (Neg-Neu). In a mediation analysis, mPFC gPPI but not mPFC activity fully mediated the association between STAI scores and RT (Neg-Neu).

CONCLUSION

With anxiety affecting the behavioral and neural responses to negative emotions in women but not in men and considering the known roles of the mPFC in emotion regulation, we discussed heightened sensitivity and regulatory demands during negative emotion processing as neurobehavioral markers of anxiety in women.

Sex modulation of faces prediction error in the autistic brain

Recent research suggests that autistic females may have superior socio-cognitive abilities compared to autistic males, potentially contributing to underdiagnosis in females. However, it remains unclear whether these differences arise from distinct neurophysiological functioning in autistic males and females. This study addresses this question by presenting 41 autistic and 48 non-autistic adults with a spatially filtered faces oddball paradigm. Analysis of event-related potentials from scalp electroencephalography reveal a neurophysiological profile in autistic females that fell between those of autistic males and non-autistic females, highlighting sex differences in autism from the initial stages of face processing. This finding underscores the urgent need to explore neurophysiological sex differences in autism and encourages efforts toward a better comprehension of compensation mechanism and a clearer definition of what is meant by camouflaging.

The effect of negative emotion processing on spatial navigation: an experimental study using virtual reality

Finding one's way in unfamiliar environments is an essential ability. When navigating, people are overwhelmed with an enormous amount of information. However, some information might be more relevant than others. Despite the mounting knowledge about the mechanisms underlying orientational skills, and the notable effects of facial emotions on human behavior, little is known about emotions' effects on spatial navigation. Hereby, this study aimed to explore how exposure to others' negative emotional facial expressions affects wayfinding performances. Moreover, gender differences that characterize both processes were considered. Fifty-five participants (31 females) entered twice in three realistic virtual reality environments: the first time, to encode a route to find an object and then to recall the learned path to reach the same object again. In between the two explorations of the virtual environment, participants were asked to undergo a gender categorization task during which they were exposed to sixty faces showing either neutral, fearful, or angry expressions. Results showed a significant interaction between emotions, time, and gender. In particular, the exposition to fearful faces, but not angry and neutral ones, decreased males' wayfinding performances (i.e., travel times and distance travelled), while females' performances were unaffected. Possible explanations for such gender and emotional dissimilarities are discussed.

Sex differences in the effects of individual anxiety state on regional responses to negative emotional scenes

Background

Men and women are known to show differences in the incidence and clinical manifestations of mood and anxiety disorders. Many imaging studies have investigated the neural correlates of sex differences in emotion processing. However, it remains unclear how anxiety might impact emotion processing differently in men and women.

Method

We recruited 119 healthy adults and assessed their levels of anxiety using State-Trait Anxiety Inventory (STAI) State score. With functional magnetic resonance imaging (fMRI), we examined regional responses to negative vs. neutral (Neg-Neu) picture matching in the Hariri task. Behavioral data were analyzed using regression and repeated-measures analysis of covariance with age as a covariate, and fMRI data were analyzed using a full-factorial model with sex as a factor and age as a covariate.

Results

Men and women did not differ in STAI score, or accuracy rate or reaction time (RT) (Neg-Neu). However, STAI scores correlated positively with RT (Neg-Neu) in women but not in men. Additionally, in women, STAI score correlated positively with lingual gyrus (LG) and negatively with medial prefrontal cortex (mPFC) and superior frontal gyrus (SFG) activity during Neg vs. Neu trials. The parameter estimates (β's) of mPFC also correlated with RT (Neg-Neu) in women but not in men. Generalized psychophysiological interaction (gPPI) analysis in women revealed mPFC connectivity with the right inferior frontal gyrus, right SFG, and left parahippocampal gyrus during Neg vs. Neu trials in positive correlation with both STAI score and RT (Neg-Neu). In a mediation analysis, mPFC gPPI but not mPFC activity fully mediated the association between STAI scores and RT (Neg-Neu).

Conclusion

With anxiety affecting the behavioral and neural responses to negative emotions in women but not in men and considering the known roles of the mPFC in emotion regulation, we discussed heightened sensitivity and regulatory demands during negative emotion processing as neurobehavioral markers of anxiety in women.

Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis

BACKGROUND

Medical humanities education is an important part of medical education. The purpose of this study was to determine the effectiveness of medical humanities in improving empathy among medical students and healthcare professionals.

METHODS

PubMed, Embase, EBSCO-ERIC, Web of Science were searched systematically for studies in the English language. The last retrieval date is May 1, 2023. Best Evidence Medical Education (BEME) Global Rating Scale and Kirkpatrick-based results were used to evaluate the quality of literature. In this study, a meta-analysis of continuous data was conducted.

RESULTS

The pooled results by single-arm test meta-analysis showed a benefit with medical humanities programs in empathy (SMD 1.33; 95% CI 0.69-1.96). For single-arm trials of medical humanities program interventions of less than 4 months, 4 months to 12 months, and more than one year, the standardized mean differences(SMD) between post-test and pre-test were 1.74 (P < 0.05), 1.26 (P < 0.05), and 0.13 (P = 0.46), respectively. The results showed a significant difference in the effect of medical humanities programs on male and female empathy (SMD - 1.10; 95% CI -2.08 - -0.13). The SMDs for the study of course, the course combined reflective writing, and the course combined reflective writing and practice as intervention modalities for medical humanities programs were 1.15 (P < 0.05), 1.64 (P < 0.05), and 1.50 (P < 0.05), respectively.

CONCLUSION

Medical humanities programs as a whole can improve the empathy of medical students and health professionals. However, different intervention durations and different intervention methods produce different intervention effects.

How Male and Female Literary Authors Write About Affect Across Cultures and Over Historical Periods

A wealth of literature suggests the existence of sex differences in how emotions are experienced, recognized, expressed, and regulated. However, to what extent these differences result from the put in place of stereotypes and social rules is still a matter of debate. Literature is an essential cultural institution, a transposition of the social life of people but also of their intimate affective experiences, which can serve to address questions of psychological relevance. Here, we created a large corpus of literary fiction enriched by authors' metadata to measure the extent to which culture influences how men and women write about emotion. Our results show that even though before the twenty-first century and across 116 countries women more than men have written about affect, starting from 2000, this difference has diminished substantially. Also, in the past, women's narratives were more positively laden and less arousing. While the difference in arousal is ubiquitous and still present nowadays, sex differences in valence vary as a function of culture and have dissolved in recent years. Altogether, these findings suggest that historic evolution is associated with men and women writing similarly about emotions and reveal a sizable impact of culture on the affective characteristics of the lexicon.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00219-9.

A systematic review of the acute effects of alcohol on emotion recognition of facial expressions

Alcohol has been linked to both positive (e.g., sociability) and negative (e.g., aggression) social outcomes, and researchers have proposed that alcohol-induced changes in emotion recognition may partially explain these effects. Here, we systematically review alcohol administration studies to clarify the acute effects of alcohol on emotion recognition. We also investigate various moderator variables (i.e., sex, study quality, study design, alcohol dosage, emotion recognition task and outcome measure). PsycINFO, PubMed and Google Scholar were searched following a pre-registered PROSPERO protocol (CRD42021225392) and PRISMA methodology. Analyses focused on differences in emotion recognition between participants consuming alcoholic and/or non-alcoholic (i.e., placebo or no-alcohol control) beverages. Nineteen unique samples (N = 1271 participants) were derived from 17 articles (two articles included two studies, each conducted on a unique sample). Data were extracted for sample characteristics, alcohol administration methods and emotion recognition tasks and outcomes. All studies compared an alcoholic beverage to a placebo beverage and used tasks that asked participants to identify emotions from images or videos of facial expressions. Otherwise, methodologies varied substantially across studies, including the alcohol dosage(s) tested, the specific emotion recognition task(s) used and the outcome variable(s) assessed. No consistent effects of alcohol on emotion recognition emerged for any emotion. None of the moderator variables affected the findings, except for some indication that alcohol may affect males' emotion recognition abilities more so than females. Alcohol does not appear to consistently affect positive or negative emotion recognition of facial expressions, at least with the tasks currently used in the field.

Sex differences in the rapid detection of neutral faces associated with emotional value

BACKGROUND

Rapid detection of faces with emotional meaning is essential for understanding the emotions of others, possibly promoting successful interpersonal relationships. Although few studies have examined sex differences in the ability to detect emotional faces, it remains unclear whether faces with emotional meaning capture the attention of females and males differently, because emotional faces have visual saliency that modulates visual attention. To overcome this issue, we tested the rapid detection of the neutral faces associated with and without learned emotional value, which are all regarded as free from visual saliency. We examined sex differences in the rapid detection of the neutral female and male faces associated with emotional value.

METHODS

First, young adult female and male participants completed an associative learning task in which neutral faces were associated with either monetary rewards, monetary punishments, or no monetary outcomes, such that the neutral faces acquired positive, negative, and no emotional value, respectively. Then, they engaged in a visual search task in which previously learned neutral faces were presented as discrepant faces among newly presented neutral distractor faces. During the visual search task, the participants were required to rapidly identify discrepant faces.

RESULTS

Female and male participants exhibited comparable learning abilities. The visual search results demonstrated that female participants achieved rapid detection of neutral faces associated with emotional value irrespective of the sex of the faces presented, whereas male participants showed this ability only for male faces.

CONCLUSIONS

Our results demonstrated that sex differences in the ability to rapidly detect neutral faces with emotional value were modulated by the sex of those faces. The results suggest greater sensitivity to faces with emotional significance in females, which might enrich interpersonal communication, regardless of sex.

Hierarchical status is rapidly assessed from behaviourally dominant faces

Recognition of social hierarchy is a key feature that helps us navigate through our complex social environment. Neuroimaging studies have identified brain structures involved in the processing of hierarchical stimuli, but the precise temporal dynamics of brain activity associated with such processing remains largely unknown. In this investigation, we used event-related potentials (ERPs) to examine the effect of social hierarchy on the neural responses elicited by dominant and nondominant faces. Participants played a game where they were led to believe that they were middle-rank players, responding alongside other alleged players, whom they perceived as higher or lower-ranking. ERPs were examined in response to dominant and nondominant faces, and low-resolution electromagnetic tomography (LORETA) was used to identify the implicated brain areas. The results revealed that the amplitude of the N170 component was enhanced for faces of dominant individuals, showing that hierarchy influences the early stages of face processing. A later component, the late positive potential (LPP) appearing between 350-700 ms, also was enhanced for faces of higher-ranking players. Source localisation suggested that the early modulation was due to an enhanced response in limbic regions. These findings provide electrophysiological evidence for enhanced early visual processing of socially dominant faces.

The influence of selective attention to specific emotions on the processing of faces as revealed by event-related brain potentials

Event-related potential studies using affective words have indicated that selective attention to valence can increase affective discrimination at early perceptual stages. This effect most likely relies on neural associations between perceptual features of a stimulus and its affective value. Similar to words, emotional expressions in human faces are linked to specific visual elements. Therefore, selectively attending to a given emotion should allow for the preactivation of neural networks coding for the emotion and associated first-order visual elements, leading to enhanced early processing of faces expressing the attended emotion. To investigate this, we employed an expression detection task (N = 65). Fearful, happy, and neutral faces were randomly presented in three blocks while participants were instructed to respond only to one predefined target level of expression in each block. Reaction times were the fastest for happy target faces, which was accompanied by an increased occipital P1 for happy compared with fearful faces. The N170 yielded an arousal effect (emotional > neutral) while both components were not modulated by target status. In contrast, the early posterior negativity (EPN) arousal effect tended to be larger for target compared with nontarget faces. The late positive potential (LPP) revealed large effects of status and expression as well as an interaction driven by an increased LPP specifically for nontarget fearful faces. These findings tentatively indicate that selective attention to facial affect may enhance early emotional processing (EPN) even though further research is needed. Moreover, late controlled processing of facial emotions appears to involve a negativity bias.

He must be mad; she might be sad: perceptual and decisional aspects of emotion recognition in ambiguous faces

While the recognition of ambiguous emotions is crucial for successful social interactions, previous work has shown that they are perceived differently depending on whether they are viewed on male or female faces. The present paper aims to shed light on this phenomenon by exploring two hypotheses: the confounded signal hypothesis, which posits the existence of perceptual overlaps between emotions and gendered morphotypes, and the social role hypothesis, according to which the observer's responses are biased by stereotypes. Participants were asked to categorise blended faces (i.e. artificial faces made ambiguous by mixing two emotions) in a forced-choice task. Six emotions were used to create each blend (neutral, surprise, sadness, fear, happiness, anger), for a total of 15 expressions. We then applied signal detection theory - considering both the morphotype of the stimuli and the participants' gender - to distinguish participants' perceptual processes from their response biases. The results showed a perceptual advantage for anger on male faces and for sadness on female faces. However, different strategies were deployed when labelling emotions on gendered morphotypes. In particular, a response bias towards angry male faces establishes their special status, as they resulted in both excellent detection and a tendency to be over-reported, especially by women.

Effects of others' gaze and facial expression on an observer's microsaccades and their association with ADHD tendencies

BACKGROUND

The aim of this study was to examine the effect of others' gaze on an observer's microsaccades. We also aimed to conduct preliminary investigations on the relationship between the microsaccadic response to a gaze and a gazer's facial expression and attention-deficit/hyperactivity disorder (ADHD) tendencies.

METHODS

Twenty healthy undergraduate and graduate students performed a peripheral target detection task by using unpredictable gaze cues. During the task, the participants' eye movements, along with changes in pupil size and response times for target detection, were recorded. ADHD tendencies were determined using an ADHD questionnaire.

RESULTS

We found that consciously perceiving the gaze of another person induced the observer's attention; moreover, microsaccades were biased in the direction opposite to the gaze. Furthermore, these microsaccade biases were differentially modulated, based on the cognitive processing of the facial expressions of the gaze. Exploratory correlation analysis indicated that microsaccade biases toward gazes with fearful expressions may specifically be correlated with participant characteristics, including inattention.

CONCLUSIONS

Our findings support that microsaccades reflect spatial attention processing and social cognitive processing. Moreover, the exploratory correlation analysis results suggested the potential benefit of using microsaccade bias toward spatial attention to assess pathophysiological responses associated with ADHD tendencies.

Role of Emotion Reactivity to Predict Facial Emotion Recognition Changes with Aging

Emotional intelligence includes an assortment of factors related to emotion function. Such factors involve emotion recognition (in this case via facial expression), emotion trait, reactivity, and regulation. We aimed to investigate how the subjective appraisals of emotional intelligence (i.e. trait, reactivity, and regulation) are associated with objective emotion recognition accuracy, and how these associations differ between young and older adults. Data were extracted from the CamCAN dataset (189 adults: 57 young/118 older) from assessments measuring these emotion constructs. Using linear regression models, we found that greater negative reactivity was associated with better emotion recognition accuracy among older adults, though the pattern was opposite for young adults with the greatest difference in disgust and surprise recognition. Positive reactivity and depression level predicted surprise recognition, with the associations significantly differing between the age groups. The present findings suggest the level to which older and young adults react to emotional stimuli differentially predicts their ability to correctly identify facial emotion expressions. Older adults with higher negative reactivity may be able to integrate their negative emotions effectively in order to recognize other's negative emotions more accurately. Alternatively, young adults may experience interference from negative reactivity, lowering their ability to recognize other's negative emotions.

Sex Differences in Neural Correlates of Emotion Regulation in Relation to Resting Heart Rate Variability

Prior studies suggest that sex differences in emotion regulation (ER) ability contribute to sex disparities in affective disorders. In behavioral studies, females rely more on maladaptive strategies to cope with emotional distress than males. Neuroimaging studies suggest that males more efficiently regulate emotion than females by showing less prefrontal cortex activity (suggesting less effort) for similar amygdala activity (similar regulation outcome). However, physiological studies involving heart rate variability (HRV) indicated that, compared with males, females have higher resting HRV, indicative of parasympathetic dominance and better control of emotion. To help resolve these apparently inconsistent findings, we examined sex differences in how resting HRV relates to brain activity while using cognitive reappraisal, one of the adaptive strategies. Based on 51 males and 49 females, we found that females showed different levels of self-rated emotional intensity and amygdala activity for negative versus positive emotions, while males did not. Females also showed greater overall prefrontal cortex activity but similar levels of amygdala activity compared to males. Sex differences in how resting HRV related to brain activity during ER were evident only during viewing or regulating positive emotion. The results suggest that sex differences in the neural correlates of ER and resting HRV might lie in valence more than arousal modulation.

Gender Differences in Facial Emotion Recognition Among Adolescents Depression with Non-Suicidal Self-Injury

Objective

Despite the perception that healthy female are superior at emotional identification, it remains unclear whether gender-specific differences exist in adolescent depression and whether such specific differences in emotional recognition are associated with the most salient feature of adolescent depression---non-suicidal self-injury (NSSI).

Methods

In this study, 1428 adolescents (1136 females and 292 males) with depression and NSSI were examined using the Facial Emotion Recognition Task, Patient Health Questionnaire-9 (PHQ-9), and Functional Assessment of Self-mutilation questionnaire (FASM). This study was grouped by gender. Data were analyzed using the descriptive statistics, independent sample t-test, chi-square test, non-parametric test (Mann-Whitney U-test), Spearman correlation and Multiple linear regression analysis.

Results

Depressed females reported a significantly greater frequency of self-injurious behaviour and more severe depressive symptoms than males. Face emotion recognition was also significantly more accurate in females and was positively correlated with levels of self-injury and depression, whereas no such correlations were found in males. Among depressed adolescents, face emotion recognition is better in females and is associated with self-injurious behaviour.

Conclusion

This study found that the greater susceptibility to depression and NSSI among adolescent females may stem in part from superior recognition and sensitivity to the negative emotions of others.

Untangling the confounded relationship between perceiver sex and walker sex on the bistable perception of emotion displaying point-light walkers

Point-light displays of walking gait carries an assortment of information about the individual and this information is often perceivable to others. Some of these bits of information are entangled, with some facilitating and others inhibiting each other. We sought to untangle the perception of basic threat emotions from sex of the walker and the perceiver, as expressed through the bistable perception of anticipated approaching or withdrawing point-light walkers. Stationary point-light walkers displaying anger or fear were shown to 164 psychology student perceivers, who were told that the walkers would be either walking towards them or walking away from them. Perceivers were asked to identify the displayed emotion for each walker stimulus. Expected walker direction showed no influence on the perception of either emotion, across either sex of the perceivers or walkers. Anger was identified better on male walkers and fear was identified better on female walkers. Female perceivers were able to identify both emotions better than male perceivers, but only when displayed by female walkers. The sex of both the perceiver and the walker interact to influence the perception of basic threat emotions displayed through point-light walking gait, with implications for the development of inter-sexual and intra-sexual group cohesion programs.

The Spatiotemporal Dynamics of Facial Movements Reveals the Left Side of a Posed Smile

Humans can recombine thousands of different facial expressions. This variability is due to the ability to voluntarily or involuntarily modulate emotional expressions, which, in turn, depends on the existence of two anatomically separate pathways. The Voluntary (VP) and Involuntary (IP) pathways mediate the production of posed and spontaneous facial expressions, respectively, and might also affect the left and right sides of the face differently. This is a neglected aspect in the literature on emotion, where posed expressions instead of genuine expressions are often used as stimuli. Two experiments with different induction methods were specifically designed to investigate the unfolding of spontaneous and posed facial expressions of happiness along the facial vertical axis (left, right) with a high-definition 3-D optoelectronic system. The results showed that spontaneous expressions were distinguished from posed facial movements as revealed by reliable spatial and speed key kinematic patterns in both experiments. Moreover, VP activation produced a lateralization effect: compared with the felt smile, the posed smile involved an initial acceleration of the left corner of the mouth, while an early deceleration of the right corner occurred in the second phase of the movement, after the velocity peak.

Emotion recognition of faces and emoji in individuals with moderate-severe traumatic brain injury

BACKGROUND

Facial emotion recognition deficits are common after moderate-severe traumatic brain injury (TBI) and linked to poor social outcomes. We examine whether emotion recognition deficits extend to facial expressions depicted by emoji.

METHODS

Fifty-one individuals with moderate-severe TBI (25 female) and fifty-one neurotypical peers (26 female) viewed photos of human faces and emoji. Participants selected the best-fitting label from a set of basic emotions (anger, disgust, fear, sadness, neutral, surprise, happy) or social emotions (embarrassed, remorseful, anxious, neutral, flirting, confident, proud).

RESULTS

We analyzed the likelihood of correctly labeling an emotion by group (neurotypical, TBI), stimulus condition (basic faces, basic emoji, social emoji), sex (female, male), and their interactions. Participants with TBI did not significantly differ from neurotypical peers in overall emotion labeling accuracy. Both groups had poorer labeling accuracy for emoji compared to faces. Participants with TBI (but not neurotypical peers) had poorer accuracy for labeling social emotions depicted by emoji compared to basic emotions depicted by emoji. There were no effects of participant sex.

DISCUSSION

Because emotion representation is more ambiguous in emoji than human faces, studying emoji use and perception in TBI is an important consideration for understanding functional communication and social participation after brain injury.

Do subtle cultural differences sculpt face pareidolia?

Face tuning to non-face images such as shadows or grilled toasts is termed face pareidolia. Face-pareidolia images represent a valuable tool for investigation of social cognition in mental disorders. Here we examined (i) whether, and, if so, how face pareidolia is affected by subtle cultural differences; and (ii) whether this impact is modulated by gender. With this purpose in mind, females and males from Northern Italy were administered a set of Face-n-Thing images, photographs of objects such as houses or waves to a varying degree resembling a face. Participants were presented with pareidolia images with canonical upright orientation and display inversion that heavily affects face pareidolia. In a two-alternative forced-choice paradigm, beholders had to indicate whether each image resembled a face. The outcome was compared with the findings obtained in the Southwest of Germany. With upright orientation, neither cultural background nor gender affected face pareidolia. As expected, display inversion generally mired face pareidolia. Yet, while display inversion led to a drastic reduction of face impression in German males as compared to females, in Italians, no gender differences were found. In a nutshell, subtle cultural differences do not sculpt face pareidolia, but instead affect face impression in a gender-specific way under unusual viewing conditions. Clarification of the origins of these effects requires tailored brain imaging work. Implications for transcultural psychiatry, in particular, for schizophrenia research, are highlighted and discussed.

A comparative study of social cognition in epilepsy, brain injury, and Parkinson's disease

The brain regions involved in social cognition and the regulation of social behavior form a widely distributed cortico-subcortical network. Therefore, many neurological disorders could affect social cognition and behavior. A persistent lack of valid tests and a rigid neuropsychological focus on language, attention, executive function, and memory have contributed to a long-standing neglect of social cognition in clinical diagnostics, although the DSM-5 recognizes it as one of the six core dimensions in neurocognitive disorders. To assess for the first time the diagnostic yield of a comprehensive social cognition battery (Networks of Emotion Processing [NEmo]), we administered several emotion recognition and theory of mind tests to three incidental clinical samples with different neurological conditions: temporal lobe epilepsy (n = 30), acquired brain injury (n = 24), Parkinson's disease (n = 19), and a healthy control group (n = 67). A multivariate analysis of covariance was performed to test the effect of group on subscales of the NEmo test battery, controlling for age and performance IQ. The results showed statistically significant differences between clinical groups and healthy controls. No differences were found for gender and lateralization of the predominant lesion side. In our incidental samples, 86% of individuals with temporal lobe epilepsy, 57% of individuals with acquired brain lesion, and 14% of individuals with Parkinson's disease underperformed on tests of social cognition compared with controls. These findings suggest a differential impact of neurological disorders on the risk of impaired social cognition and highlight the need to consider social cognition in diagnostics, counselling, therapy, and rehabilitation.

Sex differences in resting state functional connectivity across the first two years of life

Sex differences in behavior have been reported from infancy through adulthood, but little is known about sex effects on functional circuitry in early infancy. Moreover, the relationship between early sex effects on the functional architecture of the brain and later behavioral performance remains to be elucidated. In this study, we used resting-state fMRI and a novel heatmap analysis to examine sex differences in functional connectivity with cross-sectional and longitudinal mixed models in a large cohort of infants (n = 319 neonates, 1-, and 2-year-olds). An adult dataset (n = 92) was also included for comparison. We investigated the relationship between sex differences in functional circuitry and later measures of language (collected in 1- and 2-year-olds) as well as indices of anxiety, executive function, and intelligence (collected in 4-year-olds). Brain areas showing the most significant sex differences were age-specific across infancy, with two temporal regions demonstrating consistent differences. Measures of functional connectivity showing sex differences in infancy were significantly associated with subsequent behavioral scores of language, executive function, and intelligence. Our findings provide insights into the effects of sex on dynamic neurodevelopmental trajectories during infancy and lay an important foundation for understanding the mechanisms underlying sex differences in health and disease.

Development and validation of a cynomolgus macaque grimace scale for acute pain assessment

Cynomolgus macaques may undergo surgical procedures for scientific and veterinary purposes. Recognition and assessment of pain using validated tools is a necessary first step for adequately managing pain in these primates. Grimace scales are one means of assessing the occurance of acute pain using action units such as facial expressions and posture. The aim of this study was to create and validate a Cynomolgus Macaque Grimace Scale (CMGS). Cynomolgus macaques (n = 43) were video recorded before and after a surgical procedure. Images were extracted from videos at timepoints at which breakthrough pain might be expected based on analgesic pharmacokinetics. Using the CMGS images were scored by 12 observers blinded to animal identification, times, and conditions. To validate the tool, detailed behavioral analyses emphasizing changes to baseline activity ethograms were compared to grimace scores. Four action units were identified related to potential pain including orbital tightening, brow lowering, cheek tightening, and hunched posture. The CMGS tool was found to have moderate inter- (ICC_average action unit mean ± SD: 0.67 ± 0.28) and good intra- (ICC_single mean ± SD: 0.79 ± 0.14) observer reliability. Grimace scores increased significantly (p < 0.0001) in the first four post-operative timepoints compared to baseline, correlating with behavioral findings (rho range = 0.22-0.35, p < 0.001). An analgesic intervention threshold was determined and should be considered when providing additional pain relief. The CMGS was shown to be a reliable and valid tool; however, more research is needed to confirm external validity. This tool will be highly valuable for refining analgesic protocols and acute peri-procedural care for cynomolgus macaques.

Sex-Determined Alteration of Frontal Electroencephalographic (EEG) Activity in Social Presence

This study represents a follow-up event-related potential (ERP) analysis of a prior investigation. The previous results showed that participants had most negative-tending ERPs in the mid-frontal brain region during exposure to neutral emotion pictures (compared to negative and positive pictures) while being accompanied by a significant other person (social presence condition). The present analysis aimed at investigating potential sex differences related to this phenomenon. Female and male participants' brain activity data from the previous study were analyzed separately for one representative mid-frontal electrode location selected on the basis of having the highest significance level. As a result, only female participants showed significantly more negative-tending potentials in response to neutral pictures, compared to both other emotion categories (positive and negative) in the social presence condition. This was not found in male participants. The respective ERP effect was most dominant at 838 ms post stimulus onset, which is slightly later than the effect found in the prior study. However, this result is interpreted as evidence that the general effect from the prior study can be understood as a largely female phenomenon. In line with the prior study, the present results are interpreted as a predominantly female activation in the mid-frontal brain region in response to neutral picture stimuli while being accompanied by a significant other person (social presence condition). Although only speculative, this would align with previous studies demonstrating sex-related hormonal and structural differences in the anterior cingulate cortex (ACC). In general, ACC activation has been associated with an integrative weighting function in ambiguous social settings, which makes sense given the ambiguous nature of neutral pictures in combination with a social presence condition.

The impact of briefly observing faces in opaque facial masks on emotion recognition and empathic concern

Since the outbreak of SARS-CoV-2 in 2019, there have been global public health initiatives that have advocated for the community use of face masks to reduce spread of the virus. Although the community use of facial coverings has been deemed essential for public health, there have been calls for enquiries to ascertain how face masks may impact non-verbal methods of communication. This study aimed to ascertain how the brief observations of faces in opaque facial coverings could impact facial emotion recognition. It was also an aim to ascertain if there was an association between the levels of empathic concern and facial emotion recognition when viewing masked faces. An opportunity sample of 199 participants, who resided in the United Kingdom, were randomly assigned to briefly observe either masked (n = 102) or unmasked (n = 97) faces. Participants in both conditions were required to view a series of facial expressions, from the Radboud Faces Database, with models conveying the emotional states of anger, disgust, fear, happiness, sadness, and surprised. Each face was presented to participants for a period of 250 ms in the masked and unmasked conditions. A 6 (emotion type) x 2 (masked/unmasked condition) mixed ANOVA revealed that viewing masked faces significantly reduced facial emotion recognition of disgust, fear, happiness, sadness, and surprised. However, there were no differences in the success rate of recognising the emotional state of anger between the masked and unmasked conditions. Furthermore, higher levels of empathic concern were associated with greater success in facially recognising the emotional state of disgust. The results of this study suggest that significant reductions in emotion recognition, when viewing faces in opaque masks, can still be observed when people are exposed to facial stimuli for a brief period of time.

Sex/Gender Differences in Verbal Fluency and Verbal-Episodic Memory: A Meta-Analysis

Women are thought to fare better in verbal abilities, especially in verbal-fluency and verbal-memory tasks. However, the last meta-analysis on sex/gender differences in verbal fluency dates from 1988. Although verbal memory has only recently been investigated meta-analytically, a comprehensive meta-analysis is lacking that focuses on verbal memory as it is typically assessed, for example, in neuropsychological settings. On the basis of 496 effect sizes and 355,173 participants, in the current meta-analysis, we found that women/girls outperformed men/boys in phonemic fluency (ds = 0.12-0.13) but not in semantic fluency (ds = 0.01-0.02), for which the sex/gender difference appeared to be category-dependent. Women/girls also outperformed men/boys in recall (d = 0.28) and recognition (ds = 0.12-0.17). Although effect sizes are small, the female advantage was relatively stable over the past 50 years and across lifetime. Published articles reported stronger female advantages than unpublished studies, and first authors reported better performance for members of their own sex/gender. We conclude that a small female advantage in phonemic fluency, recall, and recognition exists and is partly subject to publication bias. Considerable variance suggests further contributing factors, such as participants' language and country/region.

What is missing in the study of emotion expression?

While approaching celebrations for the 150 years of "The Expression of the Emotions in Man and Animals", scientists' conclusions on emotion expression are still debated. Emotion expression has been traditionally anchored to prototypical and mutually exclusive facial expressions (e.g., anger, disgust, fear, happiness, sadness, and surprise). However, people express emotions in nuanced patterns and - crucially - not everything is in the face. In recent decades considerable work has critiqued this classical view, calling for a more fluid and flexible approach that considers how humans dynamically perform genuine expressions with their bodies in context. A growing body of evidence suggests that each emotional display is a complex, multi-component, motoric event. The human face is never static, but continuously acts and reacts to internal and environmental stimuli, with the coordinated action of muscles throughout the body. Moreover, two anatomically and functionally different neural pathways sub-serve voluntary and involuntary expressions. An interesting implication is that we have distinct and independent pathways for genuine and posed facial expressions, and different combinations may occur across the vertical facial axis. Investigating the time course of these facial blends, which can be controlled consciously only in part, is recently providing a useful operational test for comparing the different predictions of various models on the lateralization of emotions. This concise review will identify shortcomings and new challenges regarding the study of emotion expressions at face, body, and contextual levels, eventually resulting in a theoretical and methodological shift in the study of emotions. We contend that the most feasible solution to address the complex world of emotion expression is defining a completely new and more complete approach to emotional investigation. This approach can potentially lead us to the roots of emotional display, and to the individual mechanisms underlying their expression (i.e., individual emotional signatures).

The effect of observation angles on facial age perceptions: A case study of Japanese women

Most conventional aging research has limited its approach concerning the head and face shape and skin condition to the frontal face. However, in our daily lives, we observe facial features from various angles, which may reveal or obscure aging features that could only be identified under limited conditions in the past. This study systematically investigates the effect of facial observation angles-specifically, of horizontal and vertical angles-on age impression. A total of 112 Japanese women aged 20-49 years participated as observers who evaluated the age impressions of 280 Japanese women aged 20-69 years. A two-way analysis of the variance of the age impression score was conducted for two factors: observation angle (five angles with yaw and pitch directions) and age group (five ages, from the 20s to the 60s). The results reveal that, as compared with frontal observation, the perceived age tended to decrease with the facial observation angles and that the effect of the angle on perceived age decreased with increasing age, especially for the profile face. Understanding the effect of the facial observation angle on age impression and clarifying the characteristics of the face and skin not perceived in the frontal face will provide useful knowledge to make people look youthful, look more beautiful, and be happier in all aspects of their lives.

Face pareidolia in male schizophrenia

Faces are valuable signals for efficient social interaction. Yet, social cognition including the sensitivity to a coarse face scheme may be deviant in schizophrenia (SZ). Tuning to faces in non-face images such as shadows, grilled toasts, or ink blots is termed face pareidolia. This phenomenon is poorly investigated in SZ. Here face tuning was assessed in 44 male participants with SZ and person-by-person matched controls by using recently created Face-n-Thing images (photographs of non-face objects to a varying degree resembling a face). The advantage of these images is that single components do not automatically trigger face processing. Participants were administered a set of images with upright and inverted (180° in the image plane) orientation. In a two-alternative forced-choice paradigm, they had to indicate whether an image resembled a face. The findings showed that: (i) With upright orientation, SZ patients exhibited deficits in face tuning: they provided much fewer face responses than controls. (ii) Inversion generally hindered face pareidolia. However, while in neurotypical males, inversion led to a drastic drop in face impression, in SZ, the impact of orientation was reduced. (iii) Finally, in accord with the signal detection theory analysis, the sensitivity index (d-prime) was lower in SZ, whereas no difference occurred in decision criterion. The outcome suggests altered face pareidolia in SZ is caused by lower face sensitivity rather than by alterations in cognitive bias. Comparison of these findings with earlier evidence confirms that tuning to social signals is lower in SZ, and warrants tailored brain imaging research.

Differences in the recognition of sadness, anger, and fear in facial expressions: the role of the observer and model gender

This study investigated gender differences in the accuracy and speed of recognition of facial expressions of sadness, anger, and fear in male and female models showing these emotions. According to the fitness threat hypothesis, females should be faster and more accurate in recognising emotional facial expressions of fear and sadness, whereas males should be faster and more accurate in recognising anger. According to the evolutionary opponent's emotion recognition, male observers should be more efficient in recognising emotions presented by male models, and female observers in recognising emotions presented by female models. The facial expression recognition task included 210 colour images from the Karolinska Directed Emotional Faces (KDEF) database. The sample consisted of university students (29 male and 29 female). Testing was conducted individually, and efficiency measured with accuracy and speed of recognition (reaction time). The results showed that females were faster than males in recognizing all three facial expressions. They were also more accurate in recognizing fear, whereas there were no gender differences in accurate recognition of sadness and anger. No significant interactions were found between model and observer gender on either measure (accuracy and speed of recognition). However, all three emotional expressions were recognised more accurately, but not faster, when the model was female. The gender-specific pattern in facial expression recognition found in this study does not completely corroborate the fitness threat hypothesis.

How gender affects the decoding of facial expressions of pain

OBJECTIVES

Gender has been suggested to play a critical role in how facial expressions of pain are perceived by others. With the present study we aim to further investigate how gender might impact the decoding of facial expressions of pain, (i) by varying both the gender of the observer as well as the gender of the expressor and (ii) by considering two different aspects of the decoding process, namely intensity decoding and pain recognition.

METHODS

In two online-studies, videos of facial expressions of pain as well as of anger and disgust displayed by male and female avatars were presented to male and female participants. In the first study, valence and arousal ratings were assessed (intensity decoding) and in the second study, participants provided intensity ratings for different affective states, that allowed for assessing intensity decoding as well as pain recognition.

RESULTS

The gender of the avatar significantly affected the intensity decoding of facial expressions of pain, with higher ratings (arousal, valence, pain intensity) for female compared to male avatars. In contrast, the gender of the observer had no significant impact on intensity decoding. With regard to pain recognition (differentiating pain from anger and disgust), neither the gender of the avatar, nor the gender of the observer had any affect.

CONCLUSIONS

Only the gender of the expressor seems to have a substantial impact on the decoding of facial expressions of pain, whereas the gender of the observer seems of less relevance. Reasons for the tendency to see more pain in female faces might be due to psychosocial factors (e.g., gender stereotypes) and require further research.

No trait anxiety influences on early and late differential neuronal responses to aversively conditioned faces across three different tasks

The human brain's ability to quickly detect dangerous stimuli is crucial in selecting appropriate responses to possible threats. Trait anxiety has been suggested to moderate these processes on certain processing stages. To dissociate such different information-processing stages, research using classical conditioning has begun to examine event-related potentials (ERPs) in response to fear-conditioned (CS +) faces. However, the impact of trait anxiety on ERPs to fear-conditioned faces depending on specific task conditions is unknown. In this preregistered study, we measured ERPs to faces paired with aversive loud screams (CS +) or neutral sounds (CS −) in a large sample (N = 80) under three different task conditions. Participants had to discriminate face-irrelevant perceptual information, the gender of the faces, or the CS category. Results showed larger amplitudes in response to aversively conditioned faces for all examined ERPs, whereas interactions with the attended feature occurred for the P1 and the early posterior negativity (EPN). For the P1, larger CS + effects were observed during the perceptual distraction task, while the EPN was increased for CS + faces when deciding about the CS association. Remarkably, we found no significant correlations between ERPs and trait anxiety. Thus, fear-conditioning potentiates all ERP amplitudes, some processing stages being further modulated by the task. However, the finding that these ERP differences were not affected by individual differences in trait anxiety does not support theoretical accounts assuming increased threat processing or reduced threat discrimination depending on trait anxiety.

COVID-19 masks: A barrier to facial and vocal information

With the COVID-19 pandemic, we have become used to wearing masks and have experienced how masks seem to impair emotion and speech recognition. While several studies have focused on facial emotion recognition by adding images of masks on photographs of emotional faces, we have created a video database with actors really wearing masks to test its effect in more ecological conditions. After validating the emotions displayed by the actors, we found that surgical mask impaired happiness and sadness recognition but not neutrality. Moreover, for happiness, this effect was specific to the mask and not to covering the lower part of the face, possibly due to a cognitive bias associated with the surgical mask. We also created videos with speech and tested the effect of mask on emotion and speech recognition when displayed in auditory, visual, or audiovisual modalities. In visual and audiovisual modalities, mask impaired happiness and sadness but improved neutrality recognition. Mask impaired the recognition of bilabial syllables regardless of modality. In addition, it altered speech recognition only in the audiovisual modality for participants above 70 years old. Overall, COVID-19 masks mainly impair emotion recognition, except for older participants for whom it also impacts speech recognition, probably because they rely more on visual information to compensate age-related hearing loss.

Reading emotions in Dogs' eyes and Dogs' faces

Our primary goal was to investigate human ability to recognize basic emotions from only the eyes of dogs in comparison to the whole face. Simultaneously, we replicated and extended previous research (Bloom et al., 2021), while validating American canine emotional facial expression photographs cross-culturally to Brazil. Participants (N = 120) viewed behaviorally-anchored photographs of three breeds. Half the participants in each condition (faces or eyes-only) viewed two-word forced choice items while the other half viewed four-word forced choice items. Participants identified target emotions from images of both dogs' faces and eyes-only at a higher rate than chance. Fear was accurately recognized more than the other emotions. When dogs are afraid, they open their eyes and expose the sclera, a conspicuous signal. Emotion identification accuracy was highest for the Rhodesian Ridgeback, who is similar in morphology to common Brazilian stray dogs (Vira-Latas Carmelo). We conjectured that Brazilians were more accustomed to seeing dogs with the Rhodesian Ridgeback morphology than the erect-eared breeds, thus increasing accuracy for this breed. Further studies with additional dog morphologies are desirable. In addition to research interest, our Canine Eyes task has the potential to become a test of individual differences in Theory of Mind with clinical applications.