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Morales-Pillado C, Fernández-Castilla B, Sánchez-Gutiérrez T, González-Fraile E, Barbeito S, Calvo A. Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis. Psychol Med 2023; 53:6304-6315. [PMID: 36472150 PMCID: PMC10520607 DOI: 10.1017/s0033291722003610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/26/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. METHODS Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis. RESULTS Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology. CONCLUSIONS TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.
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Affiliation(s)
- Carla Morales-Pillado
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Belén Fernández-Castilla
- Department of Methodology of Behavioral and Health Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | | | | | - Sara Barbeito
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Ana Calvo
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
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Lohaus T, Rogalla S, Thoma P. Use of Technologies in the Therapy of Social Cognition Deficits in Neurological and Mental Diseases: A Systematic Review. Telemed J E Health 2023; 29:331-351. [PMID: 35532968 DOI: 10.1089/tmj.2022.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: This article systematically reviews the effects of technology-based (TB) treatments on impaired social cognition (SC) in neurological and mental disorders. Methods: Strictly adhering to the PRISMA guidelines, a systematic search was carried out in PsycINFO, PubMed, and Web of Science (last search: April 22, 2021) to identify studies that, implementing a control group design, evaluated TB treatments targeting deficits in emotion recognition, Theory of Mind (ToM) and social behavior in adult patients with nondevelopmental and nonprogressive neurological or mental disorders. Risk of bias was assessed using the PEDro Scale, certainty assessment followed the GRADE approach. Results: Sixteen studies involving 857 patients, all focusing on psychotic disorders, were retrieved. The most pronounced effects were observed concerning emotion recognition with all studies revealing overall improvements. Regarding ToM and social behavior, results were mixed. However, the number of studies including outcome measures for these domains, is significantly lower compared to the domain of emotion recognition, limiting the validity of the results. Risk of bias and certainty assessment revealed further limitations of evidence. Conclusion: TB treatment achieves positive effects especially with regard to emotion recognition impairments, at least for patients with schizophrenia. Future research should expand the evaluation of TB training of other SC domains, ought to be carried out in more diverse patient populations, rely on different devices, and include follow-up measurements.
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Affiliation(s)
- Tobias Lohaus
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Sally Rogalla
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Patrizia Thoma
- Neuropsychological Therapy Centre (NTC), Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Mandal MK, Habel U, Gur RC. Facial expression-based indicators of schizophrenia: Evidence from recent research. Schizophr Res 2023; 252:335-344. [PMID: 36709656 DOI: 10.1016/j.schres.2023.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/28/2023]
Abstract
Impaired ability to recognize emotion in other's face (decoding) or to express emotion through the face (encoding) are considered critical in schizophrenia. The topic of research draws considerable attention since clinicians rely heavily on the patient's facial expressions for diagnosis and on the patient's ability to understand the clinician's communicative intent. While most researchers argue in favor of a generalized emotion deficit, others indicate an emotion-specific deficit in schizophrenia. An early review (Mandal et al., 1998) indicated a possible breakdown in perception-expression-experience link of emotion; later reviews (Kohler et al., 2010; Chan et al., 2010) pointed to a generalized emotion processing deficit due to perceptual deficits in schizophrenia. The present review (2010-2022) revisits this controversy with 47 published studies (37 decoding, 10 encoding) conducted on 2364 patients in 20 countries. Schizophrenia is characterized by reduced emotion processing ability, especially with negative symptoms and at an acute state of illness. It is however still unclear whether this dysfunction is independent of a generalized face perception deficit or of subjective experience of emotion in schizophrenia.
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Affiliation(s)
- Manas K Mandal
- Department of Humanities & Social Sciences, Indian Institute of Technology-Kharagpur, India.
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - Ruben C Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
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Scoriels L, Genaro LT, Keffer S, Guimarães AL, Barros-Dumas B, Mororó LG, Biagioni T, Lucena C, da Hora TR, Sahakian BJ, Fisher M, Vinogradov S, Panizzutti R. Changes in emotion processing and social cognition with auditory versus visual neuroscience-informed cognitive training in individuals with schizophrenia. Schizophr Res 2022; 241:267-274. [PMID: 35182906 PMCID: PMC10664860 DOI: 10.1016/j.schres.2022.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neuroscience-informed cognitive training has been used to remediate cognitive deficits in schizophrenia, but their effect on emotion processing and social cognition deficits, which may involve auditory and visual impairments, remain relatively unknown. In this study, we compared the efficacy of auditory versus visual neuroscience-informed cognitive training on emotion processing and social cognition in individuals with schizophrenia. METHODS In this randomised, double-blind clinical trial, 79 participants with chronic schizophrenia performed 40-hours auditory or visual dynamically equivalent computerised cognitive training. We assessed emotion processing and social cognition using Emotion Recognition, Affective Go-NoGo, Mayer-Salovey-Caruso Emotional-Intelligence, Theory of mind, and Hinting tests before and after 20 h and 40 h of training. RESULTS After training, participants from both groups decreased their reaction time for facial emotion recognition (p = 3 × 10-6, d = 0.9). This was more remarkable for the auditory group when analysing individual emotions. Both groups also reduced omissions in the affective go-no go (p = 0.01, d = 0.6), which was also attributed, post hoc, to the auditory group. Trends for improvement were observed in theory of mind (p = 0.06, d = 0.6) for both groups. Improvement in emotion processing was associated with improvement in reasoning and problem solving and global cognition and improvement in theory of mind was associated with improvement in attention and global cognition. CONCLUSIONS Both the auditory and the visual neuroscience-informed cognitive training were efficacious at improving emotion processing and social cognition in individuals with schizophrenia, although improvement was more remarkable for the auditory training group. These improvements were related to cognitive - but not symptom - improvement.
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Affiliation(s)
- Linda Scoriels
- Institut de Psychiatrie et Neurosciences de Paris, Inserm - Université Paris Descartes, France; Department of Psychiatry, University of Cambridge, United Kingdom; Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil.
| | - Larissa T Genaro
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Stella Keffer
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Anna Luiza Guimarães
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Bárbara Barros-Dumas
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Luana G Mororó
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Thales Biagioni
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Camila Lucena
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | - Thaís R da Hora
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil
| | | | - Melissa Fisher
- Department of Psychiatry, University of Minnesota, United States
| | | | - Rogério Panizzutti
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Brazil; Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Brazil.
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Nijman SA, Veling W, van der Stouwe ECD, Pijnenborg GHM. Social Cognition Training for People With a Psychotic Disorder: A Network Meta-analysis. Schizophr Bull 2020; 46:1086-1103. [PMID: 32162658 PMCID: PMC7505203 DOI: 10.1093/schbul/sbaa023] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Deficits in social cognition are common in people with psychotic disorders and negatively impact functioning. Social Cognition Training (SCT) has been found to improve social cognition and functioning, but it is unknown which interventions are most effective, how characteristics of treatments and participants moderate efficacy, and whether improvements are durable. This meta-analysis included 46 randomized studies. SCTs were categorized according to their focus (targeted/broad-based) and inclusion of cognitive remediation therapy (CRT). Network meta-analysis was conducted, using both direct (original) and indirect (inferred from the network of comparisons) evidence. All SCT types were compared to treatment as usual (TAU; the chosen reference group). Moderators of outcome were investigated with meta-regression and long-term efficacy with multivariate meta-analysis. Compared to TAU, emotion perception was improved by targeted SCT without CRT (d = 0.68) and broad-based SCT without CRT (d = 0.46). Individual treatments worked better for emotion perception. All treatments significantly improved social perception (active control, d = 0.98, targeted SCT with and without CRT, d = 1.38 and d = 1.36, broad-based SCT with and without CRT, d = 1.45 and d = 1.35). Only broad-based SCT (d = 0.42) improved ToM. Broad-based SCT (d = 0.82 without and d = 0.41 with CRT) improved functioning; group treatments worked significantly better. Male gender was negatively related to effects on social functioning and psychiatric symptoms. At follow-up, a moderate effect on social functioning (d = 0.66) was found. No effect was found on attribution, social cognition (miscellaneous), and psychiatric symptoms. While targeted SCT is the most effective for emotion perception and social perception, broad-based SCT produces the best overall outcomes. CRT did not enhance SCT effects.
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Affiliation(s)
- Saskia A Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth C D van der Stouwe
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerdina H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
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Jung M, Baik SY, Kim Y, Kim S, Min D, Kim JY, Won S, Lee SH. Empathy and Social Attribution Skills Moderate the Relationship between Temporal Lobe Volume and Facial Expression Recognition Ability in Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:362-374. [PMID: 32702215 PMCID: PMC7383013 DOI: 10.9758/cpn.2020.18.3.362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Objective While impaired facial expression recognition has been closely associated with reduced temporal lobe volume in patients with schizophrenia, this study aimed at examining whether empathy and social attribution affect such a relationship. Methods A total of 43 patients with schizophrenia and 43 healthy controls underwent a facial expression recognition task (FERT) and magnetic resonance imaging. Basic empathy scale and the social attribution task-multiple choice were used to measure empathy and social attribution. Results Patients with schizophrenia showed significant positive correlations between the total temporal lobe volume and the FERT-accuracy (FERT-ACC). Diminished temporal lobe volume predicted the impaired facial emotion recognition ability. Both empathy and social attribution played roles as moderators of the path from the left amygdala volume, left fusiform gyrus volume, both sides of the superior temporal gyrus volume, and left middle temporal gyrus volume to the FERT-ACC. In contrast, empathy alone functioned as a moderator between the right fusiform gyrus volume, right middle temporal gyrus volume, and FERT-ACC. No significant interaction was found for healthy controls. Conclusion Our results suggest that social cognition remediation training on empathy and social attribution, could buffer the negative effects of small temporal lobe volume on interpersonal emotional communication in patients with schizophrenia.
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Affiliation(s)
- Minjee Jung
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Seung Yeon Baik
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Yourim Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Sungkean Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Dongil Min
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Jeong-Youn Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Seunghee Won
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea.,Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Davidson CA, Willner CJ, van Noordt SJR, Banz BC, Wu J, Kenney JG, Johannesen JK, Crowley MJ. One-Month Stability of Cyberball Post-Exclusion Ostracism Distress in Adolescents. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019; 41:400-408. [PMID: 32042218 PMCID: PMC7010318 DOI: 10.1007/s10862-019-09723-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We examined one-month reliability, internal consistency, and validity of ostracism distress (Need Threat Scale) to simulated social exclusion during Cyberball. Thirty adolescents (13-18 yrs.) completed the Cyberball task, ostracism distress ratings, and measures of related clinical symptoms, repeated over one month. Need Threat Scale ratings of ostracism distress showed adequate test-retest reliability and internal consistency at both occasions. Construct validity was demonstrated via relationships with closely related constructs of anxiety, anxiety sensitivity, and emotion dysregulation, and weaker associations with more distal constructs of state paranoia and subclinical psychosis-like experiences. While ratings of ostracism distress and anxiety were significantly attenuated at retest, most participants continued to experience post-Cyberball ostracism distress at one-month follow-up, which indicates that the social exclusion induction of Cyberball persisted despite participants' familiarity with the paradigm. Overall, results suggest that the primary construct of ostracism distress is preserved over repeated administration of Cyberball, with reliability sufficient for usage in longitudinal research. These findings have important implications for translating this laboratory simulation of social distress into developmental and clinical intervention studies.
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Affiliation(s)
- Charlie A. Davidson
- Department of Clinical Psychology, Mercer University College of Health Professions, 2930 Flowers Rd. S., Rm. 466, Atlanta, GA 30341, USA
| | - Cynthia J. Willner
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Barbara C. Banz
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jia Wu
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Joshua G. Kenney
- Psychology Service, VA Connecticut Healthcare System, 116-B, 950 Campbell Ave, West Haven, CT 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jason K. Johannesen
- Psychology Service, VA Connecticut Healthcare System, 116-B, 950 Campbell Ave, West Haven, CT 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Michael J. Crowley
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Popova P, Rockstroh B, Miller GA, Wienbruch C, Carolus AM, Popov T. The impact of cognitive training on spontaneous gamma oscillations in schizophrenia. Psychophysiology 2018; 55:e13083. [PMID: 29624694 DOI: 10.1111/psyp.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 12/27/2022]
Abstract
Schizophrenia patients exhibit less gamma-frequency EEG/MEG activity (>30 Hz), a finding interpreted as evidence of poor temporal neural organization and functional network communication. Research has shown that neuroplasticity-oriented training can improve task-related oscillatory dynamics, indicating some reorganization capacity in schizophrenia. Demonstrating a generalization of such task training effects to spontaneous oscillations at rest would not only enrich understanding of this neuroplastic potential but inform the interpretation of spontaneous gamma oscillations in the service of normal cognitive function. In the present study, neuromagnetic resting-state oscillatory brain activity and cognitive performance were assessed before and after training in 61 schizophrenia patients, who were randomly assigned to 4 weeks of neuroplasticity-oriented targeted cognitive training or treatment as usual (TAU). Gamma power of 40-90 Hz increased after training, but not after TAU, in a frontoparietal network. Across two types of training, this increase was related to improved cognitive test performance. These results indicate that abnormal oscillatory dynamics in schizophrenia patients manifested in spontaneous gamma activity can be changed with neuroplasticity-oriented training parallel to cognitive performance.
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Affiliation(s)
- Petia Popova
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | - Gregory A Miller
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Almut M Carolus
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Tzvetan Popov
- Department of Psychology, University of Konstanz, Konstanz, Germany
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Park J, Kim H, Sohn JW, Choi JR, Kim SP. EEG Beta Oscillations in the Temporoparietal Area Related to the Accuracy in Estimating Others' Preference. Front Hum Neurosci 2018; 12:43. [PMID: 29479312 PMCID: PMC5811502 DOI: 10.3389/fnhum.2018.00043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/24/2018] [Indexed: 11/13/2022] Open
Abstract
Humans often attempt to predict what others prefer based on a narrow slice of experience, called thin-slicing. According to the theoretical bases for how humans can predict the preference of others, one tends to estimate the other's preference using a perceived difference between the other and self. Previous neuroimaging studies have revealed that the network of dorsal medial prefrontal cortex (dmPFC) and right temporoparietal junction (rTPJ) is related to the ability of predicting others' preference. However, it still remains unknown about the temporal patterns of neural activities for others' preference prediction through thin-slicing. To investigate such temporal aspects of neural activities, we investigated human electroencephalography (EEG) recorded during the task of predicting the preference of others while only a facial picture of others was provided. Twenty participants (all female, average age: 21.86) participated in the study. In each trial of the task, participants were shown a picture of either a target person or self for 3 s, followed by the presentation of a movie poster over which participants predicted the target person's preference as liking or disliking. The time-frequency EEG analysis was employed to analyze temporal changes in the amplitudes of brain oscillations. Participants could predict others' preference for movies with accuracy of 56.89 ± 3.16% and 10 out of 20 participants exhibited prediction accuracy higher than a chance level (95% interval). There was a significant difference in the power of the parietal alpha (10~13 Hz) oscillation 0.6~0.8 s after the onset of poster presentation between the cases when participants predicted others' preference and when they reported self-preference (p < 0.05). The power of brain oscillations at any frequency band and time period during the trial did not show a significant correlation with individual prediction accuracy. However, when we measured differences of the power between the trials of predicting other's preference and reporting self-preference, the right temporal beta oscillations 1.6~1.8 s after the onset of facial picture presentation exhibited a significant correlation with individual accuracy. Our results suggest that right temporoparietal beta oscillations may be correlated with one's ability to predict what others prefer with minimal information.
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Affiliation(s)
- Jonghyeok Park
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Hackjin Kim
- Department of Psychology, Korea University, Seoul, South Korea
| | - Jeong-Woo Sohn
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, South Korea
| | - Jong-Ryul Choi
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, South Korea
| | - Sung-Phil Kim
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
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Grant N, Lawrence M, Preti A, Wykes T, Cella M. Social cognition interventions for people with schizophrenia: a systematic review focussing on methodological quality and intervention modality. Clin Psychol Rev 2017; 56:55-64. [PMID: 28688282 DOI: 10.1016/j.cpr.2017.06.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with a diagnosis of schizophrenia have significant social and functional difficulties. Social cognition was found to influences these outcomes and in recent years interventions targeting this domain were developed. This paper reviews the existing literature on social cognition interventions for people with a diagnosis of schizophrenia focussing on: i) comparing focussed (i.e. targeting only one social cognitive domain) and global interventions and ii) studies methodological quality. METHOD Systematic search was conducted on PubMed and PsycInfo. Studies were included if they were randomised control trials, participants had a diagnosis of schizophrenia or schizoaffective disorder, and the intervention targeted at least one out of four social cognition domains (i.e. theory of mind, affect recognition, social perception and attribution bias). All papers were assessed for methodological quality. Information on the intervention, control condition, study methodology and the main findings from each study were extracted and critically summarised. RESULTS Data from 32 studies fulfilled the inclusion criteria, considering a total of 1440 participants. Taking part in social cognition interventions produced significant improvements in theory of mind and affect recognition compared to both passive and active control conditions. Results were less clear for social perception and attributional bias. Focussed and global interventions had similar results on outcomes. Overall study methodological quality was modest. There was very limited evidence showing that social cognitive intervention result in functional outcome improvement. CONCLUSIONS The evidence considered suggests that social cognition interventions may be a valuable approach for people with a diagnosis of schizophrenia. However, evidence quality is limited by measure heterogeneity, modest study methodology and short follow-up periods. The findings point to a number of recommendations for future research, including measurement standardisation, appropriately powered studies and investigation of the impact of social cognition improvements on functioning problems.
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Affiliation(s)
- Nina Grant
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Megan Lawrence
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Antonio Preti
- Genneruxi Medical Center, Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy
| | - Til Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Matteo Cella
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
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Best MW, Bowie CR. A review of cognitive remediation approaches for schizophrenia: from top-down to bottom-up, brain training to psychotherapy. Expert Rev Neurother 2017; 17:713-723. [PMID: 28511562 DOI: 10.1080/14737175.2017.1331128] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Individuals with psychotic disorders experience profound impairment in neurocognition, which is consistently found to be the best predictor of independent community functioning. Several diverse behavioural treatments designed to enhance neurocognitive abilities have been developed, with subtle to stark differences among them. Various approaches, to varying degrees, have demonstrated success across diffuse outcomes: improved brain structure and function, performance on neuropsychological tests, and community activities associated with daily living. Areas covered: This paper reviews the different approaches to cognitive remediation and the differential effects these approaches have on neurophysiological function, neurocognitive abilities, and real-world community functioning. Cognitive remediation approaches can be broadly classified along two dimensions: 1) treatment target, and 2) treatment modality. Some approaches target more basic perceptual skills, some target higher level executive processes, while some are non-targeted and seek to improve general cognitive ability. With regard to modality, approaches might have little/no therapist involvement and rely exclusively on computerized practice or they may include intensive therapist involvment to generalize neurocognitive change to community functioning. Expert commentary: Compared to other widely implemented treatments for schizophrenia, cognitive remediation produces better effects on outcome measures. It is time for cognitive remediation to be adopted as a best practice in the treatment of schizophrenia.
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Affiliation(s)
- Michael W Best
- a Department of Psychology , Queen's University , Kingston , ON , Canada
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Harvey PD, Sand M. Pharmacological Augmentation of Psychosocial and Remediation Training Efforts in Schizophrenia. Front Psychiatry 2017; 8:177. [PMID: 28993740 PMCID: PMC5622160 DOI: 10.3389/fpsyt.2017.00177] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/06/2017] [Indexed: 12/11/2022] Open
Abstract
Pharmacological approaches to cognitive enhancement have received considerable attention but have not had considerable success in improving their cognitive and functional targets. Other intervention strategies, such as cognitive remediation therapy (CRT), have been shown to enhance cognitive performance but have not been found to improve functional outcomes without additional psychosocial interventions. Recently, several studies have attempted to enhance the effects of CRT by adding pharmacological interventions to the CRT treatments. In addition, as CRT has been shown to synergistically improve the effects of psychosocial interventions, the combination of pharmacological therapies aimed at cognition and psychosocial interventions may itself provide a promising strategy for improving functional outcomes. This review and commentary examines the current state of interventions combining CRT and psychosocial treatments with pharmacological augmentation. Our focus is on the specific level of effect of the pharmacological intervention, which could be enhancing motivation, training efficiency, or the consolidation of therapeutic gains. Different pharmacological strategies (e.g., stimulants, plasticity-inducing agents, or attentional or alertness enhancers) may have the potential to lead to different types of gains when combined with CRT or psychosocial interventions. The relative potential of these different mechanisms for immediate and durable effects is considered.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael Sand
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States
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Iakimova G, Moriano C, Farruggio L, Jover F. Socio-demographic and Clinical Correlates of Facial Expression Recognition Disorder in the Euthymic Phase of Bipolar Patients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:633-42. [PMID: 27310226 PMCID: PMC5348087 DOI: 10.1177/0706743716639927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Bipolar patients show social cognitive disorders. The objective of this study is to review facial expression recognition (FER) disorders in bipolar patients (BP) and explore clinical heterogeneity factors that could affect them in the euthymic phase: socio-demographic level, clinical and changing characteristics of the disorder, history of suicide attempt, and abuse. METHOD Thirty-four euthymic bipolar patients and 29 control subjects completed a computer task of explicit facial expression recognition and were clinically evaluated. RESULTS Compared with control subjects, BP patients show: a decrease in fear, anger, and disgust recognition; an extended reaction time for disgust, surprise and neutrality recognition; confusion between fear and surprise, anger and disgust, disgust and sadness, sadness and neutrality. In BP patients, age negatively affects anger and neutrality recognition, as opposed to education level which positively affects recognizing these emotions. The history of patient abuse negatively affects surprise and disgust recognition, and the number of suicide attempts negatively affects disgust and anger recognition. CONCLUSIONS Cognitive heterogeneity in euthymic phase BP patients is affected by several factors inherent to bipolar disorder complexity that should be considered in social cognition study.
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Affiliation(s)
- Galina Iakimova
- Université de Nice Sophia Antipolis, Laboratoire d'Anthropologie et de Psychologie cognitives et sociales (LAPCOS, EA 7278), Nice, France
| | | | - Lisa Farruggio
- Université de Nice Sophia Antipolis, Laboratoire d'Anthropologie et de Psychologie cognitives et sociales (LAPCOS, EA 7278), Nice, France
| | - Frédéric Jover
- Clinique de psychiatrie et de psychologie médicale, CHU de Nice, avenue de la Voie Romaine, Nice cedex, France
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14
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Campos C, Santos S, Gagen E, Machado S, Rocha S, Kurtz MM, Rocha NB. Neuroplastic Changes Following Social Cognition Training in Schizophrenia: A Systematic Review. Neuropsychol Rev 2016; 26:310-328. [PMID: 27541742 DOI: 10.1007/s11065-016-9326-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/27/2016] [Indexed: 01/24/2023]
Abstract
Social cognitive impairment is a key feature of schizophrenia and social cognition training (SCT) is a promising tool to address these deficits. Neurobiological dysfunction in schizophrenia has been widely researched, but neuronal changes induced by SCT have been scarcely explored. This review aims to assess the neuroplastic effects of SCT in patients with schizophrenia spectrum disorders. PubMed and Web of Science databases were searched for clinical trials testing the effects of SCT in functional and structural brain measurements of adult patients with schizophrenia or schizoaffective disorders. A total of 11 studies were included: five used fMRI, two used EEG and ERP, one used ERP only, two used MEG and one study used MRI. Data extracting and processing regarding sociodemographic and clinical variables, intervention characteristics, neuroimaging procedures, neuroplastic findings, effect sizes and study quality criteria was completed by two raters. Results indicate a wide range of structural and functional changes in numerous regions and circuits of the social brain, including early perceptual areas, the limbic system and prefrontal regions. Despite the small number of trials currently available, evidence suggests that SCT is associated with neuroplastic changes in the social brain and concomitant improvements in social cognitive performance. There is a lack of extensive knowledge about the neural mechanisms that underlie social cognitive enhancement after treatment, but the reported findings may shed light on the neural substrates of social cognitive impairment in schizophrenia and how improved treatment procedures can be developed and applied.
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Affiliation(s)
- Carlos Campos
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal. .,Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás, 71, Campus da Praia Vermelha, Rio de Janeiro, Brazil.
| | - Susana Santos
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal
| | - Emily Gagen
- Department of Psychology, University of North Carolina-Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3720, USA
| | - Sérgio Machado
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás, 71, Campus da Praia Vermelha, Rio de Janeiro, Brazil.,Physical Activity Neuroscience, Physical Activity Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Rua Marechal Deodoro, 263 - Centro, Niterói, Brazil
| | - Susana Rocha
- School of Accounting and Administration of Porto, Polytechnic Institute of Porto, Rua Jaime Lopes Amorim, s/n, 4465-004 S, Mamede de Infesta, Portugal
| | - Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, 45 Wyllys Ave, Middletown, CT, 06459, USA.,Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Nuno Barbosa Rocha
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal.
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Symons AE, El-Deredy W, Schwartze M, Kotz SA. The Functional Role of Neural Oscillations in Non-Verbal Emotional Communication. Front Hum Neurosci 2016; 10:239. [PMID: 27252638 PMCID: PMC4879141 DOI: 10.3389/fnhum.2016.00239] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/09/2016] [Indexed: 12/18/2022] Open
Abstract
Effective interpersonal communication depends on the ability to perceive and interpret nonverbal emotional expressions from multiple sensory modalities. Current theoretical models propose that visual and auditory emotion perception involves a network of brain regions including the primary sensory cortices, the superior temporal sulcus (STS), and orbitofrontal cortex (OFC). However, relatively little is known about how the dynamic interplay between these regions gives rise to the perception of emotions. In recent years, there has been increasing recognition of the importance of neural oscillations in mediating neural communication within and between functional neural networks. Here we review studies investigating changes in oscillatory activity during the perception of visual, auditory, and audiovisual emotional expressions, and aim to characterize the functional role of neural oscillations in nonverbal emotion perception. Findings from the reviewed literature suggest that theta band oscillations most consistently differentiate between emotional and neutral expressions. While early theta synchronization appears to reflect the initial encoding of emotionally salient sensory information, later fronto-central theta synchronization may reflect the further integration of sensory information with internal representations. Additionally, gamma synchronization reflects facilitated sensory binding of emotional expressions within regions such as the OFC, STS, and, potentially, the amygdala. However, the evidence is more ambiguous when it comes to the role of oscillations within the alpha and beta frequencies, which vary as a function of modality (or modalities), presence or absence of predictive information, and attentional or task demands. Thus, the synchronization of neural oscillations within specific frequency bands mediates the rapid detection, integration, and evaluation of emotional expressions. Moreover, the functional coupling of oscillatory activity across multiples frequency bands supports a predictive coding model of multisensory emotion perception in which emotional facial and body expressions facilitate the processing of emotional vocalizations.
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Affiliation(s)
- Ashley E. Symons
- School of Psychological Sciences, University of ManchesterManchester, UK
| | - Wael El-Deredy
- School of Psychological Sciences, University of ManchesterManchester, UK
- School of Biomedical Engineering, Universidad de ValparaisoValparaiso, Chile
| | - Michael Schwartze
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht UniversityMaastricht, Netherlands
| | - Sonja A. Kotz
- School of Psychological Sciences, University of ManchesterManchester, UK
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht UniversityMaastricht, Netherlands
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Isaac C, Januel D. Neural correlates of cognitive improvements following cognitive remediation in schizophrenia: a systematic review of randomized trials. SOCIOAFFECTIVE NEUROSCIENCE & PSYCHOLOGY 2016; 6:30054. [PMID: 26993787 PMCID: PMC4799394 DOI: 10.3402/snp.v6.30054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/31/2015] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cognitive impairments are a core feature in schizophrenia and are linked to poor social functioning. Numerous studies have shown that cognitive remediation can enhance cognitive and functional abilities in patients with this pathology. The underlying mechanism of these behavioral improvements seems to be related to structural and functional changes in the brain. However, studies on neural correlates of such enhancement remain scarce. OBJECTIVES We explored the neural correlates of cognitive enhancement following cognitive remediation interventions in schizophrenia and the differential effect between cognitive training and other therapeutic interventions or patients' usual care. METHOD We searched MEDLINE, PsycInfo, and ScienceDirect databases for studies on cognitive remediation therapy in schizophrenia that used neuroimaging techniques and a randomized design. Search terms included randomized controlled trial, cognitive remediation, cognitive training, rehabilitation, magnetic resonance imaging, positron emission tomography, electroencephalography, magnetoencephalography, near infrared spectroscopy, and diffusion tensor imaging. We selected randomized controlled trials that proposed multiple sessions of cognitive training to adult patients with a schizophrenia spectrum disorder and assessed its efficacy with imaging techniques. RESULTS In total, 15 reports involving 19 studies were included in the systematic review. They involved a total of 455 adult patients, 271 of whom received cognitive remediation. Cognitive remediation therapy seems to provide a neurobiological enhancing effect in schizophrenia. After therapy, increased activations are observed in various brain regions mainly in frontal - especially prefrontal - and also in occipital and anterior cingulate regions during working memory and executive tasks. Several studies provide evidence of an improved functional connectivity after cognitive training, suggesting a neuroplastic effect of therapy through mechanisms of functional reorganization. Neurocognitive and social-cognitive training may have a cumulative effect on neural networks involved in social cognition. The variety of proposed programs, imaging tasks, and techniques may explain the heterogeneity of observed neural improvements. Future studies would need to specify the effect of cognitive training depending on those variables.
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Affiliation(s)
- Clémence Isaac
- Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-Sur-Marne, France;
| | - Dominique Januel
- Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-Sur-Marne, France
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Kustermann T, Rockstroh B, Kienle J, Miller GA, Popov T. Deficient attention modulation of lateralized alpha power in schizophrenia. Psychophysiology 2016; 53:776-85. [DOI: 10.1111/psyp.12626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/15/2016] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Johanna Kienle
- Department of Psychology; University of Konstanz; Konstanz Germany
| | - Gregory A. Miller
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences; University of California Los Angeles; Los Angeles California USA
| | - Tzvetan Popov
- Department of Psychology; University of Konstanz; Konstanz Germany
- Donders Institute for Brain, Cognition and Behavior, Center for Cognitive Neuroimaging; Radboud University; Nijmegen The Netherlands
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Same clock, different time read-out: Spontaneous brain oscillations and their relationship to deficient coding of cognitive content. Neuroimage 2015; 119:316-24. [DOI: 10.1016/j.neuroimage.2015.06.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/25/2015] [Indexed: 01/09/2023] Open
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Abstract
PURPOSE OF REVIEW Deficits in social cognition are an important determinant of social functioning in schizophrenia, a core feature of the illness that persists despite treatment. Recent research in neuroplasticity-based therapeutics shows that neural systems supporting core cognitive skills improve after targeted cognitive training, suggesting that social cognition, and concomitant social functioning, may be improved by targeting the neural systems supporting social cognition. However, the success of this approach depends on the extent to which the social brain is malleable. We review the neural effects of training programs focused on improving social cognition in healthy, schizophrenia, and other clinical samples. RECENT FINDINGS The current literature suggests that the neural mechanisms underlying social cognition show neuroplastic changes after behavioral training and these neural changes confer concomitant benefits to social cognition and social behavior. Most research in schizophrenia has focused on emotion recognition, and although emotion recognition training has behavioral and neural benefits for schizophrenia, more advanced social cognitive processes need to be examined. SUMMARY The data suggest that targeting neural systems underlying social cognition through socially focused behavioral interventions may improve social functioning impairments in schizophrenia. Questions remain regarding how to optimize training, which should be addressed in future work.
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Targeted training modifies oscillatory brain activity in schizophrenia patients. NEUROIMAGE-CLINICAL 2015; 7:807-14. [PMID: 26082889 PMCID: PMC4459048 DOI: 10.1016/j.nicl.2015.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/03/2015] [Accepted: 03/15/2015] [Indexed: 01/01/2023]
Abstract
Effects of both domain-specific and broader cognitive remediation protocols have been reported for neural activity and overt performance in schizophrenia (SZ). Progress is limited by insufficient knowledge of relevant neural mechanisms. Addressing neuronal signal resolution in the auditory system as a mechanism contributing to cognitive function and dysfunction in schizophrenia, the present study compared effects of two neuroplasticity-based training protocols targeting auditory–verbal or facial affect discrimination accuracy and a standard rehabilitation protocol on magnetoencephalographic (MEG) oscillatory brain activity in an auditory paired-click task. SZ were randomly assigned to either 20 daily 1-hour sessions over 4 weeks of auditory–verbal training (N = 19), similarly intense facial affect discrimination training (N = 19), or 4 weeks of treatment as usual (TAU, N = 19). Pre-training, the 57 SZ showed smaller click-induced posterior alpha power modulation than did 28 healthy comparison participants, replicating Popov et al. (2011b). Abnormally small alpha decrease 300–800 ms around S2 improved more after targeted auditory–verbal training than after facial affect training or TAU. The improvement in oscillatory brain dynamics with training correlated with improvement on a measure of verbal learning. Results replicate previously reported effects of neuroplasticity-based psychological training on oscillatory correlates of auditory stimulus differentiation, encoding, and updating and indicate specificity of cortical training effects. Induced posterior alpha power modulation in auditory paired-click design is abnormally small in schizophrenia patients. Abnormal alpha power modulation improved after neuroplasticity-based auditory training. Results confirm targeted training effects on oscillatory correlates of auditory stimulus discrimination, encoding, updating. No similar effects of visual affect discrimination training on alpha power indicate specificity of cortical training effects.
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