The "Reading the Mind in the Eyes" test as a new way to explore complex emotions decoding in alcohol dependence

Emotional processing in binge drinking, tobacco use disorder and their comorbidity in youth: A preregistered PRISMA scoping review

BACKGROUND

Binge drinking (BD) and tobacco use disorder (TUD) are prevalent among youth, with significant social and health implications. However, research into the emotional impairments associated with BD and TUD during adolescence is sparse and lacks integration within a comprehensive model of emotional processes. Moreover, the impact of comorbid BD and TUD on emotional deficits remains largely unexplored. We propose the first review focused on the variation of emotional deficits in BD, TUD, or their comorbidity among adolescents and we systematically explore differences across various emotional abilities.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines (PRISMA-ScR), we conducted a preregistered review of existing literature on emotional processing impairments in BD and/or TUD among adolescents. From 481 papers initially identified, 7 were included in this review. Additionally, we proposed experimental avenues for future research based on identified shortcomings in current literature.

RESULTS

Our scoping review indicates that emotional deficits are likely prevalent in both BD and TUD populations, affecting emotional appraisal/identification, response, and regulation. However, further investigation is necessary to ascertain the magnitude and scope of these deficits in adolescents and adults, as well as to delineate the distinct or combined influence of BD and TUD on emotional disturbances.

CONCLUSION

While some emotional deficits are apparent, we contend that examining emotional deficits in BD and TUD separately, as well as together, would offer a more comprehensive understanding of their nature and inform the development of novel treatment strategies.

The protective effects of cognitive empathy and emotional empathy on gambling disorder are mediated by risk aversion and responsible gambling attitude

BACKGROUND

Based on social cognitive theory, this study aimed to examine whether and how social abilities (i.e., cognitive empathy and emotional empathy) are associated with gambling disorder (GD) by incorporating attitudes toward general risk (i.e., risk aversion) and responsible gambling as potential mediators of this link.

METHODS

A convenience sample of 580 past-year lottery gamblers (Mage = 34.07, SD = 13.36; 50.4% female), recruited near lottery sales shops, completed an anonymous paper-version questionnaire on site. Data were collected using the DSM-5 diagnostic criteria for GD, Interpersonal Reactivity Index, Risk Aversion Scale, Positive Play Scale, and demographic items. Path analysis and mediation analysis were applied to examine the effects of cognitive empathy and emotional empathy on GD and the mediating roles of risk aversion and responsible gambling attitude.

RESULTS

Our results showed that cognitive empathy, but not emotional empathy, was significantly and negatively correlated with GD. Also, the effect of cognitive empathy on GD was fully mediated by risk aversion and responsible gambling attitude, whilst the total indirect effect of emotional empathy on GD was nonsignificant. As hypothesized, the indirect paths from both types of empathy to GD were significantly and serially mediated by risk aversion and responsible gambling attitude.

CONCLUSION

Cognitive empathy, distinct from emotional empathy, was a statistically significant correlate of GD. Moreover, the path model results also suggest that responsible gambling attitude was a salient protective factors against GD. Future GD prevention efforts may benefit from paying more attention to the role of responsible gambling attitude.

Learning from others' experience: Social fear conditioning deficits in patients with severe alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) is a significant public health problem. A better understanding of the psychosocial factors contributing to AUD is important for developing public health policy. The purpose of this study was to identify social mechanisms involved in AUD and, more specifically, to determine whether vicarious learning deficits are related to the disorder. A secondary objective was to evaluate the role of empathy in social fear conditioning.

METHODS

Patients with severe AUD (n = 30) and healthy participants (n = 30) performed a social fear learning (SFL) task. The task assesses how an association between a stimulus and an aversive consequence is acquired through social means. Specifically, participants observed a person receiving an electric shock (unconditioned stimulus; US) that was associated (conditioned stimulus; CS+) or not (CS-) with a neutral CS. The skin conductance response was used to measure the effect of learning.

RESULTS

Individuals with severe AUD showed a deficit in SFL, indicating that they had difficulty learning from another's negative experience. Patients also evaluated the emotional experience as less unpleasant than healthy participants.

CONCLUSIONS

This study is the first to show that patients with severe AUD have social learning deficits. The findings suggest that these individuals do not learn from another's negative experience. At a fundamental level, the findings demonstrate the importance of understanding the role of social mechanisms in AUD. At a clinical level, the study highlights the potential for using social learning enhancement to prevent relapse in individuals with severe AUD.

Rejection sensitivity in severe alcohol use disorder: Increased anxious anticipation of rejection

Rejection sensitivity (RS) reflects the disposition to anxiously expect, readily perceive, and disproportionately react to rejection. It is linked to interpersonal problems and psychopathological symptoms, which are frequent in severe alcohol use disorder (SAUD) and are known to influence clinical outcomes. Consequently, RS has been put forward as a process of interest in this disorder. However, empirical studies investigating RS in SAUD are scarce and focused on its last two components, leaving the core process of anxious expectations of rejection unexplored. To fil this gap, 105 patients with SAUD and 73 age-and-gender-matched controls completed the validated Adult Rejection Sensitivity Scale. We computed anxious anticipation (AA), and rejection expectancy (RE) scores, corresponding to the affective and cognitive dimensions of anxious expectations of rejection, respectively. Participants also completed measures of interpersonal problems and psychopathological symptoms. We found that patients with SAUD had higher AA (affective dimension) but not RE (cognitive dimension) scores. Moreover, AA was associated with interpersonal problems as well as psychopathological symptoms in the SAUD sample. These findings meaningfully extend the RS and social cognition literatures in SAUD by showing that difficulties already arise at the anticipatory stage of socio-affective information processing. Moreover, they shed light on the affective component of anxious expectations of rejection as a novel, clinically relevant process in this disorder.

Social Cognition in Opioid Use Disorder

Background: Opioid use disorder (OUD) is associated with significant functional impairment and neurocognitive dysfunction, but only a handful of studies have investigated social cognitive abilities in this condition. This study aimed to investigate facial emotion recognition accuracy/biases and two different aspects of theory of mind (ToM) (ToM-decoding vs ToM-reasoning) in people with recovered OUD. Methods: The participants included 32 people with recovered OUD who were on Buprenorphine + Naloxone (B/N) maintenance treatment and 32 healthy controls. In addition to neurocognitive tasks, both groups were assessed by a facial emotion recognition task, the faux pas recognition task, and the reading the mind from the eyes task. Results: In comparison to healthy controls, people on B/N maintenance treatment showed deficits in facial emotion recognition (d = 1.32) and both aspects of ToM (d = 0.87-1.21). In analyses of individual emotions, people on B/N maintenance treatment had decreased accuracy in recognition of anger and fear and had a bias to identify other emotions as sad. The duration of opioid use was robustly associated with difficulties in the recognition of anger. Conclusion: People in B/N maintenance treatment have significant difficulties in recognizing the emotions and mental states of others. Deficits in social cognition might be important for understanding the difficulties in interpersonal and social functioning in people with OUD.

An eye-tracking study of biased attentional processing of emotional faces in severe alcohol use disorder

BACKGROUND

Social cognition impairments in severe alcohol use disorder (SAUD) are increasingly established. However, fundamental aspects of social cognition, and notably the attentional processing of socio-affective information, remain unexplored, limiting our understanding of underlying mechanisms. Here, we determined whether patients with SAUD show attentional biases to specific socio-affective cues, namely emotional faces.

METHOD

In a modified dot-probe paradigm, 30 patients with SAUD and 30 demographically matched healthy controls (HC) were presented with pairs of neutral-emotional (angry, disgusted, happy, sad) faces while having their eye movements recorded. Indices of early/automatic (first fixations, latency to first fixations) and later/controlled (number of fixations, dwell-time) processes were computed.

RESULTS

Patients with SAUD did not differ from HC in their attention to angry/disgusted/sad vs. neutral faces. However, patients with SAUD fixated/dwelled less on happy vs. neutral faces in the first block of stimuli than HC, who presented an attentional bias to happy faces.

LIMITATIONS

Sample-size was determined to detect medium-to-large effects and subtler ones may have been missed. Further, our cross-sectional design provides no explanation as to whether the evidenced biases precede or are a consequence of SAUD.

CONCLUSIONS

These results extend the social cognition literature in SAUD to the attentional domain, by evidencing the absence of a controlled attentional bias toward positive social cues in SAUD. This may reflect reduced sensitivity to social reward and could contribute to higher order social cognition difficulties and social dysfunction.

Altered hierarchical organization between empathy and gambling networks in disordered gamblers

BACKGROUND

Despite the demonstrated association between empathy and gambling at the behavioral level, limited neuroimaging research on empathy and gambling disorder (GD) has been conducted. Whether and how the brain network of empathy and that of gambling interact in disordered gamblers has not been investigated. This study aimed to address this research gap by examining the hierarchical organizational patterns, in which the differences of causal interactions of these networks between disordered gamblers and healthy controls were revealed.

METHODS

Resting-state functional magnetic resonance imaging (fMRI) data of 32 disordered gamblers and 56 healthy controls were included in the formal analysis. Dynamic causal modeling was used to examine the effective connectivity within and between empathy and gambling networks among all participants.

RESULTS

All participants showed significant effective connectivity within and between empathy and gambling networks. However, compared with healthy controls, disordered gamblers displayed more excitatory effective connectivity within the gambling network, the tendency to display more excitatory effective connectivity from the empathy network to the gambling network, and reduced inhibitory effective connectivity from the gambling network to the empathy network.

CONCLUSION

The exploratory study was the first to examine the effective connectivity within and between empathy and gambling networks among disordered gamblers and healthy controls. These results provided insights into the causal relationship between empathy and gambling from the neuroscientific perspective and further confirmed that disordered gamblers show altered effective connectivity within and between these two brain networks, which may be considered to be a potential neural index for GD identification. In addition, the altered interactions between empathy and gambling networks may also indicate the potential targets for the neuro-stimulation intervention approach (e.g., transcranial magnetic stimulation).

The effect of intranasal oxytocin on processing emotional stimuli during alcohol withdrawal: A randomized placebo-controlled double-blind clinical trial

Alcohol dependence is associated with difficulties in processing emotional stimuli, which can lead to interpersonal problems. The neuropeptide oxytocin has been shown to modulate the processing of emotional stimuli, however, oxytocin treatment has not yet been examined in patients with withdrawal symptoms during alcohol detoxification. The aim of the present study was to investigate the effect of oxytocin on the reading the mind in the eyes test (RMET), which indexes theory of mind ability, during a three-day period of alcohol detoxification at an addiction treatment centre in Norway. We performed a randomized, double-blind, placebo-controlled trial in 39 patients fulfilling criteria for ICD-10 diagnosis of alcohol dependence admitted for alcohol detoxification and withdrawal treatment. Participants were randomized to receive either intranasal oxytocin (24 IU) or placebo, twice daily for three days. We evaluated RMET performance on day 2 and day 3 of detoxification and differences in RMET scores between day 2 and day 3 of detoxification. Frequentist and Bayesian statistical inference suggested that oxytocin administration during alcohol withdrawal in alcohol-dependent patients did not improve RMET performance. However, exploratory analyses provided preliminary evidence that oxytocin might improve performance on the RMET negative emotion subscale (uncorrected p value = 0.038), and that oxytocin treatment might show the most promise for those with high levels of alcohol consumption (i.e., ≥20 alcohol units per day; uncorrected p value = 0.023). Moreover, alcohol consumption levels significantly predicted RMET performance on day 2, but not on day 3, of withdrawal.

Is Empathy Associated with Gambling and Its Addiction? A Scoping Review of Empirical Studies

Considering the low levels of empathy associated with substance-related addictions and the similarities between gambling disorder (GD) and substance-related addiction, understanding the relationship between empathy and GD may clarify the mechanism of addiction development. This scoping review aimed to evaluate the empirical evidence for the potential protective role of emotional and cognitive empathy against GD development via internalizing and/or externalizing pathways. We followed the preferred reporting items for systematic review and meta-analyses extension for scoping reviews and 11 articles met the inclusion criteria. Although most of the reviewed studies used correlational designs and non-gambling-specific samples, this review highlights (1) significant relationships between both types of empathy and the neural activity of gambling behaviors, and (2) reduced cognitive empathy (i.e., fantasy and perspective taking) and increased emotional empathy (i.e., personal distress) among problem gamblers than their gambling counterparts. Despite the lack of studies directly testing the protective role of empathy against GD, the existing studies (n = 8) nevertheless shed light on the potential protective effects of both types of empathy on GD development. This review identified research gaps, which can be addressed in future studies by discovering the underlying mechanisms (e.g., internalizing and externalizing pathways) of these relationships. Experimental or longitudinal studies in gamblers investigating how different types of empathy are associated with GD via these pathways are called for as their findings have implications for prevention and intervention designs for GD and other addictive disorders.

Impaired social perception from eyes and face visual cues: evidence from prefrontal cortex damage

Despite the key role that decoding of social-perceptual cues from faces plays in interpersonal communication, it is only recently that the potential of prefrontal cortex damage to disrupt this ability has been recognized. In fact, few studies to date had assessed whether the ability to identify the state of mind of others from the whole or part of the face is disrupted after prefrontal cortex damage and whether these two abilities are associated and share overlapped neural systems. In the present study, 30 patients with focal prefrontal lesions and 30 matched control subjects were assessed on their ability to recognize six basic emotions from facial expressions of the whole face and to identify states of mind of others from photographs of only the eyes using the "Reading the Mind in the Eyes Task". Results showed that frontal patients were significantly impaired compared with control subjects on both tasks. Moreover, regression analyses showed that these two abilities are associated and reciprocally predictive of one another. Finally, using voxel-based lesion analysis; we identified a partially common bilaterally distributed prefrontal network in the decoding of both emotional cues from both the whole face and eyes centered within the dorsomedial and ventral regions with extension to the lateral frontal pole.

Age, BMI, and inflammation: Associations with emotion recognition

Experimental studies show that inflammation impairs the ability to interpret the mental state of another person, denoted theory of mind (ToM). The current study attempted a conceptual replication in states associated with elevated low-grade inflammation, i.e., high body weight and advanced age. Ninety young (M = 26.3 years, SD = 4.1) or older (M = 70.7 years, SD = 4.0) participants with either a normal body mass index (BMI) (M = 22.4, SD = 2.2) or high BMI (M = 33.1, SD = 3.8) completed the Reading the Mind in the Eyes Test (RMET) to assess emotion recognition. Plasma interleukin-6 (IL-6) level was measured to index low-grade inflammation. As anticipated, elevated IL-6 levels were found with higher BMI, although not with increased age. IL-6 was associated with poorer task performance, independent of potential demographic and health confounders (e.g., sex, education, smoking status, alcohol intake, presence of medical conditions, and medication intake). Analyses also revealed an interaction whereby young individuals with a high BMI showed worse RMET performance compared to their normal BMI counterparts, whereas the opposite pattern was found in older individuals. The present observational study replicated experimental results showing that elevated low-grade inflammation is correlated with a lower ability to infer the mental states of others. These findings suggest that also naturalistic conditions of (protracted) low-grade inflammation may alter emotion recognition.

Sty in the Mind's Eye: A Meta-Analytic Investigation of the Nomological Network and Internal Consistency of the "Reading the Mind in the Eyes" Test

The Reading the Mind in the Eyes Test (RMET) is the most popular adult measure of individual differences in theory of mind. We present a meta-analytic investigation of the test's psychometric properties (k = 119 effect sizes, 61 studies, n_total = 8,611 persons). Using random effects models, we found the internal consistency of the test was acceptable (α = .73). However, the RMET was more strongly related with emotion perception (r = .33, ρ = .48) relative to alternative theory of mind measures (r = .29, ρ = .39), and weakly to moderately related with vocabulary (r = .25, ρ = .32), cognitive empathy (r = .14, ρ = .20), and affective empathy (r = .13, ρ = .19). Overall, we conclude that the RMET operates rather as emotion perception measure than as theory of mind measure, challenging the interpretation of RMET results.

Training emotion regulation processes in alcohol-abstinent individuals: A pilot study

The study aimed to assess whether abstinent individuals with alcohol use disorders (AUD) would benefit from enhanced emotional regulation (ER) strategies using the affect regulation training (ART) program based on weekly sessions comprising psycho-education, muscle and respiratory relaxation, awareness, acceptance and tolerance, compassionate personal support, emotion analysis and modification. Seventy-two participants with AUD benefited from ART and were compared on their ER ability, mindfulness, and their experience of abstinence to 40 participants not receiving the program, before it, at the end, and 6 months after. Improvements in ER were observed, particularly in positive centration, action centration or self-blame and in mindfulness abilities after the program and six months later. In addition, by comparing participants who received the program with a short (<18 months) or long (>18 months) abstinence duration, the results showed a greater decrease in the use of non-adaptive strategies, a greater increase in adaptive strategies and mindfulness abilities in short-term abstinent individuals. These results demonstrate improvement in ER skills after training in people who were abstinent from alcohol. ART is effective for consolidating abstinence and should be used especially at the beginning of withdrawal to promote the rapid implementation of new ER strategies.

Do Social Cognition Deficits Recover with Abstinence in Alcohol-Dependent Patients?

Background

Despite growing evidence of the presence and clinical relevance of deficits in social cognition in individuals with alcohol use disorder (AUD), less is known about the potential of “natural” recovery with abstinence in this neurocognitive domain. This study investigated the abstinence‐based recovery of neurocognitive social abilities in alcohol‐dependent patients (ADP) using a prospective longitudinal design with follow‐up assessment under controlled conditions of abstinence during alcohol dependence inpatient treatment.

Methods

Seventy‐seven participants (42 ADP and 35 healthy controls [HC]) performed social cognition testing, including facial emotion recognition, perspective taking, and affective responsiveness twice (baseline/T1 and follow‐up/T2) during comparable follow‐up periods. Assessment of social cognition in abstinent ADP was conducted at the beginning (T1; within the first 2 weeks) and at the end (T2; within the last 2 weeks) of long‐term (2 months) abstinence‐oriented alcohol dependence inpatient treatment. Only patients abstinent for >14 days (last heavy drinking day >21 days) at baseline (T1) and who remained abstinent at follow‐up (T2) were included.

Results

ADP, who on average were nearly 2 months abstinent at T1, showed poorer social cognition in all 3 areas (emotion recognition, perspective taking, and affective responsiveness) than HC. There was no difference between groups on the change in performance over time, and group differences (ADP vs. HC) remained significant at T2, indicating persistent social cognition deficits in ADP following controlled abstinence during inpatient treatment.

Conclusions

Our findings indicate no natural recovery of social cognition impairments in ADP during an intermediate to long‐term period of abstinence (2+ months), the usual active treatment phase. Research aimed at developing interventions that focus on the improvement of social cognition deficits (e.g., social cognition training) and determining whether they benefit short‐ and long‐term clinical outcomes in AUD seems warranted.

Tackling heterogeneity: Individual variability of emotion decoding deficits in severe alcohol use disorder

BACKGROUND

Severe alcohol use disorder (SAUD) is associated with social cognition deficits. Patients with SAUD are impaired for the recognition of emotional facial expressions, particularly at early stages of abstinence. These deficits damage interpersonal relations and increase relapse risk. However, uncertainties still abound on their variation across emotions and on the heterogeneity of emotional impairments across patients. We addressed these questions by exploring how the deficit varies according to emotions' type/intensity and patients' heterogeneity.

METHODS

Sixty-five recently detoxified patients with SAUD and 65 matched healthy controls performed the Facial Emotion Recognition Test, assessing the ability to identify six emotions (anger, contempt, disgust, fear, happiness, sadness) displayed by morphed faces with various intensities. Accuracy scores and detection thresholds were collected for each emotion. Beyond group comparisons, multiple single-case analyses determined the percentage of patients presenting decoding deficits for each emotion.

RESULTS

When current depression and anxiety symptoms were controlled for, patients did not present a general emotion decoding deficit, but were rather characterized by specific deficits for disgust/contempt in accuracy, and for disgust in detection threshold scores. Single-case analyses showed that only a third of patients presented a clinically significant emotional deficit.

CONCLUSIONS

Patients with SAUD only present emotional decoding deficits for specific interpersonal emotions (disgust/contempt) when subclinical psychopathological states are controlled for, and show no general emotional impairment. This goes against the proposal of a generalized social cognition deficit in this population. This group effect moreover masks a massive heterogeneity across patients, which has implications at experimental and clinical levels.

Drunkorexia: An Examination of the Role of Theory of Mind and Emotional Awareness among Adolescents

This study aimed to investigate Theory of Mind (ToM) and emotional awareness in drunkorexia, an emerging behavior characterized by calorie restriction when drinking alcohol is planned. A sample of 246 adolescents (148 females, 98 males; range 17-20) completed self-reported measures assessing drunkorexia, ToM and lack of emotional awareness. Drunkorexia was negatively correlated with ToM abilities, with reading neutral emotions, and positively with lack of emotional awareness. ToM and lack of emotional awareness were also found to predict drunkorexia. Findings highlighted that adolescents who engage in drunkorexia may have difficulties in reading others' mental states and being aware of their emotions.

Development and validation of the Korean version of the Reading the Mind in the Eyes Test

The Reading the Mind in the Eyes Test (RMET) is one of the most widely used instruments for assessing the ability to recognize emotion. To examine the psychometric properties of the Korean version of the RMET and to explore the possible implications of poor performance on this task, 200 adults aged 19–32 years completed the RMET and the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), the cognitive empathy domain of the Korean version of the Interpersonal Reactivity Index (IRI-C), and the Buss-Durkee Hostility Inventory-Aggression (BDHI-A). In the present study, confirmatory factor analyses confirmed that the hypothesized three-factor solution based on three different emotional valences of the items (positive, negative, or neutral) had a good fit to the data. The Korean version of the RMET also showed good test-retest reliability over a 4-week time interval. Convergent validity was also supported by significant correlations with subscales of the TAS-20K, and discriminant validity was identified by nonsignificant associations with IRI-C scores. In addition, no difference was found in RMET performance according to the sex of the photographed individuals or the sex or educational attainment of the participants. Individuals with poor RMET performance were more likely to experience alexithymia and aggression. The current findings will facilitate not only future research on emotion processing but also the assessment of conditions related to the decreased ability to decode emotional stimuli.

Impact of polysubstance use on social and non-affective cognitive performance among treatment-seeking individuals with alcohol use disorders

BACKGROUND

Individuals with alcohol use disorder (AUD) display deficits across a range of cognitive processes. Decrements in social cognition may be particularly important for interpersonal functioning and post-treatment adaptation. Although social cognitive deficits are associated with chronic use of numerous substances, the role of polysubstance use in AUD-associated deficits remains largely unaddressed.

METHODS

Community volunteers (n = 49; 22 men) and inpatient treatment-seekers with AUD were administered neurocognitive tasks indexing emotion processing and non-affective cognitive functioning. Tasks included an emotion discrimination task, a working memory task with affective stimuli, a general face processing (control) task, two measures of executive function, and two measures of visual spatial function. AUD subgroups included individuals with no recent (6-month) polysubstance use (AUD-Only; n = 22; 15 men), and those with at least weekly use (Poly-SU; n = 22; 18 men).

RESULTS

Poly-SU individuals evinced disadvantaged performance relative to other groups on the emotion discrimination task [ps ≤ 0.001], affective working memory task [ps ≤ 0.050], and two executive function measures [ps ≤ 0.051]. No differences were observed for visual spatial functioning [ps ≥ 0.498] or general face processing [ps ≥ 0.190]. No performance differences between AUD-Only and community volunteers were noted.

CONCLUSIONS

Results extend the emerging literature exploring emotion processing in AUD and add to the established literature regarding cognitive deficits in this population. The data suggest that among individuals with AUD, those with polysubstance use may be particularly vulnerable to deficits in decoding emotional face content. The current work highlights the need to incorporate more nuanced and careful considerations of polysubstance use in the design and analysis for future investigations of alcohol-associated deficits in emotion processing.

What Do Theory-of-Mind Tasks Actually Measure? Theory and Practice

In recent decades, the ability to represent others' mental states (i.e., theory of mind) has gained particular attention in various disciplines ranging from ethology to cognitive neuroscience. Despite the exponentially growing interest, the functional architecture of social cognition is still unclear. In the present review, we argue that not only the vocabulary but also most of the classic measures for theory of mind lack specificity. We examined classic tests used to assess theory of mind and noted that the majority of them do not require the participant to represent another's mental state or, sometimes, any mental state at all. Our review reveals that numerous classic tests measure lower-level processes that do not directly test for theory of mind. We propose that more attention should be paid to methods used in this field of social cognition to improve the understanding of underlying concepts.

Emotional Face Processing among Treatment-Seeking Individuals with Alcohol Use Disorders: Investigating Sex Differences and Relationships with Interpersonal Functioning

BACKGROUND

Individuals in treatment for alcohol use disorder (AUD) display deficits across a broad range of cognitive processes. Disruptions in affective processing are understudied, but may be particularly important for interpersonal functioning and post-treatment adaptation. In particular, the role of sex in AUD-associated emotion processing deficits remains largely unaddressed and was a focus of the current investigation.

METHODS

Fifty-six treatment seekers with AUD and 54 healthy community controls (N = 110) were administered an emotional face discrimination task. Non-affective tasks included a sex-discrimination task and two brief measures of executive functioning. Two measures of interpersonal function were included.

RESULTS

Emotion processing deficits were evident among women with AUD relative to other groups. This sex-contingent relationship was not observed in measures of executive function, sex-discrimination or interpersonal problems, although individuals with AUD performed more poorly on these measures.

CONCLUSIONS

Results were consistent with extant literatures examining cognitive, affective and interpersonal functioning among individuals with AUD, and provided novel evidence of vulnerability to alcohol-associated deficits in emotion processing among women. While similar sex-contingent effects were not apparent among other measures, results support modest interrelationships, specifically including the import of emotion processing to interpersonal functioning in AUD. These data offer guidance for further systematic investigation and highlight important considerations for future relapse-prevention and recovery-facilitation efforts.

The grey future: Overgenerality of emotional future thinking in alcohol-use disorders

BACKGROUND

While previous research has highlighted the overgenerality of future thinking in alcohol-use disorders (AUD), the emotional characteristics of future thinking were not taken into account. We therefore evaluated the ability to retrieve episodic (i.e., events that happened at a particular place and time and lasted for a day or less) emotional future events in AUD.

METHODS

We invited 36 participants with AUD and 40 control participants to imagine positive, negative and neutral future scenarios and analyzed these scenarios regarding their episodic characteristics (i.e., the ability of participants to imagine future events situated in time and space enriched with phenomenological details).

RESULTS

Analysis demonstrated lower episodic positive, negative and neutral future thinking in participants with AUD than in control participants. Participants with AUD also demonstrated lower episodic positive and negative future thinking compared to episodic neutral future thinking. Interestingly, high depression scores were associated with overgenerality of neutral, positive, and negative future thinking in AUD participants.

CONCLUSIONS

These findings demonstrate overgenerality of both positive and negative future thinking in AUD. This overgenerality may represent an avoidance strategy in which individuals with AUD may try to avoid the hopelessness and/or conflicts that may be activated when constructing future scenarios.

Emotional processing and social cognition in alcohol use disorder

OBJECTIVE

To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research.

METHOD

First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed.

RESULTS

Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition).

CONCLUSIONS

The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Does empathy change during undergraduate medical education? - A meta-analysis

Purpose: The aim of this meta-analysis was to synthesize the existing evidence examining how empathy changes during undergraduate medical education and assess whether different types of measures produce different results. Method: Three electronic bibliographic databases were last searched on 28 November 2018. Quantitative studies including a measure of empathy in medical undergraduate students and a comparison of the results among the different years of study were included. All analyses were guided by Lipsey and Wilson and conducted using Comprehensive Meta-Analysis software. Results: The overall sample size for the twelve studies (n = 12) was 4906 participants. Results indicate a significant effect (g = 0.487, SE = 0.113, 95% CI = 0.265, 0.709), suggesting that there is moderate evidence that empathy scores changed. Studies using the Jefferson's Scale for Physician Empathy (JSPE) reported higher effect sizes (g = 0.834, SE = 0.219, 95% CI = 0.406, 1.263), while the effect size for studies using other scales was smaller and non-significant (g = 0.099, SE = 0.052, 95% CI = -0.003, 0.201). Conclusions: This review indicated significant evidence that self-ratings of empathy changed across the years of medical education. However, we need to be cautious because this effect was only significant when empathy was assessed using the JSPE.

OXTR rs53576 polymorphism impacts interpersonal adaptability: Dispositional forgiveness as a mediator

Polymorphisms in the oxytocin receptor (OXTR) gene have been shown to be related to individual differences in social skills that are important for building and maintaining social relationships, such as the capability to efficiently process social information and regulate emotions. However, what remains unclear is the potential roles of OXTR polymorphisms in interpersonal adaptability, namely the ability to cope with the situational demands of interpersonal interactions. In this study, we examined the roles of OXTR rs53576 polymorphism in interpersonal adaptability, empathic perception, and dispositional forgiveness in a cohort of 573 college freshmen. The results indicated that the scores on interpersonal adaptability and dispositional forgiveness, apart from empathic perception, increased as functions of the number of G alleles of OXTR rs53576. Moreover, dispositional forgiveness, but not empathic perception, mediated the association between OXTR rs53576 and interpersonal adaptability. The findings highlight the influences of the OXTR gene on adaptive interpersonal interactions, especially when individuals face changing social situations.

Behavioral and Cerebral Impairments Associated with Binge Drinking in Youth: A Critical Review

Binge drinking is a widespread alcohol consumption pattern in youth that is linked to important behavioral and cerebral impairments, in both the short and the long term. From a critical review of the current literature on this topic, we conclude that binge drinkers display executive impairments, cerebral modifications, and problems with emotion-related processes. Five key empirical and theoretical topics are discussed to pave the way for future research in the field: (1) the specificity of the brain modifications observed in binge drinkers that may index a compensatory mechanism or result from multiple withdrawals; (2) the nature of the relationship between binge drinking and impairments, suggesting reciprocal influences between excessive alcohol consumption and executive deficits; (3) the possible recovery of brain and cognitive functioning after the cessation of binge drinking; (4) the validity of the continuum hypothesis, suggesting links between binge drinking and severe alcohol use disorders; and (5) the existing strategies to reduce binge drinking habits or rehabilitate the associated cognitive deficits. Future perspectives are described in relation to the questions raised to identify the crucial variables to be addressed in research and clinical practice.

Alcohol use and personality trait change: pooled analysis of six cohort studies

BACKGROUND

Personality has been associated with alcohol use, but less is known about how alcohol use may influence long-term personality trait change.

METHODS

The present study examines associations between alcohol use and change in the five major personality traits across two measurement occasions (mean follow-up of 5.6 years). A total of 39 722 participants (54% women) were pooled from six cohort studies for an individual-participant meta-analysis. Alcohol use was measured as (1) average alcohol consumption, (2) frequency of binge drinking, (3) symptoms of alcohol use disorder, and (4) a global indicator of risky alcohol use. Changes in the five major personality traits (extraversion, emotional stability, agreeableness, conscientiousness, and openness to experience) were used as outcomes.

RESULTS

Risky alcohol use was associated with increasing extraversion [0.25 T-scores over the mean follow-up of 5.6 years; 95% confidence interval (CI) 0.07-0.44] and decreasing emotional stability (-0.28; 95% CI -0.48 to -0.08), agreeableness (-0.67; 95% CI -0.87 to -0.36), and conscientiousness (-0.58; 95% CI -0.79 to -0.38). Except the association between alcohol use and extraversion, these associations were consistent across cohort studies and across different measures of alcohol use.

CONCLUSIONS

These findings suggest that alcohol use is associated with personality trait changes in adulthood.

Low-grade inflammation decreases emotion recognition - Evidence from the vaccination model of inflammation

The ability to adequately interpret the mental state of another person is key to complex human social interaction. Recent evidence suggests that this ability, considered a hallmark of 'theory of mind' (ToM), becomes impaired by inflammation. However, extant supportive empirical evidence is based on experiments that induce not only inflammation but also induce discomfort and sickness, factors that could also account for temporary social impairment. Hence, an experimental inflammation manipulation was applied that avoided this confound, isolating effects of inflammation and social interaction. Forty healthy male participants (mean age = 25, SD = 5 years) participated in this double-blind placebo-controlled crossover trial. Inflammation was induced using Salmonella Typhi vaccination (0.025 mg; Typhim Vi, Sanofi Pasteur, UK); saline-injection was used as a control. About 6 h 30 m after injection in each condition, participants completed the Reading the Mind in the Eyes Test (RMET), a validated test for assessing how well the mental states of others can be inferred through observation of the eyes region of the face. Vaccination induced systemic inflammation, elevating IL-6 by +419% (p < .001), without fever, sickness symptoms (e.g., nausea, light-headedness), or mood changes (all p's > .21). Importantly, compared to placebo, vaccination significantly reduced RMET accuracy (p < .05). RMET stimuli selected on valence (positive, negative, neutral) provided no evidence of a selective impact of treatment. By utilizing an inflammation-induction procedure that avoided concurrent sicknesses or symptoms in a double-blinded design, the present study provides further support for the hypothesis that immune activation impairs ToM. Such impairment may provide a mechanistic link explaining social-cognitive deficits in psychopathologies that exhibit low-grade inflammation, such as major depression.

Socio-cognitive functioning in stimulant polysubstance users

BACKGROUND

Using more than one psychotropic substance is accompanied by increased risks for psychiatric and physical disorders. Accordingly, deficits in basal cognitive functions have been consistently associated with polysubstance use (PSU), whereas little is known about potential impairments in more complex socio-cognitive skills, which are relevant for daily-life functioning. Therefore, we investigated the effects of toxicological validated stimulant PSU on social cognition under consideration of potential cumulative effects.

METHODS

We compared socio-cognitive performances of 47 individuals with stimulant PSU with 59 matched stimulant-naïve controls using the Multifaceted Empathy Test (MET) and the Movie for the Assessment of Social Cognition (MASC). Additionally, social network size was assessed by the Social Network Questionnaire (SNQ). Hair and urine testing was employed to categorize three PSU subgroups (3, 4, and ≥5 substances used) and to ensure drug abstinence in controls.

RESULTS

Individuals with stimulant PSU showed lower emotional empathy (MET) and a smaller social network (SNQ) compared to controls (both with linear trends for increasing number of used substances: p < .05). In contrast, cognitive empathy (MET and MASC) was largely unaffected by PSU. Additional linear regression analyses within PSU individuals revealed number of used substances as the best predictor for inferior performance in emotional empathy (p < .01), while severity of the use of single substances or substance-classes did not show a significant impact.

CONCLUSION

These findings demonstrate cumulative adverse effects of stimulant PSU on an important facet of socio-cognitive functioning. Therefore, emotional empathy deficits should be targeted in future interventions and rehabilitations for individuals with PSU.

Validation of the Reading the Mind in the Eyes Test in a healthy Spanish sample and women with anorexia nervosa

INTRODUCTION

The aim of this study was to build a Spanish version of the Reading the Mind in the Eyes Test (RMET) including limited time of response and an integrated glossary, and to test its validity.

METHODS

A total of 433 university students (121 men and 350 women) and 38 anorexic women completed the RMET and other related measures of empathy and alexithymia. The results of the Parallel Analysis suggested a unidimensional structure for 19 items, which was verified through a Confirmatory Factor Analysis.

RESULTS

Similarly to other research, this factor had a low reliability (α = .56, ρ = .59); however, regarding validity, the total score of the instrument showed positive correlations with empathy and negatives with alexithymia. Furthermore, healthy females were superior to males in RMET, and to anorexic women; but no significant differences appeared between healthy men and the anorexic group.

CONCLUSION

This study confirms the validity of the test and permits a relatively short and inexpensive means of administration in large samples of adults. Besides, it suggests the necessity of assessing and treating the theory of mind in anorexic women.

New steps for treating alcohol use disorder

Alcohol use disorder is a complex syndrome with multiple treatment points including drug-induced pathology, withdrawal management, behavioral/cognitive strategies, and relapse prevention. These different components may be complicated by genotype and phenotype. A huge milestone for the treatment of alcohol use disorder across several countries in the last 10 years was the introduction of practice guidelines integrating clinical expertise and research evidence. These provide a summary of interventions that have been shown to be effective following rigorous and replicated clinical trials. Inspection of these guidelines reveals good consistency, but little evidence of progress in treatment approaches for alcohol use disorder over the past decade. In this mini-review, we discuss emerging treatments for alcohol use disorder that may supplement or improve the evidence-based treatments that are currently recommended. New medications, the emergence of digital technology, and other novel approaches such as transcranial magnetic stimulation are all discussed with reference to treatments already in practice. We also consider how individual differences in genotype and phenotype may affect outcomes. Together with improvements in technology, this knowledge offers a powerful tool for designing personalized approaches to treatment, and hence improving prognosis for rehabilitation programs.

Affective impairments in binge drinking: Investigation through emotional facial expression decoding

OBJECTIVE

Binge drinking, an excessive alcohol consumption pattern frequently observed in young people, is known to be associated with psychological and cerebral deficits. While cognitive dysfunctions have been widely investigated, emotional abilities have scarcely been explored. Such an exploration would however offer a more exhaustive understanding of the deficits associated with binge drinking, as well as of the possible transition towards alcohol-dependence.

METHODS

46 young adults (23 binge drinkers, 12 women; 23 control participants, 12 women) were recruited among university students. They performed an emotional recognition task consisting of the visual decoding of six basic emotions (i.e. anger, contempt, disgust, fear, happiness, and sadness). Accuracy scores and detection thresholds were collected for each emotion.

RESULTS

Binge drinkers showed lower performance than control participants for the decoding of all emotions and increased detection threshold, this later reflecting less ability to capture an emotion. Binge drinking is thus associated with a need for higher emotional intensity to perform correct detection. Moreover, these emotional difficulties appear specifically related to alcohol consumption.

CONCLUSION

These findings reinforce previous experimental evidence of altered emotional processing among binge drinkers, and extend these results for various emotional contents. They support the hypothesis of a continuum between binge drinking and alcohol-dependence, in which massive emotional impairments have been documented. Indeed, these impairments could be involved in the onset and maintenance of excessive alcohol consumption, notably through the established relationship between emotional deficits and social distress.

Mind reading abilities in opiate-dependent patients: An exploratory study

OBJECTIVES

Impairments in social cognition have been described as playing a major role in the maintenance of addictive behavior in substance abusers. This study aimed to investigate the Theory of Mind (ToM) ability of opiate-dependent (OD) patients and to explore whether TOM ability was correlated with length of substance abuse, age at onset of substance abuse and length of abstinence.

METHODS

OD patients (N = 29) and non-dependent individuals (NDI) (N = 29) were submitted to the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi-structured interview, and to the Versailles-Lecture Intentionnelle en Situation (V-LIS), a movie paradigm in which participants have to infer the characters' intentions.

RESULTS

The results confirmed a deficit in ToM ability in OD patients, with OD patients demonstrating poorer performance than NDI on both the V-LIS and the Th.o.m.a.s. The combination of perspective taking and reflecting on others' mental states was particularly difficult for OD patients. Furthermore, impairments in ToM abilities were not correlated with the age at onset of substance abuse or to the duration of substance abuse or abstinence.

CONCLUSIONS

The results suggest OD patients may have impaired social cognition, demonstrating deficits in even basic social interaction skills, which may constitute a risk factor for addiction. These findings underline the importance of developing interventions to improve social cognition ability during the rehabilitation of OD patients.

Sex, Age, and Emotional Valence: Revealing Possible Biases in the 'Reading the Mind in the Eyes' Task

The 'Reading the Mind in the Eyes' test (RMET) assesses a specific socio-cognitive ability, i.e., the ability to identify mental states from gaze. The development of this ability in a lifespan perspective is of special interest. Whereas former investigations were limited mainly to childhood and adolescence, the focus has been shifted towards aging, and psychiatric and neurodegenerative diseases recently. Although the RMET is frequently applied in developmental psychology and clinical settings, stimulus characteristics have never been investigated with respect to potential effects on test performance. Here, we analyzed the RMET stimulus set with a special focus on interrelations between sex, age and emotional valence. Forty-three persons rated age and emotional valence of the RMET picture set. Differences in emotional valence and age ratings between male and female items were analyzed. The linear relation between age and emotional valence was tested over all items, and separately for male and female items. Male items were rated older and more negative than female stimuli. Regarding male RMET items, age predicted emotional valence: older age was associated with negative emotions. Contrary, age and valence were not linearly related in female pictures. All ratings were independent of rater characteristics. Our results demonstrate a strong confound between sex, age, and emotional valence in the RMET. Male items presented a greater variability in age ratings compared to female items. Age and emotional valence were negatively associated among male items, but no significant association was found among female stimuli. As personal attributes impact social information processing, our results may add a new perspective on the interpretation of previous findings on interindividual differences in RMET accuracy, particularly in the field of developmental psychology, and age-associated neuropsychiatric diseases. A revision of the RMET might be afforded to overcome confounds identified here.

The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults

Introduction

We investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress.

Methods

The sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants’ narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is specifically designed to trigger attachment distress. In both conditions, the narratives were evaluated using the LEAS scoring system. Additionally, we assessed the impact of childhood trauma on affect-centered mentalization with the Childhood Trauma Questionnaire (CTQ).

Results

While the non-clinical sample displayed the same level of affect-centered mentalization in both conditions, the majority of the clinical sample reached higher scores in the attachment distress condition. There was no strong relationship between reported trauma and mentalization scores.

Discussion

Our findings lend strong empirical support to the assumption that affect-centered mentalization is modulated by attachment-related distress. Several possible explanations for the differences between and within the clinical and the non-clinical sample are discussed.

Relationship between empathic processing and drinking behavior in project MATCH

INTRODUCTION

Family relationships, social connectedness and a greater network of supportive others each predict better drinking outcomes among individuals with alcohol use disorder (AUD). The association between social factors and drinking may be related to the ability of individuals to take the perspectives of others' mental and emotional states, defined as empathic processing (EP). As such, it may be the case that EP is associated with social support (SS) and drinking behavior among individuals with AUD, yet few prior studies have attempted to define EP in an AUD sample.

METHODS

The current study was a secondary data analysis of Project MATCH (N=1726) using structural equation modeling to model EP as a latent factor. The study also sought to test the baseline associations between EP, SS, and drinking behavior, as well as sex differences in the associations between EP, SS, and drinking. It was hypothesized that EP would be positively associated with SS and negatively associated with drinking behavior.

RESULTS

Results suggested adequate model fit of the EP construct. Structural equation models indicated significant associations between EP, SS, and both drinking consequences and percent drinking days, but only for males. Males reported significantly lower EP and SS from friends, but more SS from family, compared to females. EP was not related to drinking among females.

CONCLUSIONS

The current study validated a model of EP in a treatment-seeking sample of individuals with alcohol use disorder. Future work may consider EP as a treatment-modifiable risk factor for drinking frequency and consequences in males.

Executive Functions, Memory, and Social Cognitive Deficits and Recovery in Chronic Alcoholism: A Critical Review to Inform Future Research

Alcoholism is a complex and dynamic disease, punctuated by periods of abstinence and relapse, and influenced by a multitude of vulnerability factors. Chronic excessive alcohol consumption is associated with cognitive deficits, ranging from mild to severe, in executive functions, memory, and metacognitive abilities, with associated impairment in emotional processes and social cognition. These deficits can compromise efforts in initiating and sustaining abstinence by hampering efficacy of clinical treatment and can obstruct efforts in enabling good decision making success in interpersonal/social interactions, and awareness of cognitive and behavioral dysfunctions. Despite evidence for differences in recovery levels of selective cognitive processes, certain deficits can persist even with prolonged sobriety. Herein is presented a review of alcohol-related cognitive impairments affecting component processes of executive functioning, memory, and the recently investigated cognitive domains of metamemory, social cognition, and emotional processing; also considered are trajectories of cognitive recovery with abstinence. Finally, in the spirit of critical review, limitations of current knowledge are noted and avenues for new research efforts are proposed that focus on (i) the interaction among emotion-cognition processes and identification of vulnerability factors contributing to the development of emotional and social processing deficits and (ii) the time line of cognitive recovery by tracking alcoholism's dynamic course of sobriety and relapse. Knowledge about the heterochronicity of cognitive recovery in alcoholism has the potential of indicating at which points during recovery intervention may be most beneficial.

Intranasal Oxytocin Selectively Modulates Social Perception, Craving, and Approach Behavior in Subjects With Alcohol Use Disorder

OBJECTIVES

A pharmacotherapy that both improves social abilities and promotes abstinence may be particularly helpful for the treatment of alcohol use disorder. Recent clinical and preclinical evidence suggests that oxytocin has prosocial and antiaddiction effects. We performed a pilot, laboratory-based, preclinical trial of oxytocin in subjects with alcohol abuse (as per Diagnostic and Statistical Manual of Mental Disorders, 4 Edition criteria) to evaluate therapeutic potential and assess tolerability.

METHODS

Social perceptual ability, cue-induced craving, and approach bias for alcohol and appetitive imagery were quantified after intranasal oxytocin and placebo administration to 32 nontreatment-seeking individuals with alcohol abuse in a double-blind, crossover study. Because attachment style can moderate the effects of oxytocin, we also explored whether attachment style moderated oxytocin's effects on our behavioral measures.

RESULTS

Oxytocin significantly improved recognition of easier items on a social perception task, but had no significant group-level effect on cue-induced craving. However, oxytocin effects on craving were moderated by attachment anxiety, with oxytocin reducing craving in more anxiously attached individuals and increasing craving in less anxiously attached individuals. Subjects did not display an approach bias to alcohol images on the placebo day, preventing meaningful analysis of this measure. Subjects did display an approach bias to appetitive images on the placebo day, which was significantly reduced by oxytocin administration. No adverse reactions were observed.

CONCLUSIONS

Intranasal oxytocin has potential to improve social perception, reduce cue-induced alcohol cravings, and reduce appetitive approach bias in subjects with alcohol abuse, and can be safely tolerated in this population. The effects of oxytocin are complex, however, and require further investigation.

Preserved Affective Sharing But Impaired Decoding of Contextual Complex Emotions in Alcohol Dependence

BACKGROUND

Prior research has repeatedly shown that alcohol dependence is associated with a large range of impairments in psychological processes, which could lead to interpersonal deficits. Specifically, it has been suggested that these interpersonal difficulties are underpinned by reduced recognition and sharing of others' emotional states. However, this pattern of deficits remains to be clarified. This study thus aimed to investigate whether alcohol dependence is associated with impaired abilities in decoding contextual complex emotions and with altered sharing of others' emotions.

METHODS

Forty-one alcohol-dependent individuals (ADI) and 37 matched healthy individuals completed the Multifaceted Empathy Test, in which they were instructed to identify complex emotional states expressed by individuals in contextual scenes and to state to what extent they shared them.

RESULTS

Compared to healthy individuals, ADI were impaired in identifying negative (Cohen's d = 0.75) and positive (Cohen's d = 0.46) emotional states but, conversely, presented preserved abilities in sharing others' emotional states.

CONCLUSIONS

This study shows that alcohol dependence is characterized by an impaired ability to decode complex emotional states (both positive and negative), despite the presence of complementary contextual cues, but by preserved emotion-sharing. Therefore, these results extend earlier data describing an impaired ability to decode noncontextualized emotions toward contextualized and ecologically valid emotional states. They also indicate that some essential emotional competences such as emotion-sharing are preserved in alcohol dependence, thereby offering potential therapeutic levers.

Theory of Mind in Substance Users: A Systematic Minireview

BACKGROUND

Theory of mind concerns the sociocognitive ability to infer others' thoughts. It has been theorized to be impaired in substance use and abuse, as its alterations might explain negative social and interpersonal outcomes noted in the course of disorders. In addition, the brain structures involved in Theory of Mind (ToM) have been found to be disrupted in drug use conditions.

OBJECTIVE

We undertook a systematic review of ToM functioning in drug use conditions.

METHODS

Four electronic databases (MEDLINE, Web of Science, PsycINFO, and Embase) were searched to find studies that have addressed ToM and conditions related to actual or previous drug use.

RESULTS

The search found 147 papers, of which 14 fulfilled our review eligibility criteria. Different methods were used, but overall, results indicated that drugs are related to ToM deficits, particularly related to alcohol and amphetamines use. These impairments correlate with other clinical and cognitive functions.

CONCLUSION

Despite the lack of studies and the methodological limitations of the existing ones Theory of Mind seems to play a role in drug use conditions, which requires further investigation.

Brain responses to emotional salience and reward in alcohol use disorder

Heightened neural responsiveness of alcoholics to alcohol cues and social emotion may impede sobriety. To test mesocorticolimbic network responsivity, 10 (8 men) alcohol use disorder (AUD) patients sober for 3 weeks to 10 months and 11 (8 men) controls underwent fMRI whilst viewing pictures of alcohol and non-alcohol beverages and of emotional faces (happy, sad, angry). AUD and controls showed similarities in mesocorticolimbic activity: both groups activated fusiform for emotional faces and hippocampal and pallidum regions during alcohol picture processing. In AUD, less fusiform activity to emotional faces and more pallidum activity to alcohol pictures were associated with longer sobriety. Using graph theory-based network efficiency measures to specify the role of the mesocorticolimbic network nodes for emotion and reward in sober AUD revealed that the left hippocampus was less efficiently connected with the other task-activated network regions in AUD than controls when viewing emotional faces, while the pallidum was more efficiently connected when viewing alcohol beverages. Together our findings identified lower occipito-temporal sensitivity to emotional faces and enhanced striatal sensitivity to alcohol stimuli in AUD than controls. Considering the role of the striatum in encoding reward, its activation enhancement with longer sobriety may reflect adaptive neural changes in the first year of drinking cessation and mesocorticolimbic system vulnerability for encoding emotional salience and reward potentially affecting executive control ability and relapse propensity during abstinence.

Empatia e reconhecimento de expressões faciais de emoções básicas e complexas em estudantes de Medicina

RESUMO Objetivo Avaliar a empatia e a capacidade de reconhecimento de emoções básicas e complexas e suas correlações em estudantes de Medicina. Métodos O desenho do estudo foi transversal. Foram avaliados 86 alunos do 3º e 4º ano do curso de Medicina de uma faculdade de Medicina do interior do estado de São Paulo com os seguintes instrumentos: (i) escala Jefferson de empatia, (ii) tarefa de Reconhecimento de Expressões Faciais de emoções básicas (REF) e (iii) Reading the mind in the eyes test (RMEt). Resultados A média geral de acertos no REF foi 15,6 (DP: ±2,3). Houve diferença estatisticamente significante no número de acertos da emoção tristeza no sexo feminino comparado com o masculino (t84 = 2,30; p = 0,02). Em relação ao RMEt, a média geral de acertos foi de 26,5 (DP: ±3,3) com diferença estatisticamente significante entre os gêneros com maior número de acertos entre as estudantes do sexo feminino (t84 = 3,43; p < 0,01). O escore total médio na escala de empatia foi 121,3 (DP: ±9,8). Houve correlação positiva fraca entre o escore total da escala de empatia e o número de acertos para a emoção tristeza (r = 0,29; p < 0,01). Conclusão O número de acertos para a emoção tristeza no REF e o escore total do RMEt foi maior no sexo feminino comparado com sexo masculino. Além disso, a empatia parece estar diretamente relacionada com a capacidade de reconhecer a emoção tristeza. Outros estudos parecem pertinentes para avaliar de forma mais profunda aspectos de empatia e reconhecimento de expressões faciais da emoção em estudantes de medicina.

Overactivation of the Pupillary Response to Emotional Information in Short- and Long-Term Alcohol Abstinent Patients

AIMS

The aim of the study was to compare emotional information processing in patients with severe alcohol use disorder in short-term abstinence (<1 month) and long-term abstinence (at least 6 months to 9 years) with control participants.

METHODS

We studied the variation in pupil diameter during the presentation of pictures of human interactions associated with positive, negative or neutral valences.

RESULTS

Overall, the results of the short-term abstinent group revealed greater pupil dilation regardless of the valence of the pictures while the pupillary response of long-term abstainers did not differ from the control group. More specifically, according to each valence, the pupil response to neutral pictures was greater for both patient groups than for controls. For the long-term abstainers, a negative correlation was found between the length of abstinence and the pupillary response to emotional stimuli.

CONCLUSION

In long-term abstainers group, the high activation by neutral stimuli suggests however some difficulties in the processing of nonemotional stimuli, considered emotional ones and may constitute a potential relapse factor or the maintenance of addiction.