Effects of Training of Affect Recognition on the recognition and visual exploration of emotional faces in schizophrenia

The relationship between empathy, theory of mind and facial affect recognition in schizophrenia patients

Although impairments in social cognition are a core feature in schizophrenia, the relationship between its subcomponents is less clear. Nineteen schizophrenia patients and 20 matched healthy controls were tested for emotion recognition, and for the cognitive and affective subcomponents of empathy and theory of mind (ToM). Patients scored significantly worse than controls on cognitive empathy and both subcomponents of ToM. Group differences disappeared for cognitive empathy and affective ToM when emotion recognition was included as a covariate. Our results indicate that emotion recognition is an important factor involved in the deficits on higher levels of social cognition in schizophrenia.

Calling on clinicians to get social and emotional

OBJECTIVE

Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning.

METHOD

In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests.

RESULTS

In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments.

CONCLUSION

We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.

Effect of emotional awareness skills training on emotional awareness and communication skills in patients with schizophrenia: A Randomized Controlled Trial

PURPOSE

This study was conducted to examine the effect of emotional awareness skills training on emotional awareness and communication skills in patients with schizophrenia.

METHODS

This randomized controlled trial was conducted with 44 patients with schizophrenia (22 in the intervention group and 22 in the control group) registered at a community mental health center. The personal information form, Toronto Alexithymia Scale (TAS-20), and communication skills scale-adult form were used to collect patient data. The emotional awareness skills training was implemented once a week for 8 weeks.

RESULTS

After the training, the mean scores of the "Difficulty Identifying Feelings" and "Difficulty Describing Feelings" subscales of TAS-20 decreased and the mean scores of the communication skills scale-adult form increased in the intervention group; the difference between the groups was statistically significant. While there was no difference between the groups in the initial measurements, a significant difference was found between the mean scores of "Difficulty Identifying Feelings" and "Difficulty Describing Feelings" in the intervention group and a significant difference was found in both groups between the subscales of "Basic Skills and Personal (Self) Expression", "Willingness to Communicate", "Caring Communication" and "Active Listening and Non-Verbal Communication" and the total mean score after the intervention.

CONCLUSION

Based on the study results, it can be concluded that emotional awareness skills training is an effective psychiatric nursing intervention that improves emotional awareness and communication skills. NCT05038927.

Social Cognition and Interaction Training (SCIT) versus Training in Affect Recognition (TAR) in patients with schizophrenia: A randomized controlled trial

INTRODUCTION

Training in Affect Recognition (TAR) is a "targeted" and computer-aided program that has been shown to effectively attenuate facial affect recognition deficits and improve social functioning in patients with schizophrenia. Social Cognition and Interaction Training (SCIT) is a group "broad-based" intervention, that has also been shown to improve emotion recognition, theory of mind (ToM), and social functioning. To date, no study has compared the efficacy of two different social cognitive interventions.

OBJECTIVES

We aim to compare the efficacy of TAR and SCIT on schizophrenia patients' performance on facial affect recognition, theory of mind, attributional style and social functioning before, after treatment, and three months thereafter.

METHODS

One hundred outpatients with a diagnosis of schizophrenia were randomly assigned to the TAR or SCIT condition and completed pre- (T0) and posttreatment (T1) assessments and a 3-month follow up (T2) of emotion recognition (ER-40), theory of mind (Hinting Task), attributional style (AIHQ) and social functioning (PSP).

RESULTS

The entire sample, receiving TAR or SCIT, showed improvements in theory of mind, attributional style, clinical symptoms and social functioning. This effect was maintained at three-months. The TAR intervention was more efficacious than the SCIT program in improving the recognition of facial emotions (ER-40). The TAR intervention also demonstrated a lower drop-out rate than the SCIT intervention.

CONCLUSIONS

There were improvements in social cognition, symptomatology and functioning of patients in the entire sample, receiving SCIT or TAR. Both TAR and SCIT appear as valuable treatments for people with schizophrenia and social cognitive deficits.

An evaluation of a psychoeducation programme for emotion identification and expression in individuals diagnosed with schizophrenia

The inability of individuals diagnosed with schizophrenia to recognize facial expressions is an important issue that has an impact on social functioning. This study was conducted to determine the effects of a psychoeducation programme for emotion identification and expression in those diagnosed with schizophrenia on their ability to identify and discriminate between emotions and social functionality. This quasi-experimental study (pretest-post-test, with control group) comprised an intervention (21) and a control (21) group conducted with individuals diagnosed with schizophrenia. A 10-week psychoeducation programme was offered to the intervention group. Measuring instruments were administered to the groups before the intervention, after the intervention, and 3 months after that. The measuring instruments consisted of a personal information form, the Facial Emotion Identification Test, Facial Emotion Discrimination Test, and Personal and Social Performance Scale. The data were analysed using the 'two-way repeated measures analysis of variance'. The TREND method was used for reporting. In the first measurements taken after the psychoeducation programme, a significant difference was found between the two groups in terms of their 'Facial Emotion Identification Test' and 'Personal and Social Performance Scale' mean scores. In the measurements taken 3 months after the psychoeducation programme, this difference had disappeared. The psychoeducation programme is an effective programme that makes recognition of facially expressed emotions possible and increases the social functioning of patients.

Free viewing exploration in schizophrenia: Review of evidence from laboratory settings to natural environment

Several studies have investigated visual processing impairment in schizophrenia. The literature on visual exploration has described restricted scanning in schizophrenia patients. This gaze behavior is characterized by increased fixation duration, a reduced scan path length and avoidance of salient features of the face with emotional content. The aim of this paper is to give an insight on the latest update on scan path deficit. Abnormal gaze exploration was replicated in various visual stimuli. This review describes gaze patterns with stimuli that imply minimal to high cognitive process: figures, objects, faces, and scenes. Interestingly, schizophrenia patients have shown cognitive flexibility by modulating gaze scanning when they are involved in an active assignment. We will also consider scanning abnormalities in real-life environment and discuss the potential therapeutic use of eye tracking in schizophrenia. The therapeutic application of eye tracking in schizophrenia is a young emerging field in psychiatry research. The recent remediation program is based on the reorientation of visual attention on the salient features of faces. For now, this program has shown encouraging results. Further studies are needed to explore behavior in real-world situations to complement laboratory measurements to move toward a full understanding of the mechanisms underlying atypical scanning in patients with schizophrenia.

Extraction of Emotional Information via Visual Scanning Patterns: A Feasibility Study of Participants with Schizophrenia and Neurotypical Individuals

Emotion recognition impairment is a core feature of schizophrenia (SZ), present throughout all stages of this condition, and leads to poor social outcome. However, the underlying mechanisms that give rise to such deficits have not been elucidated and hence, it has been difficult to develop precisely targeted interventions. Evidence supports the use of methods designed to modify patterns of visual attention in individuals with SZ in order to effect meaningful improvements in social cognition. To date, however, attention-shaping systems have not fully utilized available technology (e.g., eye tracking) to achieve this goal. The current work consisted of the design and feasibility testing of a novel gaze-sensitive social skills intervention system called MASI-VR. Adults from an outpatient clinic with confirmed SZ diagnosis (n=10) and a comparison sample of neurotypical participants (n=10) were evaluated on measures of emotion recognition and visual attention at baseline assessment, and a pilot test of the intervention system was evaluated on the SZ sample following five training sessions over three weeks. Consistent with the literature, participants in the SZ group demonstrated lower recognition of faces showing medium intensity fear, spent more time deliberating about presented emotions, and had fewer fixations in comparison to neurotypical peers. Furthermore, participants in the SZ group showed significant improvement in the recognition of fearful faces post-training. Preliminary evidence supports the feasibility of a gaze-sensitive paradigm for use in assessment and training of emotion recognition and social attention in individuals with SZ, thus warranting further evaluation of the novel intervention.

Social cognitive interventions for people with schizophrenia: A systematic review

Social cognition is the mental process which underpins social interactions. Increasingly, it has been recognized to be impaired in people with schizophrenia, resulting in functional problems. Correspondingly, the past ten years have seen huge developments in the study of interventions to ameliorate social cognitive deficits among people with schizophrenia. In the present review, we systematically reviewed published studies on social cognitive interventions from 2005 to 2015. Of the 61 studies included in this review, 20 were on broad-based social cognitive interventions, which incorporated neurocognitive training, specialized learning technique or virtual reality social skills training. On the other hand, 31 studies on targeted interventions either focused on specific social cognitive domains, or a range of domains. Improvements in emotion processing and theory of mind were often reported, while social perception and attributional style were less frequently measured. Both broad-based and targeted interventions achieved gains in social functioning, albeit inconsistently. Lastly, nine studies on the use of oxytocin and one study on transcranial direct current stimulation reported positive preliminary results in higher-order cognition and facial affect recognition respectively. This review revealed that a wide range of social cognitive interventions is currently available and most have shown some promise in improving social cognition outcomes. However, there is a need to use a common battery of measurements for better comparisons across interventions. Future research should examine combination therapies and the sustainability of gains beyond the intervention period.

Objective assessment of exploratory behaviour in schizophrenia using wireless motion capture

Motivation deficits are a prominent feature of schizophrenia and have substantial consequences for functional outcome. The impact of amotivation on exploratory behaviour has not been extensively assessed by entirely objective means. This study evaluated deficits in exploratory behaviour in an open-field setting using wireless motion capture. Twenty-one stable adult outpatients with schizophrenia and twenty matched healthy controls completed the Novelty Exploration Task, in which participants explored a novel environment containing familiar and uncommon objects. Objective motion data were used to index participants' locomotor activity and tendency for visual and tactile object exploration. Clinical assessments of positive and negative symptoms, apathy, cognition, depression, medication side-effects, and community functioning were also administered. Relationships between task performance and clinical measures were evaluated using Spearman correlations, and group differences were evaluated using multivariate analysis of covariance tests. Although locomotor activity and tactile exploration were similar between the schizophrenia and healthy control groups, schizophrenia participants exhibited reduced visual object exploration (F(2,35)=3.40, p=0.045). Further, schizophrenia participants' geometric pattern of locomotion, visual exploration, and tactile exploration were correlated with overall negative symptoms (|ρ|=0.46-0.64, p<=0.039) and apathy (|ρ|=0.49-0.62, p<=0.028), and both visual and tactile exploration were also correlated with community functioning (|ρ|=0.46-0.48, p<=0.043). The Novelty Exploration Task may be a valuable tool to quantify exploratory behaviour beyond what is captured through standard clinical instruments and human observer ratings. Findings from this initial study suggest that locomotor activity and object interaction tendencies are impacted by motivation, and reveal deficits specifically in visual exploration in schizophrenia.

An accurate emotion recognition system using ECG and GSR signals and matching pursuit method

Background

The purpose of the current study was to examine the effectiveness of Matching Pursuit (MP) algorithm in emotion recognition.

Methods

Electrocardiogram (ECG) and galvanic skin responses (GSR) of 11 healthy students were collected while subjects were listening to emotional music clips. Applying three dictionaries, including two wavelet packet dictionaries (Coiflet, and Daubechies) and discrete cosine transform, MP coefficients were extracted from ECG and GSR signals. Next, some statistical indices were calculated from the MP coefficients. Then, three dimensionality reduction methods, including Principal Component Analysis (PCA), Linear Discriminant Analysis, and Kernel PCA were applied. The dimensionality reduced features were fed into the Probabilistic Neural Network in subject-dependent and subject-independent modes. Emotion classes were described by a two-dimensional emotion space, including four quadrants of valence and arousal plane, valence based, and arousal based emotional states.

Results

Using PCA, the highest recognition rate of 100% was achieved for sigma = 0.01 in all classification schemes. In addition, the classification performance of ECG features was evidently better than that of GSR features. Similar results were obtained for subject-dependent emotion classification mode.

Conclusions

An accurate emotion recognition system was proposed using MP algorithm and wavelet dictionaries.

Randomized Clinical Trial with e-MotionalTraining® 1.0 for Social Cognition Rehabilitation in Schizophrenia

BACKGROUND

Schizophrenia patients present deficits in social cognition (SC), emotion and social perception, theory of mind (ToM), and attributional style. This study tested the efficacy, in real clinical conditions, of a online self-training program in SC, e-Motional Training^®, in comparison with treatment as usual.

METHOD

A randomized single-blinded multicenter clinical trial was conducted with 60 schizophrenia stable outpatients. All patients (control and intervention) were treated with drug therapy, case management, and individual and group psychotherapy (not focused on SC). Intervention group was treated with e-Motional Training^®, an online program devised for SC rehabilitation.

STATISTICAL ANALYSIS

A descriptive analysis and parametric/non-parametric tests were used to compare both groups at baseline. Analysis of covariance was used to compared post-pre changes in SC between the two interventions. If the group effect was significant, follow-up univariate test (t-test for dependent samples) was carried out in each group to verify whether the effect was due to improvement in the intervention group or deterioration in the control group. We considered statistically significant differences with P < 0.05.

RESULTS

Significant improvements were obtained in the intervention group in emotion recognition and most ToM variables in comparison with the control group.

DISCUSSION

e-Motional Training^® seems to be a promising online training tool for SC deficits in schizophrenia, covering the lack of similar intervention instruments in our community.

The Importance of Social Cognition in Improving Functional Outcomes in Schizophrenia

Social cognition has become recognized as an important driver of functional outcomes and overall recovery in patients with schizophrenia, mediating the relationship between neurocognition and social functioning. Since antipsychotic therapy targeting remission of clinical symptoms has been shown to have a limited impact on social cognition, there has been an increasing drive to develop therapeutic strategies to specifically improve social cognition in schizophrenia. We sought to review current evidence relating to social cognition in schizophrenia and its clinical implications, including interventions designed to target the core domains of social cognition (emotion processing, theory of mind, attributional bias, and social perception) as a means of improving functional outcomes and thereby increasing the likelihood of recovery. Relevant articles were identified by conducting a literature search in PubMed using the search terms "schizophrenia" AND "cognition" AND "social functioning," limited to Title/Abstract, over a time period of the past 10 years. Current evidence demonstrates that schizophrenia is associated with impairments in all four core domains of social cognition, during the pre-first-episode, first-episode, early, and chronic phases of the disease, and that such impairments are important determinants of functional outcome. Interventions targeting the four core domains of social cognition comprise psychosocial approaches (social cognition training programs) and pharmacological therapies. Social cognition training programs targeting multiple and specific core domains of social cognition have shown promise in improving social cognition skills, which, in some cases, has translated into improvements in functional outcomes. Use of some psychosocial interventions has additionally resulted in improvements in clinical symptoms and/or quality of life. Pharmacological therapies, including oxytocin and certain antipsychotics, have yielded more mixed results, due in part to the confounding impact of factors including variation in receptor genetics, bioavailability, pharmacokinetics, and drug-drug interactions, and inconsistencies between study designs and medication dosages. Additional research is required to advance our understanding of the role of social cognition in schizophrenia, and to further establish the utility of targeted interventions in this setting.

The feasibility and clinical benefits of improving facial affect recognition impairments in schizophrenia: Systematic review and meta-analysis

BACKGROUND

People diagnosed with schizophrenia have significant difficulty accurately recognising emotions expressed by others. This may generate anomalous experiences which, if misinterpreted, could contribute to experiences of social defeat, psychotic symptoms and reduced social functioning. It remains unclear whether this impairment is responsive to non-pharmacological intervention, or what the effect of modifying it is.

METHODS

We did a systematic review and meta-analysis to examine whether and to what extent facial affect recognition impairments can be improved by psychological intervention and, if so, whether this leads to improvements in psychotic symptoms and social functioning.

RESULTS

A total of 8 randomised controlled trials (RCTs) consisting of 300 participants were included. Focused yet brief psychological interventions led to very large improvements in facial affect recognition ability in psychosis [k=8, N=300, g=1.26, 95% Confidence Interval (CI) 0.92, 1.60, I² 41%]. Early evidence suggests this may cause large improvements in social functioning (k=3, N=109, g=0.98, 95% CI 0.37, 1.36, I² 38%), but not psychotic symptoms.

CONCLUSIONS

Facial affect recognition difficulties in schizophrenia are highly responsive to psychological interventions designed to improve them, and there is early evidence that this may lead to large gains in social functioning for this group - but not symptoms. A large-scale high-quality RCT with longer-term follow-up period is now required to overcome the limitations of the existing evidence.

Treatment Modifications and Suggestions to Address Visual Abnormalities in Body Dysmorphic Disorder

Recent psychophysical and neurocognitive findings implicate abnormal visual processing for a range of stimuli in body dysmorphic disorder (BDD); such abnormalities differentiate BDD from other mental health disorders. Current treatments most commonly involve cognitive behavior therapy with or without accompanying antidepressant medications. These are moderately successful yet appear to overlook the core phenomenological aspect of abnormal perception in BDD. The following text summarizes the current literature of perceptual abnormalities within BDD and how these findings may be applied and incorporated into treatment options. Possible modifications of cognitive behavioral therapy (CBT) based on the widespread visual abnormalities within BDD include making perceptual mirror retraining a compulsory component of therapy and implementing self-exposure tasks within exposure and response prevention. Alternative options such as a visual training program to remediate visual abnormalities across a range of visual stimuli are also explored, which may be included as an adjunctive treatment alongside CBT.

A NOVEL SIGNAL-BASED FUSION APPROACH FOR ACCURATE MUSIC EMOTION RECOGNITION

The objective of this study is to propose an accurate emotion recognition methodology. To this end, a novel fusion framework based on wavelet transform (WT), and matching pursuit (MP) algorithm was offered. Electrocardiogram (ECG) and galvanic skin response (GSR) of 11 healthy students were collected while subjects listened to emotional music clips. In both fusion techniques, Coiflet wavelet (Coif5 at level 14) was chosen as a wavelet family and MP dictionary, respectively. After employing the proposed fusion framework, some statistical measures were extracted. To describe emotions, three schemes were adopted: two-dimensional model (five classes), valence-(three classes), and arousal-(three classes) based emotion categories. Subsequently, the probabilistic neural network (PNN) was applied to classify affective states. The experiments indicate that the MP-based fusion approach outperform the wavelet-based fusion technique or methods using only ECG or GSR indices. Considering the proposed fusion techniques, the maximum classification rate of 99.64% and 92.31% was reached for the fusion methodology based on the MP algorithm (five classes of emotion) and wavelet-based fusion technique (three classes of valence), respectively.

Role of Gaze Cues in Interpersonal Motor Coordination: Towards Higher Affiliation in Human-Robot Interaction

Background

The ability to follow one another’s gaze plays an important role in our social cognition; especially when we synchronously perform tasks together. We investigate how gaze cues can improve performance in a simple coordination task (i.e., the mirror game), whereby two players mirror each other’s hand motions. In this game, each player is either a leader or follower. To study the effect of gaze in a systematic manner, the leader’s role is played by a robotic avatar. We contrast two conditions, in which the avatar provides or not explicit gaze cues that indicate the next location of its hand. Specifically, we investigated (a) whether participants are able to exploit these gaze cues to improve their coordination, (b) how gaze cues affect action prediction and temporal coordination, and (c) whether introducing active gaze behavior for avatars makes them more realistic and human-like (from the user point of view).

Methodology/Principal Findings

43 subjects participated in 8 trials of the mirror game. Each subject performed the game in the two conditions (with and without gaze cues). In this within-subject study, the order of the conditions was randomized across participants, and subjective assessment of the avatar’s realism was assessed by administering a post-hoc questionnaire. When gaze cues were provided, a quantitative assessment of synchrony between participants and the avatar revealed a significant improvement in subject reaction-time (RT). This confirms our hypothesis that gaze cues improve the follower’s ability to predict the avatar’s action. An analysis of the pattern of frequency across the two players’ hand movements reveals that the gaze cues improve the overall temporal coordination across the two players. Finally, analysis of the subjective evaluations from the questionnaires reveals that, in the presence of gaze cues, participants found it not only more human-like/realistic, but also easier to interact with the avatar.

Conclusion/Significance

This work confirms that people can exploit gaze cues to predict another person’s movements and to better coordinate their motions with their partners, even when the partner is a computer-animated avatar. Moreover, this study contributes further evidence that implementing biological features, here task-relevant gaze cues, enable the humanoid robotic avatar to appear more human-like, and thus increase the user’s sense of affiliation.

Schizophrenia in 2020: Trends in diagnosis and therapy

Schizophrenia research is providing an increasing number of studies and important insights into the condition's etiopathogenesis based on genetic, neuropsychological and cranial neuroimaging studies. However, research progress has not yet led to the incorporation of such findings into the revised classification criteria of mental disorders or everyday clinical practice. By 2020, schizophrenia will most likely still be a clinically defined primary psychotic disorder. While there is some hope that treatment will be improved with new antipsychotic drugs, drugs addressing negative symptoms, more refined psychotherapy approaches and the introduction of new treatment modalities like transcranial magnetic stimulation, an additional hope is to improve early detection and prevention. As the results of new research into the etiopathogenesis of schizophrenia are promising to improve diagnosis, classification and therapy in the future, a picture of complex brain dysfunction is currently emerging requiring sophisticated mathematical methods of analysis. The imminent clinical challenge will be to develop comprehensive diagnostic and treatment modules individually tailored to the time-variable needs of patients and their families.

Training of Affect Recognition impacts electrophysiological correlates of facial affect recognition in schizophrenia: Analyses of fixation-locked potentials

OBJECTIVES

Training of Affect Recognition (TAR) is a useful approach to restoring cognitive function in schizophrenic patients. Along with improving visual exploration of faces and altering central information processing in relevant brain areas, TAR attenuates impairments in facial affect recognition. In the present study, we investigate the effects of TAR on early electrophysiological correlates of facial affect recognition in schizophrenia.

METHODS

The study population comprised 12 schizophrenic patients and 14 healthy controls. In each individual, we carried out EEG, concomitant measurements of scanning eye movements and fixation-based low resolution electromagnetic tomography (sLORETA) analyses of brain electric activity. All analyses were performed at baseline and after participation in TAR.

RESULTS

In patients, brain activation patterns significantly changed after completing the TAR. Functional improvements were particularly pronounced in the superior parietal and inferior parietal lobes, where trained patients showed a larger increase in activation than untrained healthy controls.

CONCLUSIONS

The TAR activates compensatory brain processes involved in the perception, attention and evaluation of emotional stimuli. This may underlie the established behavioral effects of the TAR in schizophrenic patients, which include improvements in facial affect recognition and alterations of visual exploration strategies.