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Wang J, Zhang J, Xu P, Qian T, Tan S, Liang P. Is game-based therapy effective for treating cognitive deficits in adults with schizophrenia? Evidence from a randomized controlled trial. Transl Psychiatry 2024; 14:291. [PMID: 39013871 PMCID: PMC11252351 DOI: 10.1038/s41398-024-02920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 07/18/2024] Open
Abstract
Cognitive deficits in schizophrenia are a major contributor to poor functional outcomes and everyday functioning, making them a promising therapeutic target. Recent years have witnessed a dramatic increase in the use of digital interventions, such as game-based therapy, targeting various domains of cognition to treat mental disorders. Game-based digital interventions have been suggested to have therapeutic value in health care for people with schizophrenia. To support this idea, a novel, online training program (Komori Life) that targets cognitive deficits in schizophrenia was tested for feasibility of use and initial efficiency. Inpatients with schizophrenia were randomized to complete 20 sessions of either Komori Life (N = 40 completers) or treatment as usual (N = 40 completers). Cognitive and clinical assessments were performed at enrollment and after completion of the training intervention for all patients. In addition, 32 healthy volunteers were recruited as controls, and an eye-tracking paradigm was employed to assess attentional biases to emotional information before and after game intervention for all subjects. The results showed that there were no group differences in cognitive or clinical assessments at baseline between the two patient groups. After game training, there were still no group × time interactions on cognitive or clinical assessment scores. Regarding eye movement measurements, both patient groups showed increased attention to threatening stimuli compared to healthy controls in terms of attentional maintenance at baseline. After game training, the game training group revealed greater improvement in attentional bias towards threatening scenes (decreased percentage of total duration and percentage of total fixations towards threatening stimuli) relative to the treatment as usual group. Moreover, our results partially indicated that training effectiveness was associated with cognitive improvement and that heightened attentional maintenance to threats was associated with worse cognitive performance. This study provides initial evidence that a remote, online cognitive training program is feasible and effective in improving cognitive function in schizophrenia. This form of training may serve as a complementary therapy to existing psychiatric care. Clinical trial registration: the trial is registered at http://www.chictr.org.cn , identifier ChiCTR2100048403.
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Affiliation(s)
- Junkai Wang
- School of Psychology, Capital Normal University, Beijing, China
- Beijing Key Laboratory of Learning and Cognition, Beijing, China
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Jie Zhang
- Psychiatry Research Center, Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Peng Xu
- School of Psychology, Capital Normal University, Beijing, China
- Beijing Key Laboratory of Learning and Cognition, Beijing, China
| | | | - Shuping Tan
- Psychiatry Research Center, Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China.
| | - Peipeng Liang
- School of Psychology, Capital Normal University, Beijing, China.
- Beijing Key Laboratory of Learning and Cognition, Beijing, China.
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Navalón P, Serrano E, Almansa B, Perea M, Benavent P, Domínguez A, Sierra P, Cañada Y, García-Blanco A. Attentional biases to emotional scenes in schizophrenia: An eye-tracking study. Biol Psychol 2021; 160:108045. [PMID: 33581230 DOI: 10.1016/j.biopsycho.2021.108045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 12/31/2022]
Abstract
Attentional biases to emotional information may play a key role in the onset and course of schizophrenia. The aim of this experiment was to examine the attentional processing of four emotional scenes in competition (happy, neutral, sad, threatening) in 53 patients with schizophrenia and 51 controls. The eye movements were recorded in a 20-seconds free-viewing task. The results were: (i) patients showed increased attention on threatening scenes, compared to controls, in terms of attentional engagement and maintenance; (ii) patients payed less attention to happy scenes than controls, in terms of attentional maintenance; (iii) whereas positive symptoms were associated with a late avoidance of sad scenes, negative symptoms were associated with heightened attention to threat. The findings suggest that a threat-related bias and a lack of sensitivity to positive information may represent an underlying psychological mechanism of schizophrenia. Importantly, schizophrenia symptoms modulated the attentional biases, which has aetiological and therapeutic implications.
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Affiliation(s)
- Pablo Navalón
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain; Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Elena Serrano
- Department of Psychology, University of Valencia, Valencia, Spain
| | - Belén Almansa
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain; Department of Psychology, University of Valencia, Valencia, Spain
| | - Manuel Perea
- Department of Psychology, University of Valencia, Valencia, Spain; Nebrija University, Madrid, Spain
| | - Pilar Benavent
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Alberto Domínguez
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pilar Sierra
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Yolanda Cañada
- Department of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Ana García-Blanco
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain; Department of Psychology, University of Valencia, Valencia, Spain.
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Visser KF, Esfahlani FZ, Sayama H, Strauss GP. An ecological momentary assessment evaluation of emotion regulation abnormalities in schizophrenia. Psychol Med 2018; 48:2337-2345. [PMID: 29361997 DOI: 10.1017/s0033291717003865] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prior studies using self-report questionnaires and laboratory-based methods suggest that schizophrenia is characterized by abnormalities in emotion regulation (i.e. using strategies to increase or decrease the frequency, duration, or intensity of negative emotion). However, it is unclear whether these abnormalities reflect poor emotion regulation effort or adequate effort, but limited effectiveness. It is also unclear whether dysfunction results primarily from one of the three stages of the emotion regulation process: identification, selection, or implementation. METHOD The current study used ecological momentary assessment (EMA) to address these questions in the context of everyday activities. Participants included 28 outpatients diagnosed with schizophrenia (SZ) and 28 demographically matched healthy controls (CN) who completed 6 days of EMA reports of in-the-moment emotional experience, emotion regulation strategy use, and context. RESULTS Results indicated that SZ demonstrated adequate emotion regulation effort, but poor effectiveness. Abnormalities were observed at each of the three stages of the emotion regulation process. At the identification stage, SZ initiated emotion regulation efforts at a lower threshold of negative emotion intensity. At the selection stage, SZ selected more strategies than CN and strategies attempted were less contextually appropriate. At the implementation stage, moderate to high levels of effort were ineffective at decreasing negative emotion. CONCLUSIONS Findings suggest that although SZ attempt to control their emotions using various strategies, often applying more effort than CN, these efforts are unsuccessful; emotion regulation abnormalities may result from difficulties at the identification, selection, and implementation stages.
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Affiliation(s)
| | | | - Hiroki Sayama
- Department of Systems Science and Industrial Engineering,Binghamton University,NY,USA
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Jang SK, Park SC, Lee SH, Cho YS, Choi KH. Attention and memory bias to facial emotions underlying negative symptoms of schizophrenia. Cogn Neuropsychiatry 2016; 21:45-59. [PMID: 26786812 DOI: 10.1080/13546805.2015.1127222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION This study assessed bias in selective attention to facial emotions in negative symptoms of schizophrenia and its influence on subsequent memory for facial emotions. METHODS Thirty people with schizophrenia who had high and low levels of negative symptoms (n = 15, respectively) and 21 healthy controls completed a visual probe detection task investigating selective attention bias (happy, sad, and angry faces randomly presented for 50, 500, or 1000 ms). A yes/no incidental facial memory task was then completed. Attention bias scores and recognition errors were calculated. RESULTS Those with high negative symptoms exhibited reduced attention to emotional faces relative to neutral faces; those with low negative symptoms showed the opposite pattern when faces were presented for 500 ms regardless of the valence. Compared to healthy controls, those with high negative symptoms made more errors for happy faces in the memory task. Reduced attention to emotional faces in the probe detection task was significantly associated with less pleasure and motivation and more recognition errors for happy faces in schizophrenia group only. CONCLUSIONS Attention bias away from emotional information relatively early in the attentional process and associated diminished positive memory may relate to pathological mechanisms for negative symptoms.
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Affiliation(s)
- Seon-Kyeong Jang
- a Department of Psychology , Korea University , Seoul , Republic of Korea.,b Clinical Emotion and Cognition Research Laboratory , Goyang-si , Republic of Korea
| | - Seon-Cheol Park
- c Department of Psychiatry , Yong-In Mental Hospital , Yongin-si , Republic of Korea
| | - Seung-Hwan Lee
- b Clinical Emotion and Cognition Research Laboratory , Goyang-si , Republic of Korea.,d Department of Psychiatry , Inje University Ilsan Paik Hospital , Goyang-si , Republic of Korea
| | - Yang Seok Cho
- a Department of Psychology , Korea University , Seoul , Republic of Korea
| | - Kee-Hong Choi
- a Department of Psychology , Korea University , Seoul , Republic of Korea
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Earls HA, Curran T, Mittal V. Deficits in Early Stages of Face Processing in Schizophrenia: A Systematic Review of the P100 Component. Schizophr Bull 2016; 42:519-27. [PMID: 26175474 PMCID: PMC4753590 DOI: 10.1093/schbul/sbv096] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Schizophrenia is associated with deficits in face and affect recognition, which contribute to broader social functioning deficits. The present aim was to conduct a meta-analysis of early face processing in schizophrenia, as indexed by the P100 event-related potential component. METHODS Twelve studies (n = 328 patients with schizophrenia, n = 330 healthy controls) of the P100 component during face processing were evaluated by calculating Cohen's d for each study and overall weighted mean effect size (ES). In additional exploratory analyses, moderating influences of method and design were investigated, and the P100 component during face processing was evaluated based on valence: 5 studies (n = 225 patients, n = 225 controls) included neutral stimuli, 5 studies (n = 225 patients, n = 225 controls) included happy stimuli, and 4 studies (n = 209 patients, n = 209 controls) included fearful stimuli. RESULTS The amplitude of the P100 to face stimuli was smaller in patients relative to controls (ES = .41, P < .01). Methodological or design differences did not account for heterogeneity in ES. When split by valence, results indicate smaller P100 in patients relative to control subjects in response to neutral (ES = .32, P < .001) and happy (ES = .21, P < .05) stimuli, whereas there was no difference in response to fearful faces (ES = .09, P > .05). DISCUSSION The results indicate that P100 amplitude in response to faces is smaller in patients with schizophrenia, showing that socially relevant visual processing deficits begin earlier in processing than previously suggested. Additionally, the exploratory analyses suggest emotional specificity in these deficits. Ramifications for our understanding of face processing deficits and treatment development are discussed.
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Affiliation(s)
- Holly A. Earls
- Department of Psychology and Neuroscience, Center for Neuroscience,University of Colorado Boulder, Boulder, CO;,*To whom correspondence should be addressed; Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Boulder, CO 22904, US; tel: +1-303-735-5288, fax: +1-303-492-2967, e-mail:
| | - Tim Curran
- Department of Psychology and Neuroscience, Center for Neuroscience,University of Colorado Boulder, Boulder, CO
| | - Vijay Mittal
- Department of Psychology, Northwestern University, Evanston, IL
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Wang D, Zhou Y, Zhuo C, Qin W, Zhu J, Liu H, Xu L, Yu C. Altered functional connectivity of the cingulate subregions in schizophrenia. Transl Psychiatry 2015; 5:e575. [PMID: 26035059 PMCID: PMC4490280 DOI: 10.1038/tp.2015.69] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/06/2015] [Accepted: 04/23/2015] [Indexed: 01/21/2023] Open
Abstract
Schizophrenia patients have shown altered resting-state functional connectivity (rsFC) of the cingulate cortex; however, it is unknown whether rsFCs of the cingulate subregions are differentially affected in this disorder. We aimed to clarify the issue by comparing rsFCs of each cingulate subregion between healthy controls and schizophrenia patients. A total of 102 healthy controls and 94 schizophrenia patients underwent resting-state functional magnetic resonance imaging with a sensitivity-encoded spiral-in imaging sequence to reduce susceptibility-induced signal loss and distortion. The cingulate cortex was divided into nine subregions, including the subgenual anterior cingulate cortex (ACC), areas 24 and 32 of the pregenual ACC, areas 24 and 32 of the anterior mid-cingulate cortex (aMCC), posterior MCC (pMCC), dorsal (dPCC) and ventral (vPCC) posterior cingulate cortex (PCC) and retrosplenial cortex (RSC). The rsFCs of each cingulate subregion were compared between the two groups and the atrophy effect was considered. Results with and without global signal regression were reported. Most cingulate subregions exhibited decreased rsFCs in schizophrenia after global signal regression (GSR). Without GSR, only increased rsFC was found in schizophrenia, which primarily restricted to the aMCC, PCC and RSC. Some of these increased rsFCs were also significant after GSR. These findings suggest that GSR can greatly affect between-group differences in rsFCs and the consistently increased rsFCs may challenge the functional disconnection hypothesis of schizophrenia.
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Affiliation(s)
- D Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Y Zhou
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - C Zhuo
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Anding Hospital (Tianjin Mental Health Center), Tianjin, China
- Tianjin Anning Hospital, Tianjin, China
| | - W Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - J Zhu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - H Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - L Xu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - C Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China. E-mail:
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Walsh-Messinger J, Ramirez PM, Wong P, Antonius D, Aujero N, McMahon K, Opler LA, Malaspina D. Impairment in emotional modulation of attention and memory in schizophrenia. Schizophr Res 2014; 157:63-9. [PMID: 24910446 PMCID: PMC4098815 DOI: 10.1016/j.schres.2014.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 05/01/2014] [Accepted: 05/08/2014] [Indexed: 11/18/2022]
Abstract
Emotion plays a critical role in cognition and goal-directed behavior via complex interconnections between the emotional and motivational systems. It has been hypothesized that the impairment in goal-directed behavior widely noted in schizophrenia may result from defects in the interaction between the neural (ventral) emotional system and (rostral) cortical processes. The present study examined the impact of emotion on attention and memory in schizophrenia. Twenty-five individuals with schizophrenia related psychosis and 25 healthy control subjects were administered a computerized task in which they were asked to search for target images during a Rapid Serial Visual Presentation of pictures. Target stimuli were either positive or negative, or neutral images presented at either 200ms or 700ms lag. Additionally, a visual hedonic task was used to assess differences between the schizophrenia group and controls on ratings of valence and arousal from the picture stimuli. Compared to controls, individuals with schizophrenia detected fewer emotional images under both the 200ms and 700ms lag conditions. Multivariate analyses showed that the schizophrenia group also detected fewer positive images under the 700ms lag condition and fewer negative images under the 200ms lag condition. Individuals with schizophrenia reported higher pleasantness and unpleasantness ratings than controls in response to neutral stimuli, while controls reported higher arousal ratings for neutral and positive stimuli compared to the schizophrenia group. These results highlight dysfunction in the neural modulation of emotion, attention, and cortical processing in schizophrenia, adding to the growing but mixed body of literature on emotion processing in the disorder.
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Affiliation(s)
- Julie Walsh-Messinger
- Department of Psychology, Long Island University, Brooklyn, NY, United States; InSPIRES, Department of Psychiatry, NYU School of Medicine, New York, NY, United States.
| | | | - Philip Wong
- Department of Psychology, Long Island University, Brooklyn, NY, United States
| | - Daniel Antonius
- InSPIRES, Department of Psychiatry, NYU School of Medicine, New York, NY, United States; University at Buffalo, State University of NY, Buffalo, NY, United States; Erie County Forensic Mental Health Services, Buffalo, NY, United States
| | - Nicole Aujero
- InSPIRES, Department of Psychiatry, NYU School of Medicine, New York, NY, United States
| | - Kevin McMahon
- InSPIRES, Department of Psychiatry, NYU School of Medicine, New York, NY, United States
| | - Lewis A Opler
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Dolores Malaspina
- InSPIRES, Department of Psychiatry, NYU School of Medicine, New York, NY, United States; Creedmoor Psychiatric Center, NY State Office of Mental Health, Queens, NY, United States
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Heim S, Benasich AA, Keil A. Distraction by emotion in early adolescence: affective facilitation and interference during the attentional blink. Front Psychol 2013; 4:580. [PMID: 24027547 PMCID: PMC3759785 DOI: 10.3389/fpsyg.2013.00580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/12/2013] [Indexed: 11/25/2022] Open
Abstract
This study examined the extent to which early adolescents (aged 10–13 years) differ from adults in their sensitivity to attention capture by affective stimuli during rapid processing. A rapid serial visual presentation paradigm (RSVP) was implemented as a dual task, requiring the report of two green target stimuli embedded in a stream of distractors. Known as the “attentional blink” (AB), task performance is typically impaired when the first and second targets (T1 and T2, respectively) are separated by at least one distractor and about 200 ms of time. Here we used written verbs of pleasant, neutral, and unpleasant content as T1 items, while affectively neutral exemplars served as T2 and distractor events. The temporal distance between T1 and T2 was manipulated to contain either one distractor (intertarget interval 232 ms) or five distractors (intertarget interval 696 ms). Students reported pleasant T1 words more accurately, compared to neutral and unpleasant words, indicating facilitation of appetitive content on performance during RSVP. Emotional relevance of T1 was at the expense of T2 accuracy: at an intertarget interval of 232 ms (i.e., during the AB period), identification of (neutral) T2 words was impaired when preceded by pleasant and unpleasant T1s. No interference across targets was observed, however, beyond the blink period, in which T1 and T2 were separated by 696 ms. Thus, emotionally relevant events capture and hold attentional resources, at the cost of attentive processing in subsequent episodes. Contrary to our findings in adults, these capture effects were most obvious when the available capacity was limited, i.e., during the critical interval of the AB. The findings are discussed in light of the use of alternative cognitive strategies as development proceeds beyond early adolescence into adulthood.
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Affiliation(s)
- Sabine Heim
- Infancy Studies Laboratory, Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey Newark, NJ, USA
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Affiliation(s)
- Gregory P. Strauss
- *To whom correspondence should be addressed; Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228; tel: +1-410-402-6104, fax: +1-410-402-7198,
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