The impact of facemasks on emotion recognition, trust attribution and re-identification

Duration of face mask exposure matters: evidence from Swiss and Brazilian kindergartners' ability to recognise emotions

Wearing facial masks became a common practice worldwide during the COVID-19 pandemic. This study investigated (1) whether facial masks that cover adult faces affect 4- to 6-year-old children's recognition of emotions in those faces and (2) whether the duration of children's exposure to masks is associated with emotion recognition. We tested children from Switzerland (N = 38) and Brazil (N = 41). Brazil represented longer mask exposure due to a stricter mandate during COVID-19. Children had to choose a face displaying a specific emotion (happy, angry, or sad) when the face wore either no cover, a facial mask, or sunglasses. The longer hours of mask exposure were associated with better emotion recognition. Controlling for the hours of exposure, children were less likely to recognise emotions in partially hideen faces. Moreover, Brazilian children were more accurate in recognising happy faces than Swiss children. Overall, facial masks may negatively impact children's emotion recognition. However, prolonged exposure appears to buffer the lack of facial cues from the nose and mouth. In conclusion, restricting facial cues due to masks may impair kindergarten children's emotion recognition in the short run. However, it may facilitate their broader reading of facial emotional cues in the long run.

Lesson learned from the COVID-19 pandemic: toddlers learn earlier to read emotions with face masks

In a prior study we demonstrated that the presence of face masks impairs the human capability of accurately inferring emotions conveyed through facial expressions, at all ages. The degree of impairment posed by face covering was notably more pronounced in children aged between three and five years old. In the current study, we conducted the same test as a follow-up after one year from the onset of the COVID-19 pandemic, when the requirement of wearing face masks was holding in almost all circumstances of everyday life when social interactions occur. The results indicate a noteworthy improvement in recognizing facial expressions with face masks among children aged three to five, compared to the pre-pandemic settings. These findings hold a significant importance, suggesting that toddlers effectively mitigated the social challenges associated with masks use: they overcame initial environmental limitations, improving their capability to interpret facial expressions even in the absence of visual cues from the lower part of the face.

Behind the mask: What the eyes can't tell: Facial emotion recognition in a sample of Italian health care students

Wearing a facemask remains a pivotal strategy to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection even after vaccination, but one of the possible costs of this protection is that it may interfere with the ability to read emotion in facial expressions. We explored the extent to which it may be more difficult for participants to read emotions in faces when faces are covered with masks than when they are not, and whether participants' empathy, attachment style, and patient-centred orientation would affect their performance. Medical and nursing students (N = 429) were administered either a masked or unmasked set of 24 adult faces depicting anger, sadness, fear, or happiness. Participants also completed self-report measures of empathy, patient-centredness, and attachment style. As predicted, participants made more errors to the masked than the unmasked faces with the exception of the identification of fear. Of note, when participants missed happiness, they were most likely to see it as sadness, and when they missed anger, they were most likely to see it as happiness. A multiple linear regression analysis showed that more errors identifying emotions in faces was associated with faces being masked as opposed to unmasked, lower scores on the empathy fantasy scale, and higher scores on the fearful attachment style. The findings suggest that wearing facemasks is associated with a variety of negative outcomes that might interfere with the building of positive relationships between health care workers and patients. Those who teach student health care workers would benefit from bringing this finding into their curriculum and training.

Communication challenges caused by wearing masks and strategies used by pediatric nurses during the COVID-19 pandemic: A qualitative study

PURPOSE

The COVID-19 pandemic and the use of facemasks have caused many communication challenges for pediatric nurses. The purpose of this study was to investigate these challenges and the strategies that nurses use to overcome them during the nursing care of sick children.

DESIGN AND METHODS

This was a qualitative study using conventional content analysis. The nurses were selected by purpose-based sampling and interviewed semi-structurally between April and June 2023 at the Children's Educational Therapy Center in Tabriz, Iran. The sample size was determined by the data saturation principle. The report of this research followed the COREQ guidelines.

RESULTS

Twelve nurses were interviewed. The analysis revealed four main categories: "Disturbances in communication", "Disturbances in trust", "Disturbances in providing care", and "Nurses' strategies to mitigate the challenges of mask usage. To solve the challenges caused by the mask, nurses used solutions such as removing the mask and mitigating the adverse effects of mask usage they used. The central theme of the study was "Humanistic care requires trust-based communication".

CONCLUSIONS

This study highlights the communication challenges faced by pediatric nurses due to mask-wearing during the COVID-19 pandemic. Despite these challenges, nurses have developed innovative strategies to improve communication and build trust with their young patients. Further research is needed to evaluate the effectiveness and feasibility of these strategies.

PRACTICAL IMPLICATIONS

These strategies can be useful for other nurses who work with children in similar conditions. Further research is needed to evaluate the effectiveness and feasibility of these strategies in different settings and populations.

The contribution of eye gaze and movement kinematics to the expression and identification of social intention in object-directed motor actions

The intention to include another person in an interaction (i.e., social intention) is known to influence the spatio-temporal characteristics of motor performances. However, the interplay between these kinematic variations and the social cues provided by eye gaze has not been properly assessed yet. In the present study, we tested whether limiting the access to eye gaze altered the motor-related effects of social intention on motor performances. In a dyadic interaction, the agents' task was to displace a dummy glass to a new position with the intention to fill it themselves (personal intention) or having it filled by the observers facing them (social intention). The observers performed their action only when they were able to identify a social intention in agents' action. The task was performed while having access to observers' eye gaze or not, through the manipulation of an occluder. Results showed an effect of social intention on agents' motor performances, that induced an amplification of the kinematic spatio-temporal parameters. Such amplification was smaller when the observers' eye gaze was not available. In this latter condition, the identification of the social intention in the observed actions was impaired. Altogether, the results suggest that the presence of eye gaze cues contributes significantly to the success of social interaction, by facilitating the expression and the understanding of social intentions through the kinematics of object-directed actions.

Influence of protective clothing and masks on facial trustworthiness in an investment game: insights from a Chinese population study

Facial features are important sources of information about perceived trustworthiness. Masks and protective clothing diminish the visibility of facial cues by either partially concealing the mouth and nose or covering the entire face. During the pandemic, the use of personal protective equipment affected and redefined who trusts whom in society. This study used the classical investment game of interpersonal trust with Chinese participants to explore the impact of occlusion on interpersonal trust. Faces with moderate initial trustworthiness were occluded by a mask or protective clothing in Experiment 1 and were digitally occluded by a square in Experiment 2, and faces with three levels of initial trustworthiness were occluded by a mask in Experiment 3. Results showed that both undergraduates (Experiment 1a) and non-student adults (Experiment 1b) perceived the faces with protective clothing as more trustworthy than faces wearing standard masks and faces not wearing masks. Faces with the top halves showing were perceived as trustworthy as full faces, while faces with the bottom halves showing were perceived as less trustworthy. The effect of masks is weak and complex. Masks reduced participants' trust in faces with high initial trustworthiness, had no effect on faces with low and moderate initial trustworthiness, and only slightly increased the trust of undergraduates in faces with moderate initial trustworthiness. Our findings indicate that the lack of information caused by occlusion and the social significance associated with occlusion collectively affect people's trust behavior in Chinese society. We believe the findings of this study will be useful in elucidating the effects of personal protective equipment usage on perceptions of trustworthiness.

COVID-19 Pandemic and Posttraumatic Growth in Residents of a Continuing Care Retirement Community: A Mixed Methods Study

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic impacted life for older adults living in residential settings, affecting their psychosocial well-being. Risk for COVID-19 is associated with increasing age and pre-existing health conditions. The current study aimed to describe the challenges of COVID-19 and post-traumatic growth (PTG) for residents of a continuing care retirement community (CCRC) in South Florida.

METHOD

A parallel mixed methods approach was used to explore the experience of older adults with PTG. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis to identify emergent themes.

RESULTS

Ninety-eight older adults living in a single CCRC completed a survey. Age ranged from 67 to 99 years (mean age = 86 years), with >90% identifying as non-Hispanic White and female (78%). Using the PTG theoretical framework, experiences were categorized into five dimensions: new possibilities, relating to others, personal strength, spiritual growth, and appreciation for life.

CONCLUSION

The current study focused on the challenges and growth experienced by older adults, as framed by PTG theory. Findings shed light on the capacity of this demographic, with an average age of 86 years, to overcome obstacles and achieve PTG. [Journal of Gerontological Nursing, 50(6), 25-33.].

Wearing a KN95/FFP2 facemask has no measureable effect on functional activity in a challenging working memory n-back task

Introduction

Wide use of facemasks is one of the many consequences of the COVID-19 pandemic.

Methods

We used an established working memory n-back task in functional magnetic resonance imaging (fMRI) to explore whether wearing a KN95/FFP2 facemask affects overall performance and brain activation patterns. We provide here a prospective crossover design 3 T fMRI study with/without wearing a tight FFP2/KN95 facemask, including 24 community-dwelling male healthy control participants (mean age ± SD = 37.6 ± 12.7 years) performing a 2-back task. Data analysis was performed using the FSL toolbox, performing both task-related and functional connectivity independent component analyses.

Results

Wearing an FFP2/KN95 facemask did not impact behavioral measures of the 2-back task (response time and number of errors). The 2-back task resulted in typical activations in working-memory related areas in both MASK and NOMASK conditions. There were no statistically significant differences in MASK versus NOMASK while performing the 2-back task in both task-related and functional connectivity fMRI analyses.

Conclusion

The effect of wearing a tight FFP2/KN95 facemasks did not significantly affect working memory performance and brain activation patterns of functional connectivity.

Masks wearing off: Changing effects of face masks on trustworthiness over time

During the global COVID-19 pandemic, the wearing of face masks became a common practice, raising questions about how masks affect perceptions of and behaviour towards others. Numerous studies have explored the impact of face masks on perceptions of trustworthiness, but results have been mixed and it remains unclear whether masks influence perceptions via their social meaning or their effects on facial appearance. In this study, Australian participants (N = 363) rated a series of faces which were either masked, unmasked, or occluded by a non-mask object (computer) in terms of perceived trustworthiness in 2020, 2022, or 2023. The apparent trustworthiness of unmasked faces remained stable across years, but masked faces were rated significantly more trustworthy in 2020 compared to 2022 and 2023. Furthermore, ratings of masked faces, but not unmasked faces, were correlated with participants' attitudes towards wearing masks. Faces occluded by a non-mask object were perceived to be less trustworthy than masked faces. Together, results strongly suggest the increase in perceived trustworthiness of masked faces reported in numerous studies conducted during COVID-19 were driven by positive social meanings around mask wearing rather than by their effect on facial appearance.

Recognizing and Looking at Masked Emotional Faces in Alexithymia

Alexithymia is a clinically relevant personality construct characterized by difficulties identifying and communicating one's emotions and externally oriented thinking. Alexithymia has been found to be related to poor emotion decoding and diminished attention to the eyes. The present eye tracking study investigated whether high levels of alexithymia are related to impairments in recognizing emotions in masked faces and reduced attentional preference for the eyes. An emotion recognition task with happy, fearful, disgusted, and neutral faces with face masks was administered to high-alexithymic and non-alexithymic individuals. Hit rates, latencies of correct responses, and fixation duration on eyes and face mask were analyzed as a function of group and sex. Alexithymia had no effects on accuracy and speed of emotion recognition. However, alexithymic men showed less attentional preference for the eyes relative to the mask than non-alexithymic men, which was due to their increased attention to face masks. No fixation duration differences were observed between alexithymic and non-alexithymic women. Our data indicate that high levels of alexithymia might not have adverse effects on the efficiency of emotion recognition from faces wearing masks. Future research on gaze behavior during facial emotion recognition in high alexithymia should consider sex as a moderating variable.

Investigating the impact of surgical masks on behavioral reactions to facial emotions in the COVID-19 era

Introduction

The widespread use of surgical masks during the COVID-19 pandemic has posed challenges in interpreting facial emotions. As the mouth is known to play a crucial role in decoding emotional expressions, its covering is likely to affect this process. Recent evidence suggests that facial expressions impact behavioral responses only when their emotional content is relevant to subjects' goals. Thus, this study investigates whether and how masked emotional faces alter such a phenomenon.

Methods

Forty participants completed two reaching versions of the Go/No-go task in a counterbalanced fashion. In the Emotional Discrimination Task (EDT), participants were required to respond to angry, fearful, or happy expressions by performing a reaching movement and withholding it when a neutral face was presented. In the Gender Discrimination Task (GDT), the same images were shown, but participants had to respond according to the poser's gender. The face stimuli were presented in two conditions: covered by a surgical mask (masked) or without any covering (unmasked).

Results

Consistent with previous studies, valence influenced behavioral control in the EDT but not in the GDT. Nevertheless, responses to facial emotions in the EDT exhibited significant differences between unmasked and masked conditions. In the former, angry expressions led to a slowdown in participants' responses. Conversely, in the masked condition, behavioral reactions were impacted by fearful and, to a greater extent, by happy expressions. Responses to fearful faces were slower, and those to happy faces exhibited increased variability in the masked condition compared to the unmasked condition. Furthermore, response accuracy to masked happy faces dramatically declined compared to the unmasked condition and other masked emotions.

Discussion

In sum, our findings indicate that surgical masks disrupt reactions to emotional expressions, leading people to react less accurately and with heightened variability to happy expressions, provided that the emotional dimension is relevant to people's goals.

Teaching Trainees Effective Patient Communication Skills in the Clinical Environment: Best Practices Under Crisis Conditions

ABSTRACT

Communication within the health care setting has significant implications for the safety, engagement, and well-being of patients and physicians. Evidence shows that communication training is variable or lacking in undergraduate and graduate medical education. Physician-patient communication presents a vulnerable point in patient care, which was heightened by the COVID-19 pandemic and its aftermath. Physicians have to adapt their strategies to meet new challenges, including communicating through the necessary barriers of personal protective equipment and telecommunication platforms. They also face uncharted challenges of facilitating discussions around proactive planning and scarce resources. Medical educators must be equipped to provide trainees with the skills needed to maintain empathy, facilitate trust and connection, and adapt communication behaviors under such crisis conditions. Using the Calgary-Cambridge model as a framework, the authors describe 3 new challenges to effective physician-patient communication for which COVID-19 was the impetus-face masks, visitor restrictions, and resource allocation/proactive planning discussions-and propose educational solutions.

Child mask mandates for COVID-19: a systematic review

BACKGROUND

Mask mandates for children during the COVID-19 pandemic varied in different locations. A risk-benefit analysis of this intervention has not yet been performed. In this study, we performed a systematic review to assess research on the effectiveness of mask wearing in children.

METHODS

We performed database searches up to February 2023. The studies were screened by title and abstract, and included studies were further screened as full-text references. A risk-of-bias analysis was performed by two independent reviewers and adjudicated by a third reviewer.

RESULTS

We screened 597 studies and included 22 in the final analysis. There were no randomised controlled trials in children assessing the benefits of mask wearing to reduce SARS-CoV-2 infection or transmission. The six observational studies reporting an association between child masking and lower infection rate or antibody seropositivity had critical (n=5) or serious (n=1) risk of bias; all six were potentially confounded by important differences between masked and unmasked groups and two were shown to have non-significant results when reanalysed. Sixteen other observational studies found no association between mask wearing and infection or transmission.

CONCLUSIONS

Real-world effectiveness of child mask mandates against SARS-CoV-2 transmission or infection has not been demonstrated with high-quality evidence. The current body of scientific data does not support masking children for protection against COVID-19.

Optimizing Botulinum Toxin A Administration for Forehead Wrinkles: Introducing the Lines and Dots (LADs) Technique and a Predictive Dosage Model

This study introduces the Lines and Dots (LADs) technique, a new approach for administering botulinum toxin type A (BoNT-A) in treating forehead wrinkles. (1) Background: BoNT-A application patterns in the forehead often rely solely on the anatomy of the frontalis muscle. The LADs technique proposes a combination of anatomical features with nerve pathways. (2) Methods: The technique employed a grid system aligned with the supraorbital and supratrochlear nerve pathways and used an electronic acupuncture pen for validation. This study analyzed treatment outcomes for efficacy and safety and proposed a predictive model for BoNT-A dosage. (3) Results: LADs was associated with a high satisfaction rate and low side effect incidence. The predictive model followed BoNT-A Units=0.322×Muscle Pattern Code+1.282×Line Type Code+2.905×Severity Pre-Treatment+3.947. (4) Conclusions: The LADs technique offers an alternative approach to treating forehead wrinkles, optimizing efficacy while minimizing the BoNT-A dose required.

In masks we trust: explicit and implicit reactions to masked faces vary by political orientation

Previous studies in the context of the COVID-19 pandemic indicated that wearing a medical-style mask affects whether a stranger's face is judged as more trustworthy, socially desirable, or likely to be ill. However, given political controversies around mask use, these effects might vary by political orientation. In a pre-registered online experiment, we measured evaluations of trustworthiness, social desirability and perceived illness in masked and unmasked faces by 1241 British and US participants. We included questions on political orientation, along with the implicit online-VAAST approach/avoid task to test reaction times to masked/unmasked faces. There was a medium-sized effect of masks on trustworthiness and a significant interaction with political orientation, in that conservatives found masked faces less trustworthy than did liberals. Participants were quicker to approach masked than unmasked faces, but conservatives were relatively slower than liberals. The effects on trustworthiness suggest that differential moralization of novel social norms can affect how their adherents are evaluated in terms of their suitability for social interactions. Furthermore, the congruence between implicit and explicit methods implies that such differences can have deep-seated effects on reactions.

Accuracy and Speed of Emotion Recognition With Face Masks

Wearing face masks is one of the important actions to prevent the spread of COVID-19 among people around the world. Nevertheless, social interaction is limited via masks, and this impacts the accuracy and speed of emotional perception. In the present study, we assess the impact of mask-wearing on the accuracy and speed of emotion recognition. Fifty people (female n = 39, male n = 11) aged 19-28 participated in the study (M = 21.1 years). We used frontal photos of a Kosova woman who belonged to the same participants' age group, with a grey background. Twelve different pictures were used that showed the emotional states of fear, joy, sadness, anger, neutrality, and disgust, in masked and unmasked conditions. The experiment was conducted in a controlled laboratory setting. Participants were faster for identifying emotions like joy (1.507 ms) and neutral (1.971 ms). The participants were more accurate (emotions identification) in unmasked faces (M = 85.7%) than in masked faces (M = 73.8%), F(1,98) = 20.73, MSE = 1027.66, p ≤ .001, partial η² = 0.17. Masks make confusion and reduce the accuracy and speediness of emotional detection. This may have a notable impact on social interactions among peoples.

The COVID-19 pandemic and changes in social behavior: Protective face masks reduce deliberate social distancing preferences while leaving automatic avoidance behavior unaffected

Protective face masks were one of the central measures to counteract viral transmission in the COVID-19 pandemic. Prior research indicates that face masks impact various aspects of social cognition, such as emotion recognition and social evaluation. Whether protective masks also influence social avoidance behavior is less clear. Our project assessed direct and indirect measures of social avoidance tendencies towards masked and unmasked faces in two experiments with 311 participants during the first half of 2021. Two interventions were used in half of the participants from each sample (Experiment 1: protective face masks; Experiment 2: a disease prime video) to decrease or increase the salience of the immediate contagion threat. In the direct social avoidance measure, which asked for the deliberate decision to approach or avoid a person in a hypothetical social encounter, participants showed an increased willingness to approach masked as opposed to unmasked faces across experiments. This effect was further related to interindividual differences in pandemic threat perception in both samples. In the indirect measure, which assessed automatic social approach and avoidance tendencies, we neither observed an approach advantage towards masked faces nor an avoidance advantage for unmasked faces. Thus, while the absence of protective face masks may have led to increased deliberate social avoidance during the pandemic, no such effect was observed on automatic regulation of behavior, thus indicating the relative robustness of this latter behavior against changes in superordinate social norms.

Face coverings increase apparent honesty and cooperativeness

People readily make inferences about trait-like characteristics of another person's face. Since the recent global COVID-19 pandemic, the widespread use of hygienic face masks has led to large proportions of the face being covered. We investigated the effect of face masks on the inference of prosocially relevant characteristics, namely cooperativeness and honesty. Portraits of participants of previous studies from which we knew their "true" prosocial tendencies served as stimuli. These facial stimuli were presented once with and once without a hygienic face mask to 60 naïve participants who rated the faces for cooperativeness and honesty. Results revealed that wearing face masks made people generally appear more cooperative and more honest than without a mask, but that these ratings were unrelated to the true prosocial tendencies of these people. Together, these findings have important implications for social interactions, particularly in contexts where nonverbal communication is essential, such as in healthcare settings, job interviews, and social gatherings.

Effects of wearing an opaque or transparent face mask on the perception of facial expressions: A comparative study between Japanese school-aged children and adults

The negative side effects of mask-wearing on reading facial emotional cues have been investigated in several studies with adults post-2020. However, little is known about children. This study aimed to determine the negative influence of mask-wearing on reading emotions of adult faces by Japanese school-aged children, compared to Japanese adults. We also examined whether this negative influence could be alleviated by using a transparent face mask instead of an opaque one (surgical mask). The performance on reading emotions was measured using emotion categorization and emotion intensity rating tasks for adult faces. As per the findings, the accuracy of emotion recognition in children was impaired for various facial expressions (disgust, fear, happy, neutral, sad, and surprise faces), except for angry faces. Conversely, in adults, it was impaired for a few facial expressions. The perceived intensity for happy faces with a surgical mask was weaker in both children and adults than in those without the mask. A negative influence of wearing surgical masks was generally not observed for faces wearing a transparent mask in both children and adults. Thus, negative side effects of mask-wearing on reading emotions are observed for more facial expressions in children than in adults; transparent masks can help remedy these.

Recognition of masked and unmasked facial expressions in males and females and relations with mental wellness

Background

While the effects of mask wearing/facial occlusion are known to impair facial expression recognition, little is known about the role of mental wellness on facial expression recognition, as well as the influence of sex on misattribution errors (i.e., confusions between emotions). In this large study, we aimed to address the relation between facial expression recognition and loneliness, perceived stress, anxiety, and depression symptoms in male and female adults.

Methods

We assessed the influence of mask-wearing on facial expression recognition [i.e., accuracy and response time (RT)] via an online study in N = 469 adult males and females across Canada.

Results

Expectedly, recognition was impaired under masked conditions (i.e., lower accuracy, longer RTs, more misattribution errors). Females were faster and more accurate than males, with less misattribution errors. A novel finding was that people with higher perceived stress were less accurate at identifying masked fearful faces. Perceived stress influenced the relation between sex and RT to masked happy faces; males with high stress scores were slower to recognize masked happy faces, the opposite was true for females. Finally, this study was among the first to show that higher loneliness predicted shorter RT to unmasked faces.

Impact

Our results show that facial expression recognition is impaired by mask-wearing, and that sex and mental health features are important predictors of performance. Such insight could be detrimental in certain sectors of the population (e.g., health care or education), and inform policies being adopted in future pandemics.

Drift-diffusion modeling reveals that masked faces are preconceived as unfriendly

During the COVID-19 pandemic, the use of face masks has become a daily routine. Studies have shown that face masks increase the ambiguity of facial expressions which not only affects (the development of) emotion recognition, but also interferes with social interaction and judgement. To disambiguate facial expressions, we rely on perceptual (stimulus-driven) as well as preconceptual (top-down) processes. However, it is unknown which of these two mechanisms accounts for the misinterpretation of masked expressions. To investigate this, we asked participants (N = 136) to decide whether ambiguous (morphed) facial expressions, with or without a mask, were perceived as friendly or unfriendly. To test for the independent effects of perceptual and preconceptual biases we fitted a drift-diffusion model (DDM) to the behavioral data of each participant. Results show that face masks induce a clear loss of information leading to a slight perceptual bias towards friendly choices, but also a clear preconceptual bias towards unfriendly choices for masked faces. These results suggest that, although face masks can increase the perceptual friendliness of faces, people have the prior preconception to interpret masked faces as unfriendly.

Prioritized Identification of Fearful Eyes during the Attentional Blink Is Not Automatic

The eye region conveys considerable information regarding an individual's emotions, motivations, and intentions during interpersonal communication. Evidence suggests that the eye regions of an individual expressing emotions can capture attention more rapidly than the eye regions of an individual in a neutral affective state. However, how attentional resources affect the processing of emotions conveyed by the eye regions remains unclear. Accordingly, the present study employed a dual-target rapid serial visual presentation task: happy, neutral, or fearful eye regions were presented as the second target, with a temporal lag between two targets of 232 or 696 ms. Participants completed two tasks successively: Task 1 was to identify which species the upright eye region they had seen belonged to, and Task 2 was to identify what emotion was conveyed in the upright eye region. The behavioral results showed that the accuracy for fearful eye regions was lower than that for neutral eye regions under the condition of limited attentional resources; however, accuracy differences across the three types of eye regions did not reach significance under the condition of adequate attentional resources. These findings indicate that preferential processing of fearful expressions is not automatic but is modulated by available attentional resources.

Emotions behind a mask: the value of disgust

The impact of face masks on social cognition and interaction became a popular topic due to the long-lasting COVID-19 pandemic. This theme persists in the focus of attention beyond the pandemic, since face covering not only reduces the overall amount of face information available but also introduces biases and prejudices affecting social perception at large. Many questions are still open. One of them is whether gender of beholders affects inferring of emotions covered by face masks. Reading covered faces may be particularly challenging for individuals with mental disorders, most of which are gender-specific. Previous findings are not only sparse, but inconclusive because most research had been conducted online with resulting samples heavily dominated by females. Here in a face-to-face study, females and males were presented with a randomized set of faces covered by masks. In a two-alternative forced-choice paradigm, participants had to indicate facial emotions displayed by posers. In general, the outcome dovetails with earlier findings that face masks affect emotion recognition in a dissimilar way: Inferring some emotions suffers more severely than others, with the most pronounced influence of mask wearing on disgust and close to ceiling recognition of fear and neutral expressions. Contrary to our expectations, however, males were on overall more proficient in emotion recognition. In particular, males substantially excelled in inferring disgust. The findings help to understand gender differences in recognition of disgust, the forgotten emotion of psychiatry, that is of substantial value for a wide range of mental disorders including schizophrenia. Watch Prof. Marina Pavlova discussing this her work and this article: https://vimeo.com/860126397/5966610f49?share=copy .

Influence of child and adult faces with face masks on emotion perception and facial mimicry

Emotional mimicry, the imitation of others' emotion expressions, is related to increased interpersonal closeness and better interaction quality. Yet, little research has focused on the effect of face masks on emotional mimicry and none on (masked) child faces. To address this gap, we conducted an online experiment (N = 235, German sample, adult perceivers). Masks reduced emotion recognition accuracy for all expressions, except in the case of anger in masked child faces, where perceived anger was even increased. Perceived interpersonal closeness was reduced for masked happy and sad faces. For both child and adult expressers, masks reduced facial mimicry of happy expressions, with no mask effects for sadness and anger expression. A stronger mask effect on facial happiness mimicry of child faces was mediated by the degree of emotion recognition accuracy. Smiles shown by masked children were not recognized well, likely due to the absence of wrinkles around the eyes in child faces. Independent of masks, sadness shown by children was mimicked even more strongly than when shown by adults. These results provide evidence for facial mimicry of child expressions by adult perceivers and show that the effects of face masks on emotion communication may vary when children wear them.

Effects of face masks on fairness in on-site personnel selection during a pandemic

Introduction

Despite significant challenges, personnel selection procedures had to continue as on-site testing in the Covid-19 pandemic. Health and safety measures and specifically the use of face masks threaten to limit the fairness of cognitive testing and behavioral observation in the assessment center.

Methods

In this study, we compare the performance and pass rates of pilot selection under three different conditions in the selection campaigns of 2019 (pre-pandemic), 2020 (health and safety measures without mask), and 2021 (health and safety measures with mask).

Results

Mask wearing and other health and safety measures had no influence on the objective parameters of pilot selection. However, for some of the areas of competence in the assessment center subjective observability was rated lower for the condition with face masks.

Discussion

We conclude that the fairness and precision of selection processes are not compromised by wearing face masks and that a high degree of standardization in diagnostic instruments prevents a partially reduced subjective observability from affecting the selection's outcome.

The effect of masks on the emotion perception of a facial crowd

The present study investigated the effect of facial masks on people's ability to perceive emotions in crowds. We presented faces with the bottom halves occluded by masks or full faces without occlusion. In two sequentially presented crowds, we varied the number of faces, emotional valence, and intensity of facial expressions, examining the impact of masks on the perception of crowd emotion. Participants reported which of the two crowds they would avoid based on the crowds' average emotions. The participants' ability to judge the average emotion of a crowd, especially a crowd expressing happiness, was impaired when the crowd wore masks. For faces covered by masks, crowd emotion judgments were more negatively biased than those without masks. However, participants could still distinguish the emotional intensities of a crowd wearing masks above chance. Additionally, participants responded more quickly to a crowd with more people without compromising accuracy, despite the perceptual challenges imposed by facial masks. Our results suggest that under ambiguous social situations in which individuals' emotions are partially hidden by masks, a large group may provide stronger social cues than a small group, thereby promoting communication and regulating social behaviors.

Face mask reduces gaze-cueing effect

Recent studies have found that face masks affect social cognition and behaviour in the context of the novel coronavirus (COVID-19) pandemic. The eyes, the only part of the face not covered by face masks, are an important spatial attention cue that can trigger social attention orienting. Here, we adopted a spatial gaze-cueing task to investigate whether face masks affect social attention orienting triggered by eye gaze cues. In Experiment 1, participants were asked to determine the orientation of a target line under two types of cues-masked and non-masked faces-and two stimulus onset asynchrony (SOA) conditions (300 ms and 1000 ms). The results showed that masked faces induced a smaller gaze-cueing effect (GCE) compared to non-masked faces at 300 ms SOA, while two face types induced similar GCEs at 1000 ms SOA. Experiment 2 used mouth-obscured faces and non-masked faces as cues and found that no significant difference in GCE between the two types at either 300 ms or 1000 ms SOA, indicating that the reduction of GCE caused by the masked face was due to the social meaning expressed by the mask rather than a physical effect of masking. The present study extends previous findings to support the idea that high-level social information affects the processing of eye gaze direction and provides evidence that face masks affect social cognition and behaviour in the context of COVID-19.

How does the COVID-19 pandemic affect the personal lives and care realities of people with a schizophrenia spectrum disorder? A qualitative interview study

BACKGROUND

The COVID-19 pandemic constitutes one of the greatest recent public crises. This study explored its influence on the lives and care realities of people with a schizophrenia spectrum disorder (SSD).

METHODS

Between October 2020 and April 2021, semi-structured in-depth interviews were conducted with 30 volunteers with SSDs receiving inpatient or outpatient treatment in Vienna (Austria). Interviews were audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

Three main themes were identified. First, 'Pandemic life is deprived, lonely and surreal - though certain aspects can be perceived as positive'. Second, 'Bio-psycho-social support systems were struck at their core by the pandemic and were left severely compromised'. Last, 'There is a complex interplay between one's prior experience of psychosis and the experience of the COVID-19 pandemic'. The pandemic situation affected interviewees in various ways. For many, it led to a drastic reduction in day-to-day and social activities and contributed to an atmosphere of strangeness and threat. Bio-psycho-social support providers frequently suspended their services and offered alternatives were not always helpful. Participants indicated that whilst having an SSD might render them vulnerable to the pandemic situation, prior experience with psychotic crises can also provide knowledge, skills and self-confidence which enable better coping. Some interviewees also perceived aspects of the pandemic situation as helpful for recovering from psychosis.

CONCLUSION

Healthcare providers must acknowledge the perspectives and needs of people with SSDs in present and future public health crises to ensure proper clinical support.

Hidden faces, altered perceptions: the impact of face masks on interpersonal perception

The pandemic has made wearing masks commonplace, prompting researchers to investigate their effects on interpersonal perception. Findings indicate masks obstruct face identification and expression recognition, with lower face cues being most affected. When judging attractiveness, masks can enhance the appeal of less attractive faces, but reduce the appeal of more attractive faces. Trust and speech perception outcomes are inconclusive. Future studies could focus on individual differences in how masks influence our perception of others.

Masking our emotions: Emotion recognition and perceived intensity differ by race and use of medical masks

Although medical masks have played a key role in decreasing the transmission of communicable disease, they simultaneously reduce the availability of nonverbal cues fundamental to social interaction. In the present study, we determined the collective impact of medical masks on emotional expression recognition and perceived intensity as a function of actor race. Participants completed an emotional expression recognition task involving stimuli with or without medical masks. Across six basic emotional facial expressions, medical masks were associated with significantly more emotional expression recognition errors. Overall, the effects associated with race varied depending on the emotion and appearance of masks. Whereas recognition accuracy was higher for White relative to Black actors for anger and sadness, the opposite pattern was observed for disgust. Medical mask-wearing exacerbated actor-race related recognition differences for anger and surprise, but attenuated these differences for fear. Emotional expression intensity ratings were significantly reduced for all emotions except fear, where masks were associated with increased perceived intensity. Masks further increased already higher intensity ratings for anger in Black versus White actors. In contrast, masks eliminated the tendency to give higher intensity ratings for Black versus White sad and happy facial expressions. Overall, our results suggest that the interaction between actor race and mask wearing status with respect to emotional expression judgements is complex, varying by emotion in both direction and degree. We consider the implications of these results particularly in the context of emotionally charged social contexts, such as in conflict, healthcare, and policing.

Face masks influence emotion judgments of facial expressions: a drift-diffusion model

Face masks slow the spread of SARS-CoV-2, but it has been unknown how masks might reshape social interaction. One important possibility is that masks may influence how individuals communicate emotion through facial expressions. Here, we clarify to what extent-and how-masks influence facial emotion communication, through drift-diffusion modeling (DDM). Over two independent pre-registered studies, conducted three and 6 months into the COVID-19 pandemic, online participants judged expressions of 6 emotions (anger, disgust, fear, happiness, sadness, surprise) with the lower or upper face "masked" or unmasked. Participants in Study 1 (N = 228) correctly identified expressions above chance with lower face masks. However, they were less likely-and slower-to correctly identify these expressions relative to without masks, and they accumulated evidence for emotion more slowly-via decreased drift rate in DDM. This pattern replicated and intensified 3 months later in Study 2 (N = 264). These findings highlight how effectively individuals still communicate with masks, but also explain why they can experience difficulties communicating when masked. By revealing evidence accumulation as the underlying mechanism, this work suggests that time-sensitive situations may risk miscommunication with masks. This research could inform critical interventions to promote continued mask wearing as needed.

Refraining from interaction can decrease fear of physical closeness during COVID-19

Perception of peripersonal space (PPS) and interpersonal distance (IPD) has been shown to be modified by external factors such as perceived danger, the use of tools, and social factors. Especially in times of social distancing in the context of the COVID-19 pandemic, it is vital to study factors that modify PPS and IPD. The present work addresses the question of whether wearing a face mask as a protection tool and social interaction impact the perception of IPD. We tested estimated IPD in pictures at three distances: 50 cm, 90 cm, and 150 cm in both social interaction (shaking hands) and without interaction and when the two people in the pictures wore a face mask or not. Data from 60 subjects were analyzed in a linear mixed model (on both difference in distance estimation to the depicted distance and in absolute distance estimation) and in a 3 (distance: 50, 90, 150) × 2 (interaction: no interaction, shake hands), × 2 face mask (no mask, mask) rmANOVA on distance estimation difference. All analyses showed that at a distance of 50 and 90 cm, participants generally underestimated the IPD while at an IPD of 150 cm, participants overestimated the distance. This could be grounded in perceived danger and avoidance behavior at closer distances, while the wider distance between persons was not perceived as dangerous. Our findings at an IPD of 90 cm show that social interaction has the largest effect at the border of our PPS, while the face mask did not affect social interaction at either distance. In addition, the ANOVA results indicate that when no social interaction was displayed, participants felt less unsafe when depicted persons wore a face mask at distances of 90 and 150 cm. This shows that participants are on the one hand aware of the given safety measures and internalized them; on the other hand, that refraining from physical social interaction helps to get close to other persons.

Empathising with masked targets: limited side effects of face masks on empathy for dynamic, context-rich stimuli

Multiple studies revealed detrimental effects of face masks on communication, including reduced empathic accuracy and enhanced listening effort. Yet, extant research relied on artificial, decontextualised stimuli, which prevented assessing empathy under more ecologically valid conditions. In this preregistered online experiment (N = 272), we used film clips featuring targets reporting autobiographical events to address motivational mechanisms underlying face mask effects on cognitive (empathic accuracy) and emotional facets (emotional congruence, sympathy) of empathy. Surprisingly, targets whose faces were covered by a mask (or a black bar) elicited the same level of empathy motives (affiliation, cognitive effort), and accordingly, the same level of cognitive and emotional empathy compared to targets with uncovered faces. We only found a negative direct effect of face coverings on sympathy. Additional analyses revealed that older (compared to young) adults showed higher empathy, but age did not moderate face mask effects. Our findings speak against strong negative face mask effects on empathy when using dynamic, context-rich stimuli, yet support motivational mechanisms of empathy.

When less is not more: the effect of transparent masks on facial attractiveness judgment

During the COVID-19 pandemic, face masks have been widely used in daily life. Previous studies have suggested that faces wearing typical masks that occlude the lower half of the face are perceived as more attractive than face without masks. However, relatively little work has been done on how transparent masks that reveal the lower half of the face affect the judgment of facial attractiveness. To investigate the effect of transparent masks on the perceived attractiveness, in the current study, we asked participants to rate the attractiveness of faces without masks and with a typical opaque mask and a transparent mask. The results showed that faces wearing opaque masks were evaluated as more attractive than those wearing transparent masks or no masks. The benefit of opaque masks was more pronounced in faces that were initially evaluated as unattractive. Interestingly, wearing transparent masks decreased the perceived attractiveness of faces but only for the faces initially rated as attractive, possibly because of the visual distortion of the lower half of the face by transparent masks. In summary, we found that opaque and transparent masks have different effects on perceived attractiveness, depending on the attractiveness of faces. Given benefits of transparent masks in socio-emotional and cognitive processing, it would be important to further understand the effect of transparent masks on face information processing.

Impact of facemasks on psychotherapy: Clinician's confidence and emotion recognition

OBJECTIVES

Facial emotion recognition is a key component of human interactions, and in clinical relationships contributes to building and maintaining the therapeutic alliance with patients. The introduction of facemasks has reduced the availability of facial information in private and professional relationships. This study aimed to assess the impact of facemasks on clinicians' perception of clinical interactions as well as their ability to read facial expressions.

METHODS

In this cross-sectional study, a purposive sample of 342 clinical psychologists or psychotherapists completed an online survey including the assessment of burnout, alexithymia, emotion dysregulation, and self-perceived ability to build effective relationships and communication with patients with/without facemasks. Participants were randomly assigned to the standardized facial emotion recognition task Diagnostic Analysis of Nonverbal Accuracy FACES 2-Adult Faces including 24 faces representing anger, fear, sadness, and happiness.

RESULTS

Facemasks impaired the self-perceived ability of clinicians to build effective relationships and communicate with patients and reduced satisfaction in clinical encounters. The ability of clinicians to recognize facial emotions is significantly reduced for masked happy and angry faces, but not for sad and afraid ones. The perceived difficulty in building good relationships and communication with patients had a positive correlation with alexithymia and emotion dysregulation; higher levels of discomfort when wearing facemasks had a positive correlation with burnout and emotion dysregulation.

CONCLUSION

Facemasks reduced clinicians' self-confidence in clinical encounters with patients wearing facemasks, but their facial emotion recognition performance was only partially impaired.

Face masks are less effective than sunglasses in masking face identity

The effect of covering faces on face identification is recently garnering interest amid the COVID-19 pandemic. Here, we investigated how face identification performance was affected by two types of face disguise: sunglasses and face masks. Observers studied a series of faces; then judged whether a series of test faces, comprising studied and novel faces, had been studied before or not. Face stimuli were presented either without coverings (full faces), wearing sunglasses covering the upper region (eyes, eyebrows), or wearing surgical masks covering the lower region (nose, mouth, chin). We found that sunglasses led to larger reductions in sensitivity (d') to face identity than face masks did, while both disguises increased the tendency to report faces as studied before, a bias that was absent for full faces. In addition, faces disguised during either study or test only (i.e. study disguised faces, test with full faces; and vice versa) led to further reductions in sensitivity from both studying and testing with disguised faces, suggesting that congruence between study and test is crucial for memory retrieval. These findings implied that the upper region of the face, including the eye-region features, is more diagnostic for holistic face-identity processing than the lower face region.

The effect of face masks on sign language comprehension: performance and metacognitive dimensions

In spoken languages, face masks represent an obstacle to speech understanding and influence metacognitive judgments, reducing confidence and increasing effort while listening. To date, all studies on face masks and communication involved spoken languages and hearing participants, leaving us with no insight on how masked communication impacts on non-spoken languages. Here, we examined the effects of face masks on sign language comprehension and metacognition. In an online experiment, deaf participants (N = 60) watched three parts of a story signed without mask, with a transparent mask or with an opaque mask, and answered questions about story content, as well as their perceived effort, feeling of understanding, and confidence in their answers. Results showed that feeling of understanding and perceived effort worsened as the visual condition changed from no mask to transparent or opaque masks, while comprehension of the story was not significantly different across visual conditions. We propose that metacognitive effects could be due to the reduction of pragmatic, linguistic and para-linguistic cues from the lower face, hidden by the mask. This reduction could impact on lower-face linguistic components perception, attitude attribution, classification of emotions and prosody of a conversation, driving the observed effects on metacognitive judgments but leaving sign language comprehension substantially unchanged, even if with a higher effort. These results represent a novel step towards better understanding what drives metacognitive effects of face masks while communicating face to face and highlight the importance of including the metacognitive dimension in human communication research.

Social Isolation Affects the Mimicry Response in the Use of Smartphones : An Ethological Experiment during the COVID-19 Pandemic

Humans are social animals that rely on different ways to interact with each other. The COVID-19 pandemic strongly changed our communication strategies. Because of the importance of direct contact for our species, we predict that immediately after the forced social isolation, people were more prone to engage in direct rather than in virtual interactions, thus showing a lower mimicry response in the use of smartphones. In a non-longitudinal study, we collected behavioral data under naturalistic contexts and directly compared the data of the mimicry response gathered immediately following the Italian lockdown (May-September 2020) with those gathered one year later (May-October 2021). Contrary to our expectations, the mimicry response in the use of smartphones was higher immediately after the lockdown than a year later. Probably the large use of these devices during the lockdown translated into a greater sensitivity to be affected by others' smartphone manipulation. Indeed, social isolation modified, at least in the short term, the ways we interact with others by making us more prone to engage in "virtual" social interactions. The bright side of the coin unveiled by our findings is that the effect seems to diminish over time. The large behavioral dataset analyzed here (1,608 events; 248 people) also revealed that the mimicry response in the use of smartphones was higher between familiar subjects than between strangers. In this view, mimicry in manipulating smartphones can be considered an example of joint action that fosters behavioral synchrony between individuals that, in the long-term, can translate into the formation of social bonding.

The nationwide impact of COVID-19 on life support courses. A retrospective evaluation by Resuscitation Council UK

Aim

To determine the impact of the COVID-19 pandemic on Resuscitation Council UK Advanced Life Support (ALS) and Immediate Life Support (ILS) course numbers and outcomes.

Methods

We conducted a before-after study using course data from the Resuscitation Council UK Learning Management System between January 2018 and December 2021, using 23 March 2020 as the cut-off between pre- and post-pandemic periods. Demographics and outcomes were analysed using chi-squared tests and regression models.

Results

There were 90,265 ALS participants (51,464 pre-; 38,801 post-) and 368,140 ILS participants (225,628 pre-; 142,512 post-). There was a sharp decline in participants on ALS/ILS courses due to COVID-19. ALS participant numbers rebounded to exceed pre-pandemic levels, whereas ILS numbers recovered to a lesser degree with increased uptake of e-learning versions. Mean ALS course participants reduced from 20.0 to 14.8 post-pandemic (P < 0.001).Post-pandemic there were small but statistically significant decreases in ALS Cardiac Arrest Simulation Test pass rates (from 82.1 % to 80.1 % (OR = 0.90, 95 % CI = 0.86-0.94, P < 0.001)), ALS MCQ score (from 86.6 % to 86.0 % (mean difference = -0.35, 95 % CI -0.44 to -0.26, P < 0.001)), and overall ALS course results (from 95.2 %to 94.7 %, OR = 0.92, CI = 0.85-0.99, P = 0.023). ILS course outcomes were similar post-pandemic (from 99.4 % to 99.4 %, P = 0.037).

Conclusion

COVID-19 caused a sharp decline in the number of participants on ALS/ILS courses and an accelerated uptake of e-learning versions, with the average ALS course size reducing significantly. The small reduction in performance on ALS courses requires further research to clarify the contributing factors.

Impact of face masks and sunglasses on attractiveness, trustworthiness, and familiarity, and limited time effect: a Japanese sample

Many studies conducted after the COVID-19 pandemic have examined the relationship between changes in social traits, such as attractiveness and wearing face masks. However, most studies examine the effect of wearing face masks at a single time point, and the time effect is not known. Additionally, few studies address wearing sunglasses, another facial occluding item. This study examined the effects of facial occluding (unoccluded face, face masks, sunglasses, or both) on perceived attractiveness, trustworthiness, and familiarity at two time points, September 2020, six months after the start of the COVID-19 pandemic, and April 2022, almost two years later, using Japanese higher and lower attractive faces. Results showed that only lower attractive faces wearing face masks had a time effect on attractiveness and familiarity and no time effect on social traits in higher attractive faces. Perceived all social traits were the highest for unoccluded faces, and faces wearing face masks had the same level of attractiveness and familiarity as unoccluded faces. Perceived trustworthiness was higher for unoccluded faces, faces wearing face masks, sunglasses, and both sunglasses and face masks, respectively. Additionally, faces wearing both sunglasses and face masks had the lowest perceived all social traits. These findings suggest that the positive and time effects of wearing face masks are limited in Japan, suggesting a greater positive impact of unoccluded faces. They also suggest that the negative impact of wearing sunglasses is significant.

Lay theories about emotion recognition explain cultural differences in willingness to wear facial masks during the COVID-19 pandemic

Given that mask-wearing proved to be an important tool to slow the spread of infection during the COVID-19 pandemic, investigating the psychological and cultural factors that influence norms for mask wearing across cultures is exceptionally important. One factor that may influence mask wearing behavior is the degree to which people believe masks potentially impair emotion recognition. Based on previous research suggesting that there may be cultural differences in facial regions that people in Japan and the United States attend to when inferring a target's emotional state, we predicted that Americans would perceive masks (which cover the mouth) as more likely to impair emotion recognition, whereas Japanese would perceive facial coverings that conceal the eye region (sunglasses) to be more likely to impair emotion recognition. The results showed that Japanese participants reported wearing masks more than Americans. Americans also reported higher expected difficulty in interpreting emotions of individuals wearing masks (vs. sunglasses), while Japanese reported the reverse effect. Importantly, expectations about the negative impact of facial masks on emotion recognition explained cultural differences in mask-wearing behavior, even accounting for existing social norms.

UIBVFED-Mask: A Dataset for Comparing Facial Expressions with and without Face Masks

After the COVID-19 pandemic the use of face masks has become a common practice in many situations. Partial occlusion of the face due to the use of masks poses new challenges for facial expression recognition because of the loss of significant facial information. Consequently, the identification and classification of facial expressions can be negatively affected when using neural networks in particular. This paper presents a new dataset of virtual characters, with and without face masks, with identical geometric information and spatial location. This novelty will certainly allow researchers a better refinement on lost information due to the occlusion of the mask.

Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia

BACKGROUND

In 2020, during the first wave of the COVID-19 pandemic in Australia, hospital intensive care units (ICUs) revised patient care practices, curtailed visiting, and augmented the use of personal protective equipment to protect patients, staff, and the community from viral transmission.

AIM

The aim was to explore ICU staff experiences and perceptions of care and communication with patients during the COVID-19 pandemic to understand how alternative ways of working have influenced work processes, relationships, and staff morale.

METHODS

This was a qualitative exploratory design study using audio-recorded and transcribed interviews with 20 ICU staff members. Data were analysed using thematic analysis.

FINDINGS

Four major themes were derived from the data: (i) Communication and connection, (ii) Psychological casualties, (iii) Caring for our patients, and (iv) Overcoming challenges. Patient care was affected by diminished numbers of critical care qualified staff, limited staff entry to isolation rooms, and needing to use alternative techniques for some practices. The importance of effective communication from the organisation and between clinicians, families, and staff members was emphasised. personal protective equipment hindered communication between patients and staff and inhibited nonverbal and verbal cues conveying empathy in therapeutic interactions. Communication with families by phone or videoconference was less satisfying than in-person encounters. Some staff members suffered psychological distress, especially those working with COVID-19 patients requiring extracorporeal membrane oxygenation. Moral injury occurred when staff members were required to deny family access to patients. Workload intensified with increased patient admissions, additional infection control requirements, and the need to communicate with families using alternative methods.

CONCLUSION

The results of this study reflect the difficulties in communication during the early stages of the COVID-19 pandemic. Communication between staff members and families may be improved using a more structured approach. Staff reported experiencing psychological stress when separating families and patients or working in isolation rooms for prolonged periods. A flexible, compassionate response to family presence in the ICU is essential to maintain patient- and family-centred care.

What is missing in the study of emotion expression?

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

'The Obstacle is the Way': Methodological Challenges and Opportunities for Video-Reflexive Ethnography During COVID-19

The COVID-19 pandemic greatly impacted research. In this article, we explore the opportunities and challenges presented by the pandemic to a group of researchers using video-reflexive ethnography (VRE) - a methodology used to understand practices, grounded in: exnovation, collaboration, reflexivity, and care. To understand how the pandemic impacted researchers using VRE, we facilitated two focus groups with 12 members of the International Association of Video-Reflexive Ethnographers. The findings suggest the pandemic exacerbated existing methodological challenges, yet also provided an opportunity reflect on our own practices as researchers, namely: accessing sites, building relationships, facilitating reflexive sessions, and cultivating care. Due to public health measures, some researchers used insiders to access sites. While these insiders shouldered additional burdens, this shift might have empowered participants, increased the salience of the project, and enabled access to rural sites. The inability to access sites and reliance on insiders also impeded researcher ability to build relationships with participants and generate the ethnographic insights often associated with prolonged engagement at a site. In reflexive sessions, researchers had to learn how to manage the technological, logistical, and methodological challenges associated with either themselves or participants being remote. Finally, participants noted that while the transition to more digital methodologies might have increased project reach, there needed to be a mindfulness around cultivating practices of care in the digital world to ensure psychological safety and protect participants data. These findings reflect the opportunities and challenges a group of researchers using VRE had during the pandemic and can be used to stimulate future methodologic discussions.

Face memory and facial expression recognition are both affected by wearing disposable surgical face masks

Faces are fundamental stimuli for social interactions since they provide significant information about people's identity and emotional states. With the outburst of the COVID-19 pandemic, global use of preventive measures, such as disposable surgical face masks (DSFMs), has been imposed. The massive use of DSFMs covering a large part of the face could interfere with identity and emotion recognition. Thus, the main aim of the current study was (i) to assess how DSFMs affect identity recognition (Experiment 1), (ii) how DSFMs affect emotion recognition (Experiment 2), and (iii) whether individual empathy levels correlate with emotion recognition with DSFMs. The potential relation between identity and emotion recognition with and without DSFMs was also investigated. Two tasks were administered to 101 healthy participants: (i) the Old-new face memory task aimed to assess whether the learning context (i.e., DSFMs on/off) affects recognition performance, whereas (ii) the Facial affect task explored DSFMs' effect on emotion recognition. Results from the former showed that the stimuli's features in the learning stage affect recognition performances; that is, faces wearing DSFMs were better recognized if wearing DSFMs at first exposure and vice versa. Results from the Facial affect task showed that DSFMs lead to reduced disgust, happiness, and sadness recognition. No significant correlation emerged between identity and emotion recognition. The Interpersonal Reactivity Index (IRI) was administered to assess affective and cognitive empathy; however, IRI scores did not correlate with either face memory recognition or facial affect recognition. Overall, our results demonstrate (a) a "context effect" for face memory with and without DSFMs; (b) a disruptive effect of DSFMs depending on the expressed emotion; and (c) no correlation between empathy and emotion recognition with DSFMs.

The Role of Trust in COVID-19 Vaccine Acceptance: Considerations from a Systematic Review

The goal of this research was to provide an overview of the role of trust in determining COVID-19 vaccine acceptance. Trust proved to be a key issue in all the strategic phases of the pandemic, a decisive element for the success of the worldwide vaccination campaign. By introducing a comprehensive systematic review of the state-of-the-art (N = 43), we intend to shed light on the various forms of trust that have been considered and how these relate to citizens’ vaccine acceptance. The analysis shows that trust has been used extensively, with particular reference to the COVID-19 vaccine, governments, manufacturers, healthcare systems, and science. A more in-depth analysis has also allowed us to evaluate the role that these factors have had and the social phenomena in which they have been decisive. Most notably, we proved that, in the different contributions, trust in the COVID-19 vaccine has a strong correlation with vaccine acceptance (R = 0.78, p < 0.01). Overall, vaccine acceptance emerges as a complex phenomenon that needs to be understood through the strictly interlaced relations of trust in the various factors coming into play. Besides clarifying what happened in previous years, the considerations included in this work also represent an important and useful interpretative framework to help public institutions and the healthcare system in the future.

The effect of masks on the recognition of facial expressions: A true-to-life study on the perception of basic emotions

Mouth-to-nose face masks became ubiquitous due to the COVID-19 pandemic. This ignited studies on the perception of emotions in masked faces. Most of these studies presented still images of an emotional face with a face mask digitally superimposed upon the nose-mouth region. A common finding of these studies is that smiles become less perceivable. The present study investigated the recognition of basic emotions in video sequences of faces. We replicated much of the evidence gathered from presenting still images with digitally superimposed masks. We also unearthed fundamental differences in comparison to existing studies with regard to the perception of smile which is less impeded than previous studies implied.

Wearing face masks impairs dyadic micro-activities in nonverbal social encounter: A mixed-methods first-person study on the sense of I and Thou

The COVID-19 pandemic has manifold negative consequences for people around the world, of which the psychosocial ones have been rather underrepresented in the public eye. Regarding social distancing measures, there is already some experimental work demonstrating that the use of face masks has detrimental effects on various aspects of social cognition such as emotion reading, face identification, and perceived closeness of persons. However, while these findings provide important clues, they do not shed light on what people experience when interacting in real life in a masked society. Therefore, in critical distance to cognitivist accounts and taking Direct Social Perception (DSP) approaches seriously, we developed a first-person experimental design and conducted a study with thirty-four participants in a dyadic setting with two conditions (without vs. with face mask). Data were analyzed with mixed methods including in-depth qualitative coding at three levels, code relations analyses, and various statistical tests. Results yielded significant differences across conditions at all qualitative levels, comprising, for example, expressive behavior, and, in particular, significant decreases of content-independent, complimentary mental micro-activities. In the context of DSP, we argue in the paper that these activities suggest the constitution of a quasi-sensory modality - conceived as I-Thou sense - that oscillates between strongly and weakly embodied mental activities, as the analyses show. In sum, this study suggests that mask-wearing impairs both functional directions of mental activity in relation to more or less embodied experience and thus intervenes deeply in fundamental processes of social perception and interaction.