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Birch ES, Stark BC, Neumann D. Factors related to social inferencing performance in moderate-severe, chronic TBI. Brain Inj 2024:1-12. [PMID: 38832655 DOI: 10.1080/02699052.2024.2361634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Following traumatic brain injury (TBI), deficits in social cognition are common. Social inferencing is a crucial component of social cognition that enables an individual to understand the thoughts, feelings, and intentions of a communication partner when this information is not explicitly stated. Existing literature suggests a variety of factors contribute to social inferencing success (e.g. biological sex, executive functioning), yet findings are not conclusive, largely because these factors have been examined in isolation. METHOD In this cross-sectional study, stepwise regression with cross validation was used to examine the extent that several theoretically motivated factors were associated with social inferencing (measured by performance on The Awareness of Social Inference Test [TASIT]) in adult participants with TBI (n = 105). Demographic information, executive functioning, aggression, emotional functioning measures, and participation in society were all examined in relation to social inferencing performance. RESULTS The findings confirm the importance of higher-level cognitive skills (i.e. executive functioning) in social inferencing, and advance the literature by underlining the potential importance of productive participation in social inferencing performance. CONCLUSION This study innovatively highlights factors linked with social inferencing skills and, in doing so, how deficits in social inferencing might manifest in the lives of individuals with TBI.
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Affiliation(s)
- Eleanor S Birch
- Department of Speech, Indiana University Bloomington Language and Hearing Sciences
- Program in Neuroscience, Indiana University Bloomington
| | - Brielle C Stark
- Department of Speech, Indiana University Bloomington Language and Hearing Sciences
- Program in Neuroscience, Indiana University Bloomington
| | - Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine
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Grigorescu C, Chalah MA, Ayache SS, Palm U. [Alexithymia in Multiple Sclerosis - Narrative Review]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:404-413. [PMID: 35948023 DOI: 10.1055/a-1882-6544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Alexithymia is a multidimensional construct of personality implicating difficulties in identifying and describing another's feelings, and externally oriented thinking. It is broadly reported in psychiatric patients but has gained little attention regarding its occurrence and pathophysiology in multiple sclerosis (MS). This narrative review aims to address prevalence, etiology, neurobiological, and clinical findings of alexithymia. The prevalence of alexithymia in MS ranges from 10 to 53%. There seems to be an association with anxiety, depression, fatigue, and some aspects of social cognition, while the relationship with clinical and classical cognitive variables was rarely evaluated. Only a few studies referred to its pathophysiology assuming an aberrant interhemispheric transfer or regional cerebral abnormalities. The prevalence of alexithymia in MS and the potential negative impact on quality of life and interpersonal communication could severely impact clinical MS management and a screnning for these factors should be mandatory. Thus, further evaluation is needed concerning its relationship with clinical, emotional, and cognitive confounders. Large-scale studies employing neuroimaging techniques are needed for a better understanding of the neural underpinnings of this MS feature.
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Affiliation(s)
- Christina Grigorescu
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Ulrich Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München
- Medical Park Chiemseeblick, Bernau a. Chiemsee
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Turkstra LS, Hosseini-Moghaddam S, Wohltjen S, Nurre SV, Mutlu B, Duff MC. Facial affect recognition in context in adults with and without TBI. Front Psychol 2023; 14:1111686. [PMID: 37645059 PMCID: PMC10461638 DOI: 10.3389/fpsyg.2023.1111686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Several studies have reported impaired emotion recognition in adults with traumatic brain injury (TBI), but studies have two major design features that limit application of results to real-world contexts: (1) participants choose from among lists of basic emotions, rather than generating emotion labels, and (2) images are typically presented in isolation rather than in context. To address these limitations, we created an open-labeling task with faces shown alone or in real-life scenes, to more closely approximate how adults with TBI label facial emotions beyond the lab. Methods Participants were 55 adults (29 female) with moderate to severe TBI and 55 uninjured comparison peers, individually matched for race, sex, and age. Participants viewed 60 photographs of faces, either alone or in the pictured person's real-life context, and were asked what that person was feeling. We calculated the percent of responses that were standard forced-choice-task options, and also used sentiment intensity analysis to compare verbal responses between the two groups. We tracked eye movements for a subset of participants, to explore whether gaze duration or number of fixations helped explain any group differences in labels. Results Over 50% of responses in both groups were words other than basic emotions on standard affect tasks, highlighting the importance of eliciting open-ended responses. Valence of labels by participants with TBI was attenuated relative to valence of Comparison group labels, i.e., TBI group responses were less positive to positive images and the same was true for negative images, although the TBI group responses had higher lexical diversity. There were no significant differences in gaze duration or number of fixations between groups. Discussion Results revealed qualitative differences in affect labels between adults with and without TBI that would not have emerged on standard forced-choice tasks. Verbal differences did not appear to be attributable to differences in gaze patterns, leaving open the question of mechanisms of atypical affect processing in adults with TBI.
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Affiliation(s)
- Lyn S. Turkstra
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Sophie Wohltjen
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Sara V. Nurre
- American Speech-Language-Hearing Association, Rockville, MD, United States
| | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, United States
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Torregrossa W, Raciti L, Rifici C, Rizzo G, Raciti G, Casella C, Naro A, Calabrò RS. Behavioral and Psychiatric Symptoms in Patients with Severe Traumatic Brain Injury: A Comprehensive Overview. Biomedicines 2023; 11:biomedicines11051449. [PMID: 37239120 DOI: 10.3390/biomedicines11051449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is defined as an altered brain structure or function produced by an external force. Adults surviving moderate and severe TBI often experience long-lasting neuropsychological and neuropsychiatric disorders (NPS). NPS can occur as primary psychiatric complications or could be an exacerbation of pre-existing compensated conditions. It has been shown that changes in behavior following moderate to severe TBI have a prevalence rate of 25-88%, depending on the methodology used by the different studies. Most of current literature has found that cognitive behavioral and emotional deficit following TBI occurs within the first six months whereas after 1-2 years the condition becomes stable. Identifying the risk factors for poor outcome is the first step to reduce the sequelae. Patients with TBI have an adjusted relative risk of developing any NPS several-fold higher than in the general population after six months of moderate-severe TBI. All NPS features of an individual's life, including social, working, and familiar relationships, may be affected by the injury, with negative consequences on quality of life. This overview aims to investigate the most frequent psychiatric, behavioral, and emotional symptoms in patients suffering from TBI as to improve the clinical practice and tailor a more specific rehabilitation training.
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Affiliation(s)
- William Torregrossa
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Loredana Raciti
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Carmela Rifici
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Giuseppina Rizzo
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Gianfranco Raciti
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Carmela Casella
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Antonino Naro
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
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Abstract
OBJECTIVE Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning. METHOD In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests. RESULTS In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments. CONCLUSION We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Travis Wearne
- School of Psychology, University of Western Sydney, Penrith South, Australia
| | - Michelle Kelly
- School of Psychological Sciences, University of Newcastle, Callaghan, Australia
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Dalokay EB, Aydin A. The relationship between alexithymia, communication skills and mental well-being of Nurses' in Turkey: A cross-sectional study. Arch Psychiatr Nurs 2023; 43:81-86. [PMID: 37032020 DOI: 10.1016/j.apnu.2022.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/22/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of this study is to examine the relationship between alexithymia, communication skills, and mental well-being of nurses. METHODS This descriptive and correlational study was conducted with 272 nurses working in a hospital in Turkey. Data were collected using the "Introductory Information Form", "Health Professionals Communication Skills Scale", "Warwick-Edinburgh Mental Wellbeing Scale", and "Toronto Alexithymia Scale". Mean and percentage distributions as well as Pearson's correlation analysis and multiple regression analysis were used to analyze the data. The STROBE checklist was used to report this study. RESULTS It was determined that non-alexithymic nurses had higher mean scores communication skills and in mental well-being compared to alexithymic nurses. The nurses' alexithymia scores were negatively correlated with their communication skills and mental well-being scores. On the other hand, their nurses' mental well-being scores were positively correlated with their communication skills scores. Communication skills and mental well-being of the nurses accounted for 38.5 % of their alexithymia levels. CONCLUSIONS It is recommended that awareness-based interventions be carried out since increasing the emotional awareness of nurses will contribute to the development of their professional skills as well as their positive psychological effects.
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Affiliation(s)
- Elif Buse Dalokay
- Eskişehir Osmangazi University Health, Practice and Research Hospital, Eskişehir, Turkey
| | - Adeviye Aydin
- Sinop University Faculty of Health Sciences Nursing Department, Sinop, Turkey.
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Klyce DW, Merced K, Erickson A, Neumann DM, Hammond FM, Sander AM, Bogner JA, Bushnik T, Chung JS, Finn JA. Perceived care partner burden at 1-year post-injury and associations with emotional awareness, functioning, and empathy after TBI: A TBI model systems study. NeuroRehabilitation 2023; 52:59-69. [PMID: 36617759 PMCID: PMC10325691 DOI: 10.3233/nre-220128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND People with traumatic brain injury (TBI) can lack awareness of their own emotions and often have problems with emotion dysregulation, affective disorders, and empathy deficits. These impairments are known to impact psychosocial behaviors and may contribute to the burden experienced by care partners of individuals with TBI. OBJECTIVE To examine the associations of emotional awareness, emotional functioning, and empathy among participants with TBI with care partner burden. METHOD This multisite, cross-sectional, observational study used data from 90 dyads (participants with TBI and their care partner) 1-year post-injury. Participants with TBI completed the Difficulty with Emotional Regulation Scale (DERS; Awareness, Clarity, Goals, Impulse, Nonacceptance, and Strategies subscales); PTSD Checklist-Civilian Version; NIH Toolbox Anger-Affect, Hostility and Aggression Subdomains; PHQ-9; GAD-7; and the Interpersonal Reactivity Index (empathic concern and perspective taking subscales). Care partners completed the Zarit Burden Inventory (ZBI) and provided demographic information. RESULTS Care partners were predominately female (77%), and most were either a spouse/partner (55.2%) or parent (34.4%). In an unadjusted model that included assessments of emotional awareness, emotional functioning, and empathy of the participant with TBI, the DERS-Awareness and NIH-Hostility subscales accounted for a significant amount of variance associated with care partner burden. These findings persisted after adjusting for care partner age, relationship, education, and the functional status of the participant with TBI (β= 0.493 and β= 0.328, respectively). CONCLUSION These findings suggest that high levels of hostility and low emotional self-awareness can significantly affect the burden felt by TBI care partners.
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Affiliation(s)
- Daniel W. Klyce
- Central Virginia VA Health Care System, Richmond, VA, USA
- Virginia Commonwealth University Health System, Richmond, VA, USA
- Sheltering Arms Institute, Richmond, VA, USA
| | | | - Alexander Erickson
- Central Virginia VA Health Care System, Richmond, VA, USA
- Palo Alto University, Palo Alto, CA, USA
| | - Dawn M. Neumann
- Indiana University School of Medicine, Indianapolis, IN, USA
- Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - Flora M. Hammond
- Indiana University School of Medicine, Indianapolis, IN, USA
- Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - Angelle M. Sander
- Baylor College of Medicine, Houston, TX, USA
- TIRR Memorial Hermann, Houston, TX, USA
| | | | - Tamara Bushnik
- New York University Langone Health, New York, NY, USA
- Rusk Rehabilitation Center, New York, NY, USA
| | | | - Jacob A. Finn
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
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Smith RA, Cross ES. The McNorm library: creating and validating a new library of emotionally expressive whole body dance movements. PSYCHOLOGICAL RESEARCH 2023; 87:484-508. [PMID: 35385989 PMCID: PMC8985749 DOI: 10.1007/s00426-022-01669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
The ability to exchange affective cues with others plays a key role in our ability to create and maintain meaningful social relationships. We express our emotions through a variety of socially salient cues, including facial expressions, the voice, and body movement. While significant advances have been made in our understanding of verbal and facial communication, to date, understanding of the role played by human body movement in our social interactions remains incomplete. To this end, here we describe the creation and validation of a new set of emotionally expressive whole-body dance movement stimuli, named the Motion Capture Norming (McNorm) Library, which was designed to reconcile a number of limitations associated with previous movement stimuli. This library comprises a series of point-light representations of a dancer's movements, which were performed to communicate to observers neutrality, happiness, sadness, anger, and fear. Based on results from two validation experiments, participants could reliably discriminate the intended emotion expressed in the clips in this stimulus set, with accuracy rates up to 60% (chance = 20%). We further explored the impact of dance experience and trait empathy on emotion recognition and found that neither significantly impacted emotion discrimination. As all materials for presenting and analysing this movement library are openly available, we hope this resource will aid other researchers in further exploration of affective communication expressed by human bodily movement.
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Affiliation(s)
- Rebecca A. Smith
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, Scotland
| | - Emily S. Cross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, Scotland ,Department of Cognitive Science, Macquarie University, Sydney, Australia
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Sherer M, Clark AN, Sander AM, Struchen MA, Bogaards J, Leon-Novelo L, Ngan E. Relationships of self-awareness and facial affect recognition to social communication ability in persons with traumatic brain injury. Neuropsychol Rehabil 2022; 32:2013-2028. [PMID: 35666684 DOI: 10.1080/09602011.2022.2084118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Traumatic brain injury (TBI) can cause changes to the injured person's physical ability, cognitive functioning, and social interactions. Since these attributes largely determine a person's concept of who they are, TBI poses a threat to sense of self. Due to the importance of social communication skills for community integration, impairment of these skills is a particular threat to sense of self. The present investigation sought to explore characteristics that influence social communication abilities. We hypothesized that both ability to interpret facial affect and self-awareness would be associated with communication ability. We also expected that facial affect recognition would influence self-awareness and that the effect of facial affect recognition on social communication would be partially mediated by self-awareness. For this prospective cohort study, participants were 77 individuals with documented TBI. Of these, 65% were male and 83% sustained severe injuries. The hypothesized association of facial affect recognition with social communication was demonstrated with path analysis as was the effect of facial affect recognition on self-awareness. However, the effect of facial affect recognition on social communication was not mediated by self-awareness. In addition, social communication was associated with employment, social integration, and loneliness. Findings highlighted the importance of social communication after TBI.
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Affiliation(s)
- Mark Sherer
- Brain Injury Research Center TIRR Memorial Hermann, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Allison N Clark
- Brain Injury Research Center TIRR Memorial Hermann, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.,Department of Physical Medicine and Rehabilitation, Harris Health System, Houston, TX, USA
| | - Angelle M Sander
- Brain Injury Research Center TIRR Memorial Hermann, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.,Department of Physical Medicine and Rehabilitation, Harris Health System, Houston, TX, USA
| | - Margaret A Struchen
- Center for Rehabilitation Psychology and Neuropsychology, PC, Walnut Creek, CA, USA
| | - Jay Bogaards
- Brain Injury Research Center TIRR Memorial Hermann, Houston, TX, USA
| | - Luis Leon-Novelo
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Esther Ngan
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Fynn DM, Preece DA, Gignac GE, Pestell CF, Allan A, Kraats CV, Green SL, Weinborn M, Becerra R. Assessing alexithymia in adults with acquired brain injury: Psychometric properties of the Perth Alexithymia Questionnaire. J Affect Disord 2022; 302:224-233. [PMID: 35092756 DOI: 10.1016/j.jad.2022.01.091] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/13/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Alexithymia is a multidimensional personality trait comprised of difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking. The assessment of alexithymia in people with acquired brain injury (ABI) is of clinical interest because alexithymia is linked to poor psychosocial functioning and community reintegration after ABI. To date, alexithymia measures have not been psychometrically investigated/validated in an ABI sample, restricting confident empirical work in this area. We aimed to fill this gap by assessing the psychometric properties of the Perth Alexithymia Questionnaire (PAQ) in adults with ABI and determining whether the alexithymia construct manifests similarly in ABI samples compared to the general community. METHODS The PAQ and Depression Anxiety Stress Scales-21 were administered to an ABI sample (N = 350) and a community sample (N = 1012). Factor structure, measurement invariance, internal consistency reliability, and concurrent/discriminant validity were explored. RESULTS Our confirmatory factor analysis of the PAQ supported the intended five-factor correlated model as the best solution, where items loaded well onto the five intended subscales. This factor structure was invariant across ABI and community samples. Good reliability and concurrent and discriminant validity were also established. LIMITATIONS The PAQ is a self-report measure and may be impacted by insight deficits known to occur after ABI. CONCLUSION Our data suggests that the PAQ has good validity and reliability as a measure of alexithymia. The latent structure of alexithymia manifests similarly in ABI and community samples. This study provides the first psychometric foundation for confident assessment of alexithymia in ABI.
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Affiliation(s)
- Danielle M Fynn
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | | | - Gilles E Gignac
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Carmela F Pestell
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | | | | | - Sarah L Green
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Michael Weinborn
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Rodrigo Becerra
- The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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Rodríguez-Rajo P, García-Rudolph A, Sánchez-Carrión R, Aparicio-López C, Enseñat-Cantallops A, García-Molina A. Computerized social cognitive training in the subacute phase after traumatic brain injury: A quasi-randomized controlled trial. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-14. [PMID: 35196474 DOI: 10.1080/23279095.2022.2042693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To assess the usefulness of a computerized tasks module designed for the rehabilitation of social cognition (SC) in acquired brain injury. METHODS Quasi-randomized controlled trial (ClinicalTrials.gov:NCT03479970) involving 45 patients with moderate-severe traumatic brain injury (TBI) in a subacute inpatient rehabilitation hospital. The experimental group (n = 28) received treatment with a computerized SC module in combination with a non-SC module. The control group (n = 26) only received a treatment with non-SC module. RESULTS Intragroup comparisons showed that the experimental group had better results for all SC measures, except for International Affective Picture System (IAPS). The control group improved for Facial Expressions of cEmotion-Stimuli and Tests (FEEST) and Moving Shapes Paradigm (MSP), showing no changes with respect to pretreatment in IAPS, MSP and Reading the Mind in the Eyes Test (RMET). Intergroup comparisons did not present differences between the two groups for pretreatment measures. Post-treatment comparison showed that the experimental group obtained better results for RMET than the control group. CONCLUSION The computerized SC module was useful for the rehabilitation of SC in patients with moderate-severe TBI in the subacute phase. The group that received combined rehabilitative treatment (SC + non-SC) obtained better results for SC than the group that received treatment intended only for non-SC.
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Affiliation(s)
- P Rodríguez-Rajo
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A García-Rudolph
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - R Sánchez-Carrión
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - C Aparicio-López
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - A Enseñat-Cantallops
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - A García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
- Facultad de Psicología, Centro de Estudios en Neurociencia Humana y Neuropsicología, Universidad Diego Portales, Santiago de Chile, Chile
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Brewer R, Murphy J, Bird G. Atypical interoception as a common risk factor for psychopathology: A review. Neurosci Biobehav Rev 2021; 130:470-508. [PMID: 34358578 PMCID: PMC8522807 DOI: 10.1016/j.neubiorev.2021.07.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023]
Abstract
The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.
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Affiliation(s)
- Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Jennifer Murphy
- Department of Psychology, Royal Holloway, University of London, United Kingdom.
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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13
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The relationship between alexithymia and theory of mind: A systematic review. Neurosci Biobehav Rev 2021; 131:497-524. [PMID: 34599917 DOI: 10.1016/j.neubiorev.2021.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 12/19/2022]
Abstract
Theory of Mind (ToM), the ability to represent the mental states of oneself and others, is an essential social skill disrupted across many psychiatric conditions. The transdiagnostic nature of ToM impairment means it is plausible that ToM impairment is related to alexithymia (difficulties identifying and describing one's own emotions), as alexithymia is seen across psychiatric conditions. Whilst many studies have examined links between alexithymia and ToM, results are mixed. Therefore, the purpose of this systematic review is to provide a taxonomy of ToM tests and assess their relationship with alexithymia. Tests are grouped according to whether they assess propensity to engage spontaneously in ToM or accuracy of ToM inferences, with tests further subdivided into those that do, and do not, require emotion recognition. A review of 63 suitable studies suggests that alexithymia is often associated with reduced ToM, and inaccurate ToM when tasks require emotion recognition. This latter finding appears due to impaired emotion recognition, rather than ToM impairment per se. Further directions and considerations for future research are discussed.
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14
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Johnstone B, Cohen D, Dennison A. The integration of sensations and mental experiences into a unified experience: A neuropsychological model for the "sense of self". Neuropsychologia 2021; 159:107939. [PMID: 34237328 DOI: 10.1016/j.neuropsychologia.2021.107939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/16/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022]
Abstract
A continued weakness in the cognitive neurosciences is the lack of a model to explain the phenomenological experience of the "self." This article proposes a model that suggests that the right hemisphere association area integrates physical sensations and mental experiences into a unified experience (i.e., a "sense of self") that is best conceptualized and understood as the subjective experience of "mineness." This model presents a unifying framework for neurologic and psychiatric disorders of the self (i.e., dis-integrated sense of "mineness"), as well as a neuropsychological framework to explain several human characteristics and experiences. Research is reviewed that indicates the sense of self can be activated to serve as the neuropsychological foundation of "self-integrated" character traits such as empathy (i.e., experiencing other's thoughts/emotions as "mine"), and conversely, the inhibition of this integrative process which can serve as the foundation of "selfless" experiences such as transcendence and forgiveness. Future research and clinical applications are discussed.
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Affiliation(s)
| | - Daniel Cohen
- Department of Religious Studies, University of Missouri, USA
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15
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Problems with Social Cognition and Decision-Making in Huntington's Disease: Why Is it Important? Brain Sci 2021; 11:brainsci11070838. [PMID: 34202701 PMCID: PMC8301991 DOI: 10.3390/brainsci11070838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 01/21/2023] Open
Abstract
Huntington’s disease starts slowly and progresses over a 15–20 year period. Motor changes begin subtly, often going unnoticed by patients although they are typically visible to those close to them. At this point, it is the early non-motor problems of HD that arguably cause the most functional impairment. Approximately 65% of gene carriers will experience a reduction in their occupational level, and just under half will feel unable to manage their finances independently before a clinical diagnosis is made. Understanding what drives this impairment in activities of daily living is the key to helping people with HD to live more independently for longer, especially in early disease. Early cognitive decline is likely to play a contributory factor although few studies have looked directly at this relationship. Recently, it has been shown that along with the well documented dysexecutive syndrome seen in HD, changes in social cognition and decision-making are more common than previously thought. Furthermore, some of the early neuropathological and neurochemical changes seen in HD disrupt networks known to be involved in social functioning. In this review, we explore how HD changes the way individuals interact in a social world. Specifically, we summarise the literature on both classical and social decision-making (value-based decision-making in a social context) along with studies of theory of mind, empathy, alexithymia, and emotion recognition in HD. The literature specific to HD is discussed and supported by evidence from similar neurodegenerative disorders and healthy individuals to propose future directions and potential therapeutic avenues to be explored.
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16
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Emotion Recognition and Traumatic Brain Injury: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2021; 32:520-536. [PMID: 34131885 DOI: 10.1007/s11065-021-09510-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
Traumatic brain injury (TBI) can lead to impairments in emotion recognition that can present considerable challenges to social communication and the maintenance of interpersonal relationships. This review aimed to estimate the magnitude of emotion recognition impairments in TBI patients overall, and at the emotion category level, and to determine if the magnitude of observed impairments were moderated by modality (e.g., face, voice, multi-modal) of emotional expression, and severity of injury. Searches of PubMed, Scopus, PsycINFO, and Medline databases identified 17 studies which satisfied strict inclusion and exclusion criteria for the systematic review (comparing TBI patients to matched controls). Of these studies, 15 were included in the meta-analysis (NTBI = 474; NControl = 461). Moderate/large average deficits emerged for TBI patients relative to controls (Hedges' g = 0.79, 95% CI: 0.61 - 0.96, p < .001; Q = 22.53, p = .068, τ2 = 0.04, I2 = 37.84; indicating low heterogeneity). TBI patients were impaired across all emotion categories, with moderate/large effect sizes observed for fear and anger, moderate effect sizes for disgust, neutral and sadness, while effect sizes for happiness and surprise were small. The magnitude of impairment for individuals with TBI severity classified as moderate/severe TBI was moderate, whereas severe TBI was large. Moderate/large effect sizes were observed across the different modalities of presentation. This meta-analysis provides evidence for marked global impairments in emotion recognition, with the magnitude of impairment greatest for negative emotions (i.e., anger and fear). This meta-analysis provided no evidence to suggest that the magnitude of impairment is influenced by injury severity or modality of stimulus presentation. Recommendations for future research are discussed.
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17
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Zimmermann KM, Schmidt KD, Gronow F, Sommer J, Leweke F, Jansen A. Seeing things differently: Gaze shapes neural signal during mentalizing according to emotional awareness. Neuroimage 2021; 238:118223. [PMID: 34098065 DOI: 10.1016/j.neuroimage.2021.118223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 12/19/2022] Open
Abstract
Studies on social cognition often use complex visual stimuli to asses neural processes attributed to abilities like "mentalizing" or "Theory of Mind" (ToM). During the processing of these stimuli, eye gaze, however, shapes neural signal patterns. Individual differences in neural operations on social cognition may therefore be obscured if individuals' gaze behavior differs systematically. These obstacles can be overcome by the combined analysis of neural signal and natural viewing behavior. Here, we combined functional magnetic resonance imaging (fMRI) with eye-tracking to examine effects of unconstrained gaze on neural ToM processes in healthy individuals with differing levels of emotional awareness, i.e. alexithymia. First, as previously described for emotional tasks, people with higher alexithymia levels look less at eyes in both ToM and task-free viewing contexts. Further, we find that neural ToM processes are not affected by individual differences in alexithymia per se. Instead, depending on alexithymia levels, gaze on critical stimulus aspects reversely shapes the signal in medial prefrontal cortex (MPFC) and anterior temporoparietal junction (TPJ) as distinct nodes of the ToM system. These results emphasize that natural selective attention affects fMRI patterns well beyond the visual system. Our study implies that, whenever using a task with multiple degrees of freedom in scan paths, ignoring the latter might obscure important conclusions.
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Affiliation(s)
- Kristin Marie Zimmermann
- Laboratory for Multimodal Neuroimaging, Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen.
| | - Kirsten Daniela Schmidt
- Laboratory for Multimodal Neuroimaging, Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Franziska Gronow
- Laboratory for Multimodal Neuroimaging, Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen
| | - Jens Sommer
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen; Core-Unit Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Frank Leweke
- Clinic for Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Andreas Jansen
- Laboratory for Multimodal Neuroimaging, Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen; Core-Unit Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
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18
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Cristofori I, Zhong W, Cohen-Zimerman S, Bulbulia J, Gordon B, Krueger F, Grafman J. Brain networks involved in the influence of religion on empathy in male Vietnam War veterans. Sci Rep 2021; 11:11047. [PMID: 34040097 PMCID: PMC8155118 DOI: 10.1038/s41598-021-90481-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/07/2021] [Indexed: 11/18/2022] Open
Abstract
Humans all over the world believe in spirits and deities, yet how the brain supports religious cognition remains unclear. Drawing on a unique sample of patients with penetrating traumatic brain injuries (pTBI) and matched healthy controls (HCs) we investigate dependencies of religious cognition on neural networks that represent (1) others agents’ intentions (Theory of Mind, ToM) and (2) other agents’ feelings (Empathy). Extending previous observations that ToM networks are recruited during prayer, we find that people with vmPFC damage report higher scores on the personal relationship with God inventory even when they are not praying. This result offers evidence that it is the modulation of ToM networks that support beliefs in supernatural agents. With respect to empathetic processing, we observed that vmPFC and pSTS/TPJ lesions mediated by the strength of the personal relationship with God affect empathetic responses. We suggest that the neurological networks underpinning God representations amplify human empathetic responses. The cultural evolutionary study of religion has argued that supernatural beliefs evoke pro-social responses because people fear the wrath of Gods. Our findings imply greater attention should be paid to the mechanisms by which religious cognition may regulate empathetic responses to others.
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Affiliation(s)
- Irene Cristofori
- Institute of Cognitive Sciences Marc Jeannerod CNRS, UMR 5229, 67 Boulevard Pinel, 69675, Bron, France. .,University of Lyon, Etablissement 1, Villeurbanne, France.
| | - Wanting Zhong
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Shira Cohen-Zimerman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Joseph Bulbulia
- School of Psychology, Faculty of Science, Victoria University of Wellington, Wellington, New Zealand.,Max Plank Institute for the Science of Human History, Jena, Germany
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Frank Krueger
- School of Systems Biology, George Mason University, Fairfax, VA, USA.,Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.,Department of Neurology, Feinberg School of Medicine, Chicago, IL, USA.,Department of Psychiatry, Feinberg School of Medicine, Chicago, IL, USA.,Department of Cognitive Neurology & Alzheimer's Disease, Feinberg School of Medicine, Chicago, IL, USA.,Department of Psychology, Northwestern University, Chicago, IL, USA
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19
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Fryc AM, Raudales AM, Nelson-Aguiar RR, Risi MM, Weiss NH. The Role of Presumed Head and Neck Injuries in Emotion Dysregulation Among Community Women With a History of Physical Intimate Partner Violence. Violence Against Women 2021; 28:417-442. [PMID: 34018422 DOI: 10.1177/10778012211005568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intimate partner violence (IPV) is prevalent among women and associated with negative outcomes, including emotion dysregulation. Limited research has examined factors that contribute to emotion dysregulation in this population. This study explores the potential influence of presumed head and neck injuries from IPV on five dimensions of emotion dysregulation. Participants were 352 community women who responded to an online survey. Results of a path analysis indicated that presumed head and neck injuries from IPV were significantly associated with lack of emotional clarity and difficulties engaging in goal-directed behaviors when experiencing emotions. Findings suggest an association between presumed head and neck injuries from IPV and emotion dysregulation, underscoring the potential need for considering both neurological and psychological factors in the assessment and treatment of emotion dysregulation in this population.
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20
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Fynn DM, Gignac GE, Becerra R, Pestell CF, Weinborn M. The Prevalence and Characteristics of Alexithymia in Adults Following Brain Injury: A Meta-Analysis. Neuropsychol Rev 2021; 31:722-738. [PMID: 33624197 DOI: 10.1007/s11065-021-09484-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/07/2021] [Indexed: 01/06/2023]
Abstract
Alexithymia is the inability to identify and describe one's own emotions. Some research suggests that organic alexithymia may occur after acquired brain injury (ABI). However, the results in the literature are inconsistent, when comparisons are made against healthy controls. Furthermore, a precise estimate of alexithymia prevalence in the ABI population has not yet been reported. Consequently, this meta-analysis aimed to estimate the prevalence and characteristics of alexithymia in ABI, as measured by the Toronto Alexithymia Scale-20 (TAS-20). Based on 22 unique ABI samples, a series of random-effects meta-analyses estimated moderate to large positive effect sizes (i.e., greater alexithymia in ABI samples) for the TAS-20 total scale (Hedges' g = 1.00, 95% CI [0.75, 1.35]), as well as the subscales: difficulty identifying feelings (Hedges' g = 0.92, 95% CI [0.66, 1.17]), difficulty describing feelings (Hedges' g = 0.69, 95% CI [0.50, 0.87]) and externally oriented thinking (Hedges' g = 0.75, 95% CI [0.64, 0.85]). Furthermore, a meta-regression identified a larger effect size (TAS-20 total scale score) for traumatic brain injury (TBI) samples, in comparison to non-TBI samples. Finally, the prevalence of clinically significant levels of alexithymia (TAS-20 total scale ≥ 68.4; i.e., two SDs above the general population mean) in ABI patients was estimated at 15.2%. We interpreted the results to suggest that ABI may have a substantial negative impact on affective processing abilities and, thus, comprehensive assessment of emotional functioning deficits following ABI should be considered by practitioners.
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Affiliation(s)
- Danielle M Fynn
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Gilles E Gignac
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Rodrigo Becerra
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Carmela F Pestell
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Michael Weinborn
- School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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21
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The relationship between vocal affect recognition and psychosocial functioning for people with moderate to severe traumatic brain injury: a systematic review. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2020.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe purpose of this review was to explore how vocal affect recognition deficits impact the psychosocial functioning of people with moderate to severe traumatic brain injury (TBI). A systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines was conducted, whereby six databases were searched, with additional hand searching of key journals also completed. The search identified 1847 records after duplicates were removed, and 1749 were excluded through title and abstract screening. After full text screening of 65 peer-reviewed articles published between January 1999 and August 2019, only five met inclusion criteria. The methodological quality of selected studies was assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018 with a fair level of agreement reached. A narrative synthesis of the results was completed, exploring vocal affect recognition and psychosocial functioning of people with moderate to severe TBI, including aspects of social cognition (i.e., empathy; Theory of Mind) and social behaviour. Results of the review were limited by a paucity of research in this area, a lack of high-level evidence, and wide variation in the outcome measures used. More rigorous study designs are required to establish more conclusive evidence regarding the degree and direction of the association between vocal affect recognition and aspects of psychosocial functioning. This review is registered with Prospero.
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22
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Nadeau SE. Treatment of disorders of emotional comprehension, expression, and emotional semantics. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:283-297. [PMID: 34389123 DOI: 10.1016/b978-0-12-822290-4.00013-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurological disease can impair emotional communication by several means: damaging the networks important in understanding the meaning of emotional stimuli (emotional semantics); damaging networks important in the perceptual recognition and production of emotional stimuli, and damaging the connections between networks supporting emotional semantics and recognition/production networks. Disorders of emotional expression, comprehension, and emotional semantics may improve with pharmacological or behavioral treatments. Pharmacological treatments can be used to redress naturally occurring or disease-related alterations in the computational properties of target neural systems. No drug treatment can replace a loss of cerebral knowledge related to the pathological loss of neural connectivity. Behavioral treatments that benefit either comprehension or expression of specific emotions may be of value if these emotions are particularly important in enabling human social interaction. However, behavioral treatments that achieve generalization, that is, improve performance with untrained exemplars and in daily life, are much to be preferred, even as they pose the greatest methodological challenges. This chapter will discuss possible mechanisms of generalization and then review what is known about the treatment of expressive and receptive affective aprosodia, deficits in recognition of facial emotions, and pseudobulbar affect. The final section of the chapter is devoted to a discussion of three disorders of emotional semantics, apathy, alexithymia, and impaired empathy.
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Affiliation(s)
- Stephen E Nadeau
- Research Service and the Brain Rehabilitation Research Center, Malcom Randall Veteran Affairs Medical Center, Gainesville, FL, United States; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States.
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23
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Neumann D, Sander AM, Perkins SM, Bhamidipalli SS, Hammond FM. Negative Attribution Bias and Related Risk Factors After Brain Injury. J Head Trauma Rehabil 2021; 36:E61-E70. [PMID: 32769831 PMCID: PMC7769858 DOI: 10.1097/htr.0000000000000600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE In participants with traumatic brain injury (TBI) and peer controls, examine (1) differences in negative attributions (interpret ambiguous behaviors negatively); (2) cognitive and emotional factors associated with negative attributions; and (3) negative attribution associations with anger responses, life satisfaction, and participation. SETTING Two TBI outpatient rehabilitation centers. PARTICIPANTS Participants with complicated mild to severe TBI (n = 105) and peer controls (n = 105). DESIGN Cross-sectional survey study. MAIN MEASURES Hypothetical scenarios describing ambiguous behaviors were used to assess situational anger and attributions of intent, hostility, and blame. Executive functioning, perspective taking, emotion perception and social inference, alexithymia, aggression, anxiety, depression, participation, and life satisfaction were also assessed. RESULTS Compared with peer controls, participants with TBI rated behaviors significantly more intentional, hostile, and blameworthy. Regression models explained a significant amount of attribution variance (25%-43%). Aggression was a significant predictor in all models; social inference was also a significant predictor of intent and hostility attributions. Negative attributions were associated with anger responses and lower life satisfaction. CONCLUSION People with TBI who have higher trait aggression and poor social inferencing skills may be prone to negative interpretations of people's ambiguous actions. Negative attributions and social inferencing skills should be considered when treating anger problems after TBI.
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Affiliation(s)
- Dawn Neumann
- Departments of Physical Medicine and Rehabilitation (Drs Neumann and Hammond) and Biostatistics (Dr Perkins and Ms Bhamidipalli), Indiana University School of Medicine, Indianapolis; Rehabilitation Hospital of Indiana, Indianapolis (Drs Neumann and Hammond); Division of Clinical Neuropsychology and Rehabilitation Psychology, H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander)
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24
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Abstract
Humans are highly adept at differentiating, regulating, and responding to their emotions. At the core of all these functions is emotional awareness: the conscious feeling states that are central to human mental life. Disrupted emotional awareness-a subclinical construct commonly referred to as alexithymia-is present in a range of psychiatric and neurological disorders and can have a deleterious impact on functional outcomes and treatment response. This chapter is a selective review of the current state of the science on alexithymia. We focus on two separate but related issues: (i) the functional deficits associated with alexithymia and what they reveal about the importance of emotional awareness for shaping normative human functioning, and (ii) the neural correlates of alexithymia and what they can inform us about the biological bases of emotional awareness. Lastly, we outline challenges and opportunities for alexithymia research, focusing on measurement issues and the potential utility of formal computational models of emotional awareness for advancing the fields of clinical and affective science.
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Affiliation(s)
- Jeremy Hogeveen
- Department of Psychology and Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, NM, United States.
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Brain Injury Research, Shirley Ryan AbilityLab, Chicago, IL, United States; Departments of Physical Medicine and Rehabilitation, Neurology, and Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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25
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Lu X, Zhang R. Impact of patient information behaviours in online health communities on patient compliance and the mediating role of patients' perceived empathy. PATIENT EDUCATION AND COUNSELING 2021; 104:186-193. [PMID: 32665071 DOI: 10.1016/j.pec.2020.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patient health information seeking and physician-patient communication in OHCs proved to have impacts on patient compliance, but related studies from psychological perspectives are limited. This study aims to investigate the impact of patient health information seeking and physician-patient communication in OHCs on patient compliance. METHODS This study established a research model and proposed six hypotheses. An anonymous investigation was conducted using Chinese OHCs. Confirmatory factor analysis, partial least squares, and structural equation modelling were used to test the hypotheses. RESULTS We received 371 responses, and 316 of them were valid. Patient health information seeking and physician-patient communication frequency in OHCs had positive impacts on patients' perceived affective and cognitive empathies, which positively impacted patient compliance. CONCLUSIONS Patient compliance can be improved by patient health information seeking and physician-patient communication in OHCs and affective and cognitive empathies. Patients' perceived affective empathy is the preferred perspective to improve patient compliance. PRACTICE IMPLICATIONS Physicians should encourage patients to seek health information and communicate with them through OHCs, be concerned about patients' experiences, feelings, and attitudes, understand patients' demands and mental states, and show their patients that they can feel patients' pain. Increasing physician-patient communication frequency in OHCs can help improve patient compliance.
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Affiliation(s)
- Xinyi Lu
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Runtong Zhang
- School of Economics and Management, Beijing Jiaotong University, Beijing, China.
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26
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Establishing 'proof of concept' for a social cognition group treatment program (SIFT IT) after traumatic brain injury: two case studies. Brain Inj 2020; 34:1781-1793. [PMID: 33180565 DOI: 10.1080/02699052.2020.1831072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Social cognitive deficits are prevalent after traumatic brain injury (TBI). Despite this, few remediation studies exist. This study aimed to demonstrate 'proof of concept' for a novel group treatment that comprehensively targeted the core processes of social cognition. DESIGN Pre-post case study with two participants, "Greg" and "Aaron", living with severe TBI, with three assessment time points. METHOD Participants were screened at baseline to confirm social cognitive deficits: Greg exhibited difficulties with emotion perception and detecting hints; Aaron with detecting sarcasm and hints. Both reported everyday social problems. Participants then completed the 14-week group treatment program (SIFT IT). Feasibility and outcome measures were repeated post-group and at three-month follow-up. RESULTS The study procedure was implemented with 100% assessment and 89% SIFT IT session attendance, albeit with a lack of proxy-report measures. Both participants described procedures as acceptable, although suggested more group participants could be beneficial. They both demonstrated reliable improvements (RCI > 1.96) on relevant social cognitive measures. Qualitative feedback corroborated findings: Greg reported generalization of therapeutic gains, Aaron reported increased self-awareness but nominal generalization. CONCLUSION Feasibility and limited efficacy outcomes established 'proof of concept' of SIFT IT. Findings will inform the study protocol for a larger randomized-controlled trial.
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27
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Neumann D, Zupan B. Sex Differences in Emotional Insight After Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 101:1922-1928. [PMID: 32445846 DOI: 10.1016/j.apmr.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare sex differences in alexithymia (poor emotional processing) in males and females with traumatic brain injury (TBI) and uninjured controls. DESIGN Cross-sectional study. SETTING TBI rehabilitation facility in the United States and a university in Canada. PARTICIPANTS Sixty adults with moderate to severe TBI (62% men) and 60 uninjured controls (63% men) (N=120). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Toronto Alexithymia Scale-20 (TAS-20). RESULTS Uninjured men had significantly higher (worse) alexithymia scores than uninjured female participants on the TAS-20 (P=.007), whereas, no sex differences were found in the TBI group (P=.698). Men and women with TBI had significantly higher alexithymia compared with uninjured same-sex controls (both P<.001). The prevalence of participants with scores exceeding alexithymia sex-based norms for men and women with TBI was 37.8% and 47.8%, respectively, compared with 7.9% and 0% for men and women without TBI. CONCLUSIONS Contrary to most findings in the general population, men with TBI were not more alexithymic than their female counterparts with TBI. Both men and women with TBI have more severe alexithymia than their uninjured same-sex peers. Moreover, both are equally at risk for elevated alexithymia compared with the norms. Alexithymia should be evaluated and treated after TBI regardless of patient sex.
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Affiliation(s)
- Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC, Canada.
| | - Barbra Zupan
- Department of Applied Linguistics, Brock University, St. Catharines, ON, Canada
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Williams JHG, Huggins CF, Zupan B, Willis M, Van Rheenen TE, Sato W, Palermo R, Ortner C, Krippl M, Kret M, Dickson JM, Li CSR, Lowe L. A sensorimotor control framework for understanding emotional communication and regulation. Neurosci Biobehav Rev 2020; 112:503-518. [PMID: 32070695 PMCID: PMC7505116 DOI: 10.1016/j.neubiorev.2020.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Our research team was asked to consider the relationship of the neuroscience of sensorimotor control to the language of emotions and feelings. Actions are the principal means for the communication of emotions and feelings in both humans and other animals, and the allostatic mechanisms controlling action also apply to the regulation of emotional states by the self and others. We consider how motor control of hierarchically organised, feedback-based, goal-directed action has evolved in humans, within a context of consciousness, appraisal and cultural learning, to serve emotions and feelings. In our linguistic analysis, we found that many emotion and feelings words could be assigned to stages in the sensorimotor learning process, but the assignment was often arbitrary. The embodied nature of emotional communication means that action words are frequently used, but that the meanings or senses of the word depend on its contextual use, just as the relationship of an action to an emotion is also contextually dependent.
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Affiliation(s)
- Justin H G Williams
- University of Aberdeen, Institute of Medical Sciences, Foresterhill, AB25 2ZD, Scotland, United Kingdom.
| | - Charlotte F Huggins
- University of Aberdeen, Institute of Medical Sciences, Foresterhill, AB25 2ZD, Scotland, United Kingdom
| | - Barbra Zupan
- Central Queensland University, School of Health, Medical and Applied Sciences, Bruce Highway, Rockhampton, QLD 4702, Australia
| | - Megan Willis
- Australian Catholic University, School of Psychology, ARC Centre for Excellence in Cognition and its Disorders, Sydney, NSW 2060, Australia
| | - Tamsyn E Van Rheenen
- University of Melbourne, Melbourne Neuropsychiatry Centre, Department of Psychiatry, 161 Barry Street, Carlton, VIC 3053, Australia
| | - Wataru Sato
- Kyoto University, Kokoro Research Centre, 46 Yoshidashimoadachicho, Sakyo Ward, Kyoto, 606-8501, Japan
| | - Romina Palermo
- University of Western Australia, School of Psychological Science, Perth, WA, 6009, Australia
| | - Catherine Ortner
- Thompson Rivers University, Department of Psychology, 805 TRU Way, Kamloops, BC V2C 0C8, Canada
| | - Martin Krippl
- Otto von Guericke University Magdeburg, Faculty of Natural Sciences, Department of Psychology, Universitätsplatz 2, Magdeburg, 39106, Germany
| | - Mariska Kret
- Leiden University, Cognitive Psychology, Pieter de la Court, Waassenaarseweg 52, Leiden, 2333 AK, the Netherlands
| | - Joanne M Dickson
- Edith Cowan University, Psychology Department, School of Arts and Humanities, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Chiang-Shan R Li
- Yale University, Connecticut Mental Health Centre, S112, 34 Park Street, New Haven, CT 06519-1109, USA
| | - Leroy Lowe
- Neuroqualia, Room 229A, Forrester Hall, 36 Arthur Street, Truro, Nova Scotia, B2N 1X5, Canada
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Johnstone B, Kvandal A, Winslow R, Kilgore J, Guerra M. The behavioral presentation of an individual with a disordered sense of self. Brain Inj 2020; 34:438-443. [DOI: 10.1080/02699052.2020.1717622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Brick Johnstone
- Defense and Veterans Brain Injury Center, Fort Belvoir Intrepid Spirit Center, Fort Belvoir, Virginia, USA
| | - Aimee Kvandal
- Defense and Veterans Brain Injury Center, Fort Belvoir Intrepid Spirit Center, Fort Belvoir, Virginia, USA
| | - Robin Winslow
- Fort Belvoir Intrepid Spirit Center, Fort Belvoir, Virginia, USA
| | - Jocelyn Kilgore
- Fort Belvoir Intrepid Spirit Center, Fort Belvoir, Virginia, USA
| | - Melissa Guerra
- Fort Belvoir Intrepid Spirit Center, Fort Belvoir, Virginia, USA
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Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, Malec JF, Bergquist TF, Kingsley K, Nagele D, Trexler L, Fraas M, Bogdanova Y, Harley JP. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Arch Phys Med Rehabil 2019; 100:1515-1533. [DOI: 10.1016/j.apmr.2019.02.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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Roelofs RL, Wingbermühle E, Kessels RPC, Egger JIM. Social cognitive training for adults with Noonan syndrome: a feasibility study. Neuropsychiatr Dis Treat 2019; 15:611-626. [PMID: 30880986 PMCID: PMC6396661 DOI: 10.2147/ndt.s179527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Noonan syndrome (NS) is a genetic disorder that is associated with social cognitive problems. While treatment aimed at the improvement of social cognition is available for other neuropsychiatric disorders, no such interventions yet exist for NS patients. In this study, the development of the first social cognitive training for NS patients is described and its applicability and feasibility evaluated. METHODS Eleven adult patients with NS participated in this controlled proof-of-principle study. Six patients were included in the treatment group and five in the control group. Neuropsychological testing was performed in both groups at baseline and posttreatment. Social cognition was a primary outcome measure and nonsocial cognition and psychopathology secondary outcome measures. Differences between pre- and posttest were investigated with Wilcoxon signed-rank tests, and a process evaluation was performed to aid interpretation of the results. RESULTS Both groups were comparable with regard to age, estimated intelligence, and baseline performance. Although no significant differences were found between pre- and posttest scores on primary and secondary outcome measures in either group, a medium-large effect size was found on emotion recognition in the treatment group. Also, the process evaluation demonstrated the feasibility of the training. CONCLUSION This first social cognitive training for adult patients with NS has proven to be feasible for this population and showed some encouraging results regarding emotion recognition, although the training protocol could be optimized. Further investigation is required using a randomized controlled design in a larger sample, in order to substantiate the overall effectiveness of the training.
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Affiliation(s)
- Renée L Roelofs
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands, .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands,
| | - Ellen Wingbermühle
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands, .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands,
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands, .,Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos I M Egger
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands, .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands, .,Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Stevig Specialized and Forensic Care for Patients with Intellectual Disabilities, Dichterbij, Oostrum, The Netherlands
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Neumann D, Zupan B. Empathic Responses to Affective Film Clips Following Brain Injury and the Association With Emotion Recognition Accuracy. Arch Phys Med Rehabil 2018; 100:458-463. [PMID: 30142314 DOI: 10.1016/j.apmr.2018.07.431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/03/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare empathic responses to affective film clips in participants with traumatic brain injury (TBI) and controls, and examine associations with affect recognition. DESIGN Cross sectional study using a quasi-experimental design. SETTING Multi-site study conducted at a postacute rehabilitation facility in the United States and a university in Canada. PARTICIPANTS Adults (N=120) with moderate to severe TBI (n=60) and those without TBI (n=60), frequency matched for age and sex. Average time postinjury was 14 years (range: .5-37). MAIN OUTCOME MEASURES Participants were shown affective film clips and asked to report how the main character in the clip felt and how they personally felt in response to the clip. Empathic responses were operationalized as participants feeling the same emotion they identified the character to be feeling. RESULTS Participants with TBI had lower emotion recognition scores (P=.007) and fewer empathic responses than controls (67% vs 79%; P<.001). Participants with TBI accurately identified and empathically responded to characters' emotions less frequently (65%) than controls (78%). Participants with TBI had poorer recognition scores and fewer empathic responses to sad and fearful clips compared to controls. Affect recognition was associated with empathic responses in both groups (P<.001). When participants with TBI accurately recognized characters' emotions, they had an empathic response 71% of the time, which was more than double their empathic responses for incorrectly identified emotions. CONCLUSIONS Participants with TBI were less likely to recognize and respond empathically to others' expressions of sadness and fear, which has implications for interpersonal interactions and relationships. This is the first study in the TBI population to demonstrate a direct association between an affect stimulus and an empathic response.
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Affiliation(s)
- Dawn Neumann
- Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, Indianapolis, IN.
| | - Barbra Zupan
- School of Health, Medical, and Applied Sciences, Department of Exercise and Health Sciences, Central Queensland University, Rockhampton, QLD, Australia
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Babbage DR, Zupan B, Neumann D, Willer B. Sex differences in response to emotion recognition training after traumatic brain injury. Brain Inj 2018; 32:1492-1499. [PMID: 30015503 DOI: 10.1080/02699052.2018.1497811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine sex differences in the effectiveness of a Stories intervention for teaching affect recognition in people with a traumatic brain injury (TBI). SETTING Post-acute rehabilitation facilities. PARTICIPANTS 203 participants (53 women and 150 men) with moderate to severe TBI were screened. 71 were eligible and randomized to one of three treatment conditions: two affect recognition conditions and an active control (cognition). This paper examines sex differences between the Stories intervention (n = 23, 5 women and 18 men) and the cognitive treatment control (n = 24, 8 women and 16 men). DESIGN Randomized controlled trial with immediate, 3- and 6-month follow-up post-tests. Interventions were 9 hours of computer-based training with a therapist. MEASURES Facial Affect Recognition (DANVA2-AF); Emotional Inference from Stories Test (EIST). RESULTS A significant treatment effect was observed for the Stories intervention for women, who demonstrated and maintained improved facial affect recognition. In contrast, males in our sample did not benefit from the Stories intervention. CONCLUSION This positive finding for the Stories intervention for females contrasts with our conclusions in a previous paper, where an analysis collapsed across sex did not reveal an overall effectiveness of the Stories intervention. This intervention warrants further research and development.
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Affiliation(s)
- Duncan R Babbage
- a Centre for Person Centred Research , Auckland University of Technology , Auckland , New Zealand.,b Centre for eHealth , Auckland University of Technology , Auckland , New Zealand
| | - Barbra Zupan
- c Department of Exercise and Health Sciences , Central Queensland University, School of Health, Medical and Applied Sciences , Rockhampton , Queensland , Australia
| | - Dawn Neumann
- d Department of Physical Medicine and Rehabilitation and the Rehabilitation Hospital of Indiana , Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Barry Willer
- e Department of Psychiatry , State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences , Buffalo , New York , USA
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Bivona U, Formisano R, Mastrilli L, Zabberoni S, Caltagirone C, Costa A. Theory of Mind after Severe Acquired Brain Injury: Clues for Interpretation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5205642. [PMID: 30069471 PMCID: PMC6057350 DOI: 10.1155/2018/5205642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/24/2018] [Accepted: 06/04/2018] [Indexed: 11/30/2022]
Abstract
Background. Recently, increased interest has been shown in Theory of Mind (ToM) abilities of individuals with severe acquired brain injury (sABI). ToM impairment following sABI can be associated with altered executive functioning and/or with difficulty in decoding and elaborating emotions. Two main theoretical models have been proposed to explain the mechanisms underlying ToM in the general population: Theory Theory and Simulation Theory. This review presents and discusses the literature on ToM abilities in individuals with sABI by examining whether they sustain the applicability of the Theory Theory and/or Simulation Theory to account for ToM deficits in this clinical population. We found 32 papers that are directly aimed at investigating ToM in sABI. Results did not show the univocal predominance of one model with respect to the other in explaining ToM deficits in sABI. We hypothesised that ToM processes could be explained by coinvolvement of the two models, i.e., according to personal experience, cognitive features, or the emotional resources of the persons with sABI.
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Affiliation(s)
- U. Bivona
- Fondazione Santa Lucia, IRCCS, Rome, Italy
| | | | | | - S. Zabberoni
- Fondazione Santa Lucia, IRCCS, Rome, Italy
- Università telematica Niccolò Cusano, Rome, Italy
| | - C. Caltagirone
- Fondazione Santa Lucia, IRCCS, Rome, Italy
- Università Tor Vergata, Rome, Italy
| | - A. Costa
- Fondazione Santa Lucia, IRCCS, Rome, Italy
- Università telematica Niccolò Cusano, Rome, Italy
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Neumann D, Malec JF, Hammond FM. Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial. J Head Trauma Rehabil 2018; 32:286-295. [PMID: 28060205 PMCID: PMC5498277 DOI: 10.1097/htr.0000000000000277] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING An outpatient rehabilitation hospital. PARTICIPANTS Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.
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Affiliation(s)
- Dawn Neumann
- Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, 4141 Shore Drive, Indianapolis, IN 46254, , Phone: 317-329-2188
| | - James F. Malec
- Indiana University School of Medicine, Department of Physical, Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Flora M. Hammond
- Indiana University School of Medicine, Department of Physical, Medicine and Rehabilitation, Chief of Medical Affairs, Rehabilitation Hospital of Indiana, Indianapolis, IN
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Roberts S, Henry JD, Molenberghs P. Immoral behaviour following brain damage: A review. J Neuropsychol 2018; 13:564-588. [DOI: 10.1111/jnp.12155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/21/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Stefanie Roberts
- School of Psychological Sciences Monash Institute of Cognitive and Clinical Neurosciences Monash University Clayton Victoria Australia
| | - Julie D. Henry
- School of Psychology University of Queensland St Lucia Queensland Australia
| | - Pascal Molenberghs
- School of Psychological Sciences The University of Melbourne Parkville Victoria Australia
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Chalah MA, Ayache SS. Alexithymia in multiple sclerosis: A systematic review of literature. Neuropsychologia 2017; 104:31-47. [DOI: 10.1016/j.neuropsychologia.2017.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 02/07/2023]
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The Relations of Self-Reported Aggression to Alexithymia, Depression, and Anxiety After Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:205-213. [DOI: 10.1097/htr.0000000000000261] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martínez-Velázquez ES, Honoré J, de Zorzi L, Ramos-Loyo J, Sequeira H. Autonomic Reactivity to Arousing Stimuli with Social and Non-social Relevance in Alexithymia. Front Psychol 2017; 8:361. [PMID: 28348539 PMCID: PMC5346581 DOI: 10.3389/fpsyg.2017.00361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
Emotional difficulties in alexithymia and their social consequences have been linked to alterations in autonomic nervous system. However, most of previous studies did not take into account the distinction between the affective and the cognitive dimensions of the alexithymia, leading to inconsistent results. Aim: In this study, we compared the effects of both dimensions of alexithymia on the autonomic arousal to emotional and social visual stimulations. Methods: Skin conductance responses (SCRs) to items of the International Affective Pictures System characterized by emotional (unpleasant, neutral, and pleasant), social (with humans) or non-social (without humans) content were recorded in non-alexithymic (NA), affective (AA) and cognitive alexithymic (CA) participants, selected on the basis of the Toronto Alexithymia Scale and the Bermond-Vorst Alexithymia Questionnaire. All participants responded to questionnaires of empathy, social phobia, depression, and anxiety before the experiment and evaluated the arousal of the pictures after it. Results: Cognitive alexithymic group showed lower amplitudes of SCRs to pictures with social than without social relevance whereas the opposite pattern was observed for the NA group. Arousal emotional effects of the pictures on SCRs did not differ among groups. In addition, CA participants showed lower scores than NA in the Personal Taking sub-scale of the empathy questionnaire, while AA showed lower scores than NA in the fantasy sub-scale. The CA group showed higher social phobia, depression and anxiety scores, than the other two groups. Conclusion: This work has two original outcomes: first, affective alexithymics expressed lower empathic affective scores than other groups; second, alexithymia modulated the impact of the social relevance of the stimuli on the autonomic reactivity, this impact vanishing in affective alexithymics and reversing in cognitive alexithymics. Thus, though the groups could not be distinguished on the basis of emotional effect on SCRs, they clearly differed when the empathic characteristics and the autonomic impact of social relevance were considered. Finally, the described autonomic signature to social relevant information could contribute to elucidate the difficulty of alexithymics to deal with emotions during social transactions.
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Affiliation(s)
- Eduardo S. Martínez-Velázquez
- Laboratorio de Psicofisiologia, Institute of Neuroscience, University of GuadalajaraGuadalajara, Mexico
- Facultad de Psicología, Meritorious Autonomous University of PueblaPuebla, Mexico
| | - Jacques Honoré
- DEEP Team, SCALab, UMR 9193, CNRS & University of LilleLille, France
| | - Lucas de Zorzi
- DEEP Team, SCALab, UMR 9193, CNRS & University of LilleLille, France
| | - Julieta Ramos-Loyo
- Laboratorio de Psicofisiologia, Institute of Neuroscience, University of GuadalajaraGuadalajara, Mexico
| | - Henrique Sequeira
- DEEP Team, SCALab, UMR 9193, CNRS & University of LilleLille, France
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Cecchetto C, Korb S, Rumiati RI, Aiello M. Emotional reactions in moral decision-making are influenced by empathy and alexithymia. Soc Neurosci 2017; 13:226-240. [DOI: 10.1080/17470919.2017.1288656] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Sebastian Korb
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, University of Vienna, Vienna, Austria
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Abstract
Social cognition refers to the ability to use social cues to infer the meaning and intentions behind the behaviour of others in order to respond in a socially adaptive manner. It is increasingly recognised that disorders of social cognition, including problems with emotion perception, theory of mind, conversational inference, morality judgements, decision making and social inhibition, characterise many developmental and psychiatric disorders and are highly relevant to many with acquired brain injuries or diseases, especially the frontotemporal dementias. This review provides an introduction and overview of the papers in this special edition on social cognition and places these in the context of other recent research. In doing so, several current issues in the clinical management of social cognition are delineated. Given that social cognition seems to be a sensitive predictor of psychosocial function, the assessment of social cognition is seen by many clinicians to be important although which profession is responsible is yet to be resolved. Issues in how social cognition are assessed are discussed, including the importance of context to social cognition, its interactive nature and the need to recognise influences such as family upbringing, gender and emotional state on social cognitive performance. There also needs to be development of tests that address all aspects of social cognition, including decision making and inhibition. Finally, this review discusses intervention research. Interventions are especially well developed in relation to schizophrenia, and less well developed in brain injury. These appear to be generally effective although treatments for emotional self-awareness are yet to be developed.
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Abstract
Recognition of facial affect has been studied extensively in adults with and without traumatic brain injury (TBI), mostly by asking examinees to match basic emotion words to isolated faces. This method may not capture affect labelling in everyday life when faces are in context and choices are open-ended. To examine effects of context and response format, we asked 148 undergraduate students to label emotions shown on faces either in isolation or in natural visual scenes. Responses were categorised as representing basic emotions, social emotions, cognitive state terms, or appraisals. We used students' responses to create a scoring system that was applied prospectively to five men with TBI. In both groups, over 50% of responses were neither basic emotion words nor synonyms, and there was no significant difference in response types between faces alone vs. in scenes. Adults with TBI used labels not seen in students' responses, talked more overall, and often gave multiple labels for one photo. Results suggest benefits of moving beyond forced-choice tests of faces in isolation to fully characterise affect recognition in adults with and without TBI.
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Cassel A, McDonald S, Kelly M, Togher L. Learning from the minds of others: A review of social cognition treatments and their relevance to traumatic brain injury. Neuropsychol Rehabil 2016; 29:22-55. [DOI: 10.1080/09602011.2016.1257435] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Anneli Cassel
- National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Skye McDonald
- National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Michelle Kelly
- National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia
- School of Psychology, University of Newcastle, Newcastle, Australia
| | - Leanne Togher
- National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, University of New South Wales, Sydney, Australia
- Discipline of Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Visser-Keizer AC, Westerhof-Evers HJ, Gerritsen MJJ, van der Naalt J, Spikman JM. To Fear Is to Gain? The Role of Fear Recognition in Risky Decision Making in TBI Patients and Healthy Controls. PLoS One 2016; 11:e0166995. [PMID: 27870900 PMCID: PMC5117759 DOI: 10.1371/journal.pone.0166995] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022] Open
Abstract
Fear is an important emotional reaction that guides decision making in situations of ambiguity or uncertainty. Both recognition of facial expressions of fear and decision making ability can be impaired after traumatic brain injury (TBI), in particular when the frontal lobe is damaged. So far, it has not been investigated how recognition of fear influences risk behavior in healthy subjects and TBI patients. The ability to recognize fear is thought to be related to the ability to experience fear and to use it as a warning signal to guide decision making. We hypothesized that a better ability to recognize fear would be related to a better regulation of risk behavior, with healthy controls outperforming TBI patients. To investigate this, 59 healthy subjects and 49 TBI patients were assessed with a test for emotion recognition (Facial Expression of Emotion: Stimuli and Tests) and a gambling task (Iowa Gambling Task (IGT)). The results showed that, regardless of post traumatic amnesia duration or the presence of frontal lesions, patients were more impaired than healthy controls on both fear recognition and decision making. In both groups, a significant relationship was found between better fear recognition, the development of an advantageous strategy across the IGT and less risk behavior in the last blocks of the IGT. Educational level moderated this relationship in the final block of the IGT. This study has important clinical implications, indicating that impaired decision making and risk behavior after TBI can be preceded by deficits in the processing of fear.
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Affiliation(s)
- Annemarie C. Visser-Keizer
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
- * E-mail:
| | - Herma J. Westerhof-Evers
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands
- University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, the Netherlands
| | - Marleen J. J. Gerritsen
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Joukje van der Naalt
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Jacoba M. Spikman
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
- University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, the Netherlands
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Sex Differences in Emotion Recognition and Emotional Inferencing Following Severe Traumatic Brain Injury. BRAIN IMPAIR 2016. [DOI: 10.1017/brimp.2016.22] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The primary objective of the current study was to determine if men and women with traumatic brain injury (TBI) differ in their emotion recognition and emotional inferencing abilities. In addition to overall accuracy, we explored whether differences were contingent upon the target emotion for each task, or upon high- and low-intensity facial and vocal emotion expressions. A total of 160 participants (116 men) with severe TBI completed three tasks – a task measuring facial emotion recognition (DANVA-Faces), vocal emotion recognition (DANVA-Voices) and one measuring emotional inferencing (emotional inference from stories test (EIST)). Results showed that women with TBI were significantly more accurate in their recognition of vocal emotion expressions and also for emotional inferencing. Further analyses of task performance showed that women were significantly better than men at recognising fearful facial expressions and also facial emotion expressions high in intensity. Women also displayed increased response accuracy for sad vocal expressions and low-intensity vocal emotion expressions. Analysis of the EIST task showed that women were more accurate than men at emotional inferencing in sad and fearful stories. A similar proportion of women and men with TBI were impaired (≥ 2 SDs when compared to normative means) at facial emotion perception, χ2 = 1.45, p = 0.228, but a larger proportion of men was impaired at vocal emotion recognition, χ2 = 7.13, p = 0.008, and emotional inferencing, χ2 = 7.51, p = 0.006.
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Winegardner J, Keohane C, Prince L, Neumann D. Perspective training to treat anger problems after brain injury: Two case studies. NeuroRehabilitation 2016; 39:153-62. [DOI: 10.3233/nre-161347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jill Winegardner
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Clare Keohane
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Leyla Prince
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, UK
| | - Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
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Zupan B, Neumann D. Exploring the Use of Isolated Expressions and Film Clips to Evaluate Emotion Recognition by People with Traumatic Brain Injury. J Vis Exp 2016. [PMID: 27213280 DOI: 10.3791/53774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The current study presented 60 people with traumatic brain injury (TBI) and 60 controls with isolated facial emotion expressions, isolated vocal emotion expressions, and multimodal (i.e., film clips) stimuli that included contextual cues. All stimuli were presented via computer. Participants were required to indicate how the person in each stimulus was feeling using a forced-choice format. Additionally, for the film clips, participants had to indicate how they felt in response to the stimulus, and the level of intensity with which they experienced that emotion.
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Affiliation(s)
- Barbra Zupan
- Department of Applied Linguistics, Brock University;
| | - Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Indiana School of Medicine and Rehabilitation Hospital of Indiana
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49
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50
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Chikovani G, Babuadze L, Iashvili N, Gvalia T, Surguladze S. Empathy costs: Negative emotional bias in high empathisers. Psychiatry Res 2015; 229:340-6. [PMID: 26235473 DOI: 10.1016/j.psychres.2015.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/21/2015] [Accepted: 07/01/2015] [Indexed: 12/30/2022]
Abstract
Excessive empathy has been associated with compassion fatigue in health professionals and caregivers. We investigated an effect of empathy on emotion processing in 137 healthy individuals of both sexes. We tested a hypothesis that high empathy may underlie increased sensitivity to negative emotion recognition which may interact with gender. Facial emotion stimuli comprised happy, angry, fearful, and sad faces presented at different intensities (mild and prototypical) and different durations (500ms and 2000ms). The parameters of emotion processing were represented by discrimination accuracy, response bias and reaction time. We found that higher empathy was associated with better recognition of all emotions. We also demonstrated that higher empathy was associated with response bias towards sad and fearful faces. The reaction time analysis revealed that higher empathy in females was associated with faster (compared with males) recognition of mildly sad faces of brief duration. We conclude that although empathic abilities were providing for advantages in recognition of all facial emotional expressions, the bias towards emotional negativity may potentially carry a risk for empathic distress.
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Affiliation(s)
- George Chikovani
- Ilia State University, Cholokashvili Avenue 3/5, Tbilisi 0162, Georgia
| | - Lasha Babuadze
- Ilia State University, Cholokashvili Avenue 3/5, Tbilisi 0162, Georgia
| | - Nino Iashvili
- Ilia State University, Cholokashvili Avenue 3/5, Tbilisi 0162, Georgia
| | - Tamar Gvalia
- Ilia State University, Cholokashvili Avenue 3/5, Tbilisi 0162, Georgia
| | - Simon Surguladze
- Ilia State University, Cholokashvili Avenue 3/5, Tbilisi 0162, Georgia; King's College London Institute of Psychiatry, Psychology and Neuroscience, PO Box 69, De Crespigny Park, London SE5 8 AF, UK.
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