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Moosavi J, Resch A, Lecchi A, Sokolov AN, Fallgatter AJ, Pavlova MA. Reading language of the eyes in female depression. Cereb Cortex 2024; 34:bhae253. [PMID: 38990517 DOI: 10.1093/cercor/bhae253] [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] [Received: 05/10/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
Aberrations in non-verbal social cognition have been reported to coincide with major depressive disorder. Yet little is known about the role of the eyes. To fill this gap, the present study explores whether and, if so, how reading language of the eyes is altered in depression. For this purpose, patients and person-by-person matched typically developing individuals were administered the Emotions in Masked Faces task and Reading the Mind in the Eyes Test, modified, both of which contained a comparable amount of visual information available. For achieving group homogeneity, we set a focus on females as major depressive disorder displays a gender-specific profile. The findings show that facial masks selectively affect inferring emotions: recognition of sadness and anger are more heavily compromised in major depressive disorder as compared with typically developing controls, whereas the recognition of fear, happiness, and neutral expressions remains unhindered. Disgust, the forgotten emotion of psychiatry, is the least recognizable emotion in both groups. On the Reading the Mind in the Eyes Test patients exhibit lower accuracy on positive expressions than their typically developing peers, but do not differ on negative items. In both depressive and typically developing individuals, the ability to recognize emotions behind a mask and performance on the Reading the Mind in the Eyes Test are linked to each other in processing speed, but not recognition accuracy. The outcome provides a blueprint for understanding the complexities of reading language of the eyes within and beyond the COVID-19 pandemic.
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Affiliation(s)
- Jonas Moosavi
- Social Neuroscience Unit, Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Calwerstr. 14, 72076, Tübingen, Germany
| | - Annika Resch
- Social Neuroscience Unit, Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Calwerstr. 14, 72076, Tübingen, Germany
| | - Alessandro Lecchi
- Social Neuroscience Unit, Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Calwerstr. 14, 72076, Tübingen, Germany
| | - Alexander N Sokolov
- Social Neuroscience Unit, Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Calwerstr. 14, 72076, Tübingen, Germany
| | - Andreas J Fallgatter
- Social Neuroscience Unit, Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Calwerstr. 14, 72076, Tübingen, Germany
- German Center for Mental Health (DZPG), Partner Site Tübingen, Tübingen, Germany
| | - Marina A Pavlova
- Social Neuroscience Unit, Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Calwerstr. 14, 72076, Tübingen, Germany
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Mastorogianni ME, Konstanti S, Dratsiou I, Bamidis PD. Masked emotions: does children's affective state influence emotion recognition? Front Psychol 2024; 15:1329070. [PMID: 38962230 PMCID: PMC11220387 DOI: 10.3389/fpsyg.2024.1329070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/22/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Facial emotion recognition abilities of children have been the focus of attention across various fields, with implications for communication, social interaction, and human behavior. In response to the COVID-19 pandemic, wearing a face mask in public became mandatory in many countries, hindering social information perception and emotion recognition. Given the importance of visual communication for children's social-emotional development, concerns have been raised on whether face masks could impair their ability to recognize emotions and thereby possibly impact their social-emotional development. Methods To this extent, a quasiexperimental study was designed with a two-fold objective: firstly, to identify children's accuracy in recognizing basic emotions (anger, happiness, fear, disgust, sadness) and emotional neutrality when presented with faces under two conditions: one with no-masks and another with faces partially covered by various types of masks (medical, nonmedical, surgical, or cloth); secondly, to explore any correlation between children's emotion recognition accuracy and their affective state. Sixty-nine (69) elementary school students aged 6-7 years old from Greece were recruited for this purpose. Following specific requirements of the second phase of the experiment students were assigned to one of three (3) distinct affective condition groups: Group A-Happiness, Group B-Sadness, and Group C-Emotional Neutrality. Image stimuli were drawn from the FACES Dataset, and students' affective state was registered using the self-reporting emotions-registration tool, AffectLecture app. Results The study's findings indicate that children can accurately recognize emotions even with masks, although recognizing disgust is more challenging. Additionally, following both positive and negative affective state priming promoted systematic inaccuracies in emotion recognition. Most significantly, results showed a negative bias for children in negative affective state and a positive bias for those in positive affective state. Discussion Children's affective state significantly influenced their emotion recognition abilities; sad affective states led to lower recognition overall and a bias toward recognizing sad expressions, while happy affective states resulted in a positive bias, improving recognition of happiness, and affecting how emotional neutrality and sadness were actually perceived. In conclusion, this study sheds light on the intriguing dynamics of how face masks affect children's emotion recognition, but also underlines the profound influence of their affective state.
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Affiliation(s)
- Maria Eirini Mastorogianni
- MSc in Learning Technologies-Education Sciences, School of Early Childhood Education, School of Electrical and Computer Engineering, School of Medicine, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Styliani Konstanti
- MSc in Learning Technologies-Education Sciences, School of Early Childhood Education, School of Electrical and Computer Engineering, School of Medicine, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Ioanna Dratsiou
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Panagiotis D. Bamidis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
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Kuczyk C, Münch K, Nöhre M, Stephan M, de Zwaan M. Development and testing of a questionnaire on the expectations and experiences with wearing face masks in inpatient and day hospitals. PLoS One 2024; 19:e0304140. [PMID: 38820397 PMCID: PMC11142604 DOI: 10.1371/journal.pone.0304140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/07/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The Covid-19 pandemic made wearing of face masks mandatory in the psychotherapeutic context. Against this background, the present study aimed to compare the expectations of patients undergoing day-hospital or inpatient treatment regarding wearing a mask in psychotherapy before the start of therapy with the final experience after the end of therapy. The study also investigated the extent to which expectations and experiences were influenced by other factors such as socio-demographic characteristics, patients' general attitudes towards wearing a mask, duration of treatment, or mental health diagnoses. METHODS Patients' expectations and experiences were recorded using two versions of a self-developed questionnaire: the pre-version, which was administered before the start of therapy and recorded expectations, and the post-version, which was administered after the end of therapy and recorded the final experiences. An exploratory factor analysis was conducted for the questionnaire's pre- and post-version. T-tests for paired samples were calculated to compare the patients' expectations regarding the extracted factors with the final experiences. Bivariate correlations were calculated to explore the association of other potential factors with expectations and experiences. RESULTS The exploratory factor analysis revealed a three-factor structure: communication barriers, self-confidence, and infection protection. The communication barriers expected by the patients before the start of the therapy turned out to be significantly higher than ultimately experienced after the therapy. Higher age correlated significantly negatively with expectations and experiences, with less self-confidence expected and experienced in therapy with a mask by older patients. There was a significant positive correlation between the expectations and the duration of treatment. Patients' general attitudes correlated significantly with their expectations and experiences. CONCLUSION Based on the results, wearing a mask does not appear to negatively impact the success of psychotherapy from the patient's perspective. However, patient-specific characteristics also appear to play a role in this context.
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Affiliation(s)
- Charlotte Kuczyk
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kathrin Münch
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Michael Stephan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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Montandon ML, Haller S, Rodriguez C, Herrmann FR, Giannakopoulos P. Wearing a KN95/FFP2 facemask has no measureable effect on functional activity in a challenging working memory n-back task. Front Hum Neurosci 2024; 18:1374625. [PMID: 38770397 PMCID: PMC11103007 DOI: 10.3389/fnhum.2024.1374625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Wide use of facemasks is one of the many consequences of the COVID-19 pandemic. Methods We used an established working memory n-back task in functional magnetic resonance imaging (fMRI) to explore whether wearing a KN95/FFP2 facemask affects overall performance and brain activation patterns. We provide here a prospective crossover design 3 T fMRI study with/without wearing a tight FFP2/KN95 facemask, including 24 community-dwelling male healthy control participants (mean age ± SD = 37.6 ± 12.7 years) performing a 2-back task. Data analysis was performed using the FSL toolbox, performing both task-related and functional connectivity independent component analyses. Results Wearing an FFP2/KN95 facemask did not impact behavioral measures of the 2-back task (response time and number of errors). The 2-back task resulted in typical activations in working-memory related areas in both MASK and NOMASK conditions. There were no statistically significant differences in MASK versus NOMASK while performing the 2-back task in both task-related and functional connectivity fMRI analyses. Conclusion The effect of wearing a tight FFP2/KN95 facemasks did not significantly affect working memory performance and brain activation patterns of functional connectivity.
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Affiliation(s)
- Marie-Louise Montandon
- Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Sven Haller
- CIMC—Centre d’Imagerie Médicale de Cornavin, Geneva, Switzerland
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Faculty of Medicine of the University of Geneva, Geneva, Switzerland
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cristelle Rodriguez
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - François R. Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Ger E, Manfredi M, Osório AAC, Ribeiro CF, Almeida A, Güdel A, Calbi M, Daum MM. Duration of face mask exposure matters: evidence from Swiss and Brazilian kindergartners' ability to recognise emotions. Cogn Emot 2024:1-15. [PMID: 38576358 DOI: 10.1080/02699931.2024.2331795] [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: 03/10/2023] [Accepted: 03/09/2024] [Indexed: 04/06/2024]
Abstract
Wearing facial masks became a common practice worldwide during the COVID-19 pandemic. This study investigated (1) whether facial masks that cover adult faces affect 4- to 6-year-old children's recognition of emotions in those faces and (2) whether the duration of children's exposure to masks is associated with emotion recognition. We tested children from Switzerland (N = 38) and Brazil (N = 41). Brazil represented longer mask exposure due to a stricter mandate during COVID-19. Children had to choose a face displaying a specific emotion (happy, angry, or sad) when the face wore either no cover, a facial mask, or sunglasses. The longer hours of mask exposure were associated with better emotion recognition. Controlling for the hours of exposure, children were less likely to recognise emotions in partially hideen faces. Moreover, Brazilian children were more accurate in recognising happy faces than Swiss children. Overall, facial masks may negatively impact children's emotion recognition. However, prolonged exposure appears to buffer the lack of facial cues from the nose and mouth. In conclusion, restricting facial cues due to masks may impair kindergarten children's emotion recognition in the short run. However, it may facilitate their broader reading of facial emotional cues in the long run.
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Affiliation(s)
- Ebru Ger
- Department of Psychology, University of Bern, Bern, Switzerland
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Mirella Manfredi
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Ana Alexandra Caldas Osório
- Developmental Disorders Program, Mackenzie Presbyterian University, São Paulo, Brazil
- Mackenzie Center for Research in Childhood and Adolescence, Mackenzie Presbyterian University, São Paulo, Brazil
| | | | - Alessandra Almeida
- Department of Psychology, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Annika Güdel
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Marta Calbi
- Department of Philosophy "Piero Martinetti", State University of Milan, Milan, Italy
| | - Moritz M Daum
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
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Thomas PJN, Caharel S. Do masks cover more than just a face? A study on how facemasks affect the perception of emotional expressions according to their degree of intensity. Perception 2024; 53:3-16. [PMID: 37709269 DOI: 10.1177/03010066231201230] [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: 09/16/2023]
Abstract
Emotional facial expressions convey crucial information in nonverbal communication and serve as a mediator in face-to-face relationships. Their recognition would rely on specific facial traits depending on the perceived emotion. During the COVID-19 pandemic, wearing a facemask has thus disrupted the human ability to read emotions from faces. Yet, these effects are usually assessed across studies from faces expressing stereotypical and exaggerated emotions, which is far removed from real-life conditions. The objective of the present study was to evaluate the impact of facemasks through an emotion categorization task using morphs ranging from a neutral face and an expressive face (anger, disgust, fear, happiness, and sadness) (from 0% neutral to 100% expressive in 20% steps). Our results revealed a strong impact of facemasks on the recognition of expressions of disgust, happiness, and sadness, resulting in a decrease in performance and an increase in misinterpretations, both for low and high levels of intensity. In contrast, the recognition of anger and fear, as well as neutral expression, was found to be less impacted by mask-wearing. Future studies should address this issue from a more ecological point of view with the aim of taking concrete adaptive measures in the context of daily interactions.
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Gehdu BK, Tsantani M, Press C, Gray KL, Cook R. Recognition of facial expressions in autism: Effects of face masks and alexithymia. Q J Exp Psychol (Hove) 2023; 76:2854-2864. [PMID: 36872641 DOI: 10.1177/17470218231163007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
It is often assumed that the recognition of facial expressions is impaired in autism. However, recent evidence suggests that reports of expression recognition difficulties in autistic participants may be attributable to co-occurring alexithymia-a trait associated with difficulties interpreting interoceptive and emotional states-not autism per se. Due to problems fixating on the eye-region, autistic individuals may be more reliant on information from the mouth region when judging facial expressions. As such, it may be easier to detect expression recognition deficits attributable to autism, not alexithymia, when participants are forced to base expression judgements on the eye-region alone. To test this possibility, we compared the ability of autistic participants (with and without high levels of alexithymia) and non-autistic controls to categorise facial expressions (a) when the whole face was visible, and (b) when the lower portion of the face was covered with a surgical mask. High-alexithymic autistic participants showed clear evidence of expression recognition difficulties: they correctly categorised fewer expressions than non-autistic controls. In contrast, low-alexithymic autistic participants were unimpaired relative to non-autistic controls. The same pattern of results was seen when judging masked and unmasked expression stimuli. In sum, we find no evidence for an expression recognition deficit attributable to autism, in the absence of high levels of co-occurring alexithymia, either when participants judge whole-face stimuli or just the eye-region. These findings underscore the influence of co-occurring alexithymia on expression recognition in autism.
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Affiliation(s)
- Bayparvah Kaur Gehdu
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Maria Tsantani
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Clare Press
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
- Wellcome Centre for Human Neuroimaging, University College London (UCL), London, UK
| | - Katie Lh Gray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Richard Cook
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
- School of Psychology, University of Leeds, Leeds, UK
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Burns EJ, Gaunt E, Kidane B, Hunter L, Pulford J. A new approach to diagnosing and researching developmental prosopagnosia: Excluded cases are impaired too. Behav Res Methods 2023; 55:4291-4314. [PMID: 36459376 PMCID: PMC9718472 DOI: 10.3758/s13428-022-02017-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 12/04/2022]
Abstract
Developmental prosopagnosia is characterized by severe, lifelong difficulties when recognizing facial identity. Unfortunately, the most common diagnostic assessment (Cambridge Face Memory Test) misses 50-65% of individuals who believe that they have this condition. This results in such excluded cases' absence from scientific knowledge, effect sizes of impairment potentially overestimated, treatment efficacy underrated, and may elicit in them a negative experience of research. To estimate their symptomology and group-level impairments in face processing, we recruited a large cohort who believes that they have prosopagnosia. Matching prior reports, 56% did not meet criteria on the Cambridge Face Memory Test. However, the severity of their prosopagnosia symptoms and holistic perception deficits were comparable to those who did meet criteria. Excluded cases also exhibited face perception and memory impairments that were roughly one standard deviation below neurotypical norms, indicating the presence of objective problems. As the prosopagnosia index correctly classified virtually every case, we propose it should be the primary method for providing a diagnosis, prior to subtype categorization. We present researchers with a plan on how they can analyze these excluded prosopagnosia cases in their future work without negatively impacting their traditional findings. We anticipate such inclusion will enhance scientific knowledge, more accurately estimate effect sizes of impairments and treatments, and identify commonalities and distinctions between these different forms of prosopagnosia. Owing to their atypicalities in visual perception, we recommend that the prosopagnosia index should be used to screen out potential prosopagnosia cases from broader vision research.
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Affiliation(s)
- Edwin J Burns
- Department of Psychology, Edge Hill University, Ormskirk, UK.
| | - Elizabeth Gaunt
- Department of Psychology, Edge Hill University, Ormskirk, UK
| | - Betiel Kidane
- Department of Psychology, Edge Hill University, Ormskirk, UK
| | - Lucy Hunter
- Department of Psychology, Edge Hill University, Ormskirk, UK
| | - Jaylea Pulford
- Department of Psychology, Edge Hill University, Ormskirk, UK
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Franca M, Bolognini N, Brysbaert M. Seeing emotions in the eyes: a validated test to study individual differences in the perception of basic emotions. Cogn Res Princ Implic 2023; 8:67. [PMID: 37919608 PMCID: PMC10622392 DOI: 10.1186/s41235-023-00521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
People are able to perceive emotions in the eyes of others and can therefore see emotions when individuals wear face masks. Research has been hampered by the lack of a good test to measure basic emotions in the eyes. In two studies respectively with 358 and 200 participants, we developed a test to see anger, disgust, fear, happiness, sadness and surprise in images of eyes. Each emotion is measured with 8 stimuli (4 male actors and 4 female actors), matched in terms of difficulty and item discrimination. Participants reliably differed in their performance on the Seeing Emotions in the Eyes test (SEE-48). The test correlated well not only with Reading the Mind in the Eyes Test (RMET) but also with the Situational Test of Emotion Understanding (STEU), indicating that the SEE-48 not only measures low-level perceptual skills but also broader skills of emotion perception and emotional intelligence. The test is freely available for research and clinical purposes.
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Affiliation(s)
- Maria Franca
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nadia Bolognini
- Department of Psychology and NeuroMI - Milan Centre for Neuroscience, University of Milano-Bicocca, Milan, Italy.
- Laboratory of Neuropsychology, Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Via Mercalli 32, 20122, Milan, Italy.
| | - Marc Brysbaert
- Department of Experimental Psychology, Ghent University, H. Dunantlaan 2, 9000, Ghent, Belgium.
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Miyazaki Y, Kamatani M, Tsurumi S, Suda T, Wakasugi K, Matsunaga K, Kawahara JI. Effects of wearing an opaque or transparent face mask on the perception of facial expressions: A comparative study between Japanese school-aged children and adults. Perception 2023; 52:782-798. [PMID: 37728164 DOI: 10.1177/03010066231200693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
The negative side effects of mask-wearing on reading facial emotional cues have been investigated in several studies with adults post-2020. However, little is known about children. This study aimed to determine the negative influence of mask-wearing on reading emotions of adult faces by Japanese school-aged children, compared to Japanese adults. We also examined whether this negative influence could be alleviated by using a transparent face mask instead of an opaque one (surgical mask). The performance on reading emotions was measured using emotion categorization and emotion intensity rating tasks for adult faces. As per the findings, the accuracy of emotion recognition in children was impaired for various facial expressions (disgust, fear, happy, neutral, sad, and surprise faces), except for angry faces. Conversely, in adults, it was impaired for a few facial expressions. The perceived intensity for happy faces with a surgical mask was weaker in both children and adults than in those without the mask. A negative influence of wearing surgical masks was generally not observed for faces wearing a transparent mask in both children and adults. Thus, negative side effects of mask-wearing on reading emotions are observed for more facial expressions in children than in adults; transparent masks can help remedy these.
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Huc M, Bush K, Atias G, Berrigan L, Cox S, Jaworska N. Recognition of masked and unmasked facial expressions in males and females and relations with mental wellness. Front Psychol 2023; 14:1217736. [PMID: 38023041 PMCID: PMC10643509 DOI: 10.3389/fpsyg.2023.1217736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background While the effects of mask wearing/facial occlusion are known to impair facial expression recognition, little is known about the role of mental wellness on facial expression recognition, as well as the influence of sex on misattribution errors (i.e., confusions between emotions). In this large study, we aimed to address the relation between facial expression recognition and loneliness, perceived stress, anxiety, and depression symptoms in male and female adults. Methods We assessed the influence of mask-wearing on facial expression recognition [i.e., accuracy and response time (RT)] via an online study in N = 469 adult males and females across Canada. Results Expectedly, recognition was impaired under masked conditions (i.e., lower accuracy, longer RTs, more misattribution errors). Females were faster and more accurate than males, with less misattribution errors. A novel finding was that people with higher perceived stress were less accurate at identifying masked fearful faces. Perceived stress influenced the relation between sex and RT to masked happy faces; males with high stress scores were slower to recognize masked happy faces, the opposite was true for females. Finally, this study was among the first to show that higher loneliness predicted shorter RT to unmasked faces. Impact Our results show that facial expression recognition is impaired by mask-wearing, and that sex and mental health features are important predictors of performance. Such insight could be detrimental in certain sectors of the population (e.g., health care or education), and inform policies being adopted in future pandemics.
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Affiliation(s)
- Marie Huc
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Katie Bush
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Gali Atias
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Lindsay Berrigan
- Department of Psychology, St Francis Xavier University, Antigonish, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sylvia Cox
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Psychology, Dawson College, Montreal, QC, Canada
| | - Natalia Jaworska
- University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Cellular & Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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12
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Pavlova MA, Moosavi J, Carbon CC, Fallgatter AJ, Sokolov AN. Emotions behind a mask: the value of disgust. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:58. [PMID: 37709796 PMCID: PMC10502067 DOI: 10.1038/s41537-023-00388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023]
Abstract
The impact of face masks on social cognition and interaction became a popular topic due to the long-lasting COVID-19 pandemic. This theme persists in the focus of attention beyond the pandemic, since face covering not only reduces the overall amount of face information available but also introduces biases and prejudices affecting social perception at large. Many questions are still open. One of them is whether gender of beholders affects inferring of emotions covered by face masks. Reading covered faces may be particularly challenging for individuals with mental disorders, most of which are gender-specific. Previous findings are not only sparse, but inconclusive because most research had been conducted online with resulting samples heavily dominated by females. Here in a face-to-face study, females and males were presented with a randomized set of faces covered by masks. In a two-alternative forced-choice paradigm, participants had to indicate facial emotions displayed by posers. In general, the outcome dovetails with earlier findings that face masks affect emotion recognition in a dissimilar way: Inferring some emotions suffers more severely than others, with the most pronounced influence of mask wearing on disgust and close to ceiling recognition of fear and neutral expressions. Contrary to our expectations, however, males were on overall more proficient in emotion recognition. In particular, males substantially excelled in inferring disgust. The findings help to understand gender differences in recognition of disgust, the forgotten emotion of psychiatry, that is of substantial value for a wide range of mental disorders including schizophrenia. Watch Prof. Marina Pavlova discussing this her work and this article: https://vimeo.com/860126397/5966610f49?share=copy .
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Affiliation(s)
- Marina A Pavlova
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany.
| | - Jonas Moosavi
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Claus-Christian Carbon
- Department of General Psychology and Methodology, University of Bamberg, Bamberg, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Alexander N Sokolov
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
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13
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Kastendieck T, Dippel N, Asbrand J, Hess U. Influence of child and adult faces with face masks on emotion perception and facial mimicry. Sci Rep 2023; 13:14848. [PMID: 37684246 PMCID: PMC10491609 DOI: 10.1038/s41598-023-40007-w] [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] [Received: 02/18/2023] [Accepted: 08/03/2023] [Indexed: 09/10/2023] Open
Abstract
Emotional mimicry, the imitation of others' emotion expressions, is related to increased interpersonal closeness and better interaction quality. Yet, little research has focused on the effect of face masks on emotional mimicry and none on (masked) child faces. To address this gap, we conducted an online experiment (N = 235, German sample, adult perceivers). Masks reduced emotion recognition accuracy for all expressions, except in the case of anger in masked child faces, where perceived anger was even increased. Perceived interpersonal closeness was reduced for masked happy and sad faces. For both child and adult expressers, masks reduced facial mimicry of happy expressions, with no mask effects for sadness and anger expression. A stronger mask effect on facial happiness mimicry of child faces was mediated by the degree of emotion recognition accuracy. Smiles shown by masked children were not recognized well, likely due to the absence of wrinkles around the eyes in child faces. Independent of masks, sadness shown by children was mimicked even more strongly than when shown by adults. These results provide evidence for facial mimicry of child expressions by adult perceivers and show that the effects of face masks on emotion communication may vary when children wear them.
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Affiliation(s)
- Till Kastendieck
- Department of Psychology, Social and Organizational Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Nele Dippel
- Clinic for Psychiatry, Psychosomatics, and Psychotherapy of Childhood and Adolescence, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Asbrand
- Department of Psychology, Clinical Psychology of Childhood and Adolescence, Friedrich-Schiller-University Jena, Jena, Germany
| | - Ursula Hess
- Department of Psychology, Social and Organizational Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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14
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Kawagoe T, Teramoto W. Mask wearing provides psychological ease but does not affect facial expression intensity estimation. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230653. [PMID: 37650062 PMCID: PMC10465193 DOI: 10.1098/rsos.230653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
During the COVID-19 pandemic, wearing a face mask became a global daily practice. Japanese people were already accustomed to wearing masks due to their collectivistic culture, which prioritizes conformity and group harmony. In such a culture, where individuals are concerned about how others perceive them and their actions, wearing masks can be a self-protective action to prevent, escape, or reduce the severity of perceived negative feelings. Previous studies indicate that people experiencing anxiety tend to have negative biases when evaluating emotional expressions on faces. Therefore, we hypothesized that wearing a mask can reduce the negative feelings caused by social pressure, emotion processing, especially intensity perception. While our findings confirmed that wearing a mask reduced negative feelings caused by social pressure, there was no significant change in emotion intensity recognition performance. This null result might be attributed to the small effect size of the association between negative bias in emotion processing and an individual's state. In future studies, it would be valuable to include participants from non-collectivistic cultures to gain a broader understanding of the impact of wearing masks on emotion processing.
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Affiliation(s)
- Toshikazu Kawagoe
- School of Humanities and Science, Tokai University, Kumamoto Campus, Toroku 9-1-1, Kumamoto City, Kumamoto 862-8652, Japan
| | - Wataru Teramoto
- Division of Cognitive Psychology, Kumamoto University, 2-40-1 Kurokami, Chuo-ku, Kumamoto 860-8555, Japan
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15
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Williams WC, Haque E, Mai B, Venkatraman V. Face masks influence emotion judgments of facial expressions: a drift-diffusion model. Sci Rep 2023; 13:8842. [PMID: 37258558 DOI: 10.1038/s41598-023-35381-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
Face masks slow the spread of SARS-CoV-2, but it has been unknown how masks might reshape social interaction. One important possibility is that masks may influence how individuals communicate emotion through facial expressions. Here, we clarify to what extent-and how-masks influence facial emotion communication, through drift-diffusion modeling (DDM). Over two independent pre-registered studies, conducted three and 6 months into the COVID-19 pandemic, online participants judged expressions of 6 emotions (anger, disgust, fear, happiness, sadness, surprise) with the lower or upper face "masked" or unmasked. Participants in Study 1 (N = 228) correctly identified expressions above chance with lower face masks. However, they were less likely-and slower-to correctly identify these expressions relative to without masks, and they accumulated evidence for emotion more slowly-via decreased drift rate in DDM. This pattern replicated and intensified 3 months later in Study 2 (N = 264). These findings highlight how effectively individuals still communicate with masks, but also explain why they can experience difficulties communicating when masked. By revealing evidence accumulation as the underlying mechanism, this work suggests that time-sensitive situations may risk miscommunication with masks. This research could inform critical interventions to promote continued mask wearing as needed.
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Affiliation(s)
- W Craig Williams
- Department of Marketing, Fox School of Business, Temple University, Philadelphia, PA, 19122, USA.
| | - Eisha Haque
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Becky Mai
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Vinod Venkatraman
- Department of Marketing, Fox School of Business, Temple University, Philadelphia, PA, 19122, USA
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16
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Scheibe S, Grundmann F, Kranenborg B, Epstude K. Empathising with masked targets: limited side effects of face masks on empathy for dynamic, context-rich stimuli. Cogn Emot 2023; 37:683-695. [PMID: 37013854 DOI: 10.1080/02699931.2023.2193385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/05/2023]
Abstract
Multiple studies revealed detrimental effects of face masks on communication, including reduced empathic accuracy and enhanced listening effort. Yet, extant research relied on artificial, decontextualised stimuli, which prevented assessing empathy under more ecologically valid conditions. In this preregistered online experiment (N = 272), we used film clips featuring targets reporting autobiographical events to address motivational mechanisms underlying face mask effects on cognitive (empathic accuracy) and emotional facets (emotional congruence, sympathy) of empathy. Surprisingly, targets whose faces were covered by a mask (or a black bar) elicited the same level of empathy motives (affiliation, cognitive effort), and accordingly, the same level of cognitive and emotional empathy compared to targets with uncovered faces. We only found a negative direct effect of face coverings on sympathy. Additional analyses revealed that older (compared to young) adults showed higher empathy, but age did not moderate face mask effects. Our findings speak against strong negative face mask effects on empathy when using dynamic, context-rich stimuli, yet support motivational mechanisms of empathy.
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Affiliation(s)
- Susanne Scheibe
- Department of Psychology, University of Groningen, Groningen, Netherlands
| | - Felix Grundmann
- Department of Psychology, University of Groningen, Groningen, Netherlands
| | - Bart Kranenborg
- Department of Psychology, University of Groningen, Groningen, Netherlands
| | - Kai Epstude
- Department of Psychology, University of Groningen, Groningen, Netherlands
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17
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Bani M, Raggi E, Russo S, Riccelli M, Ardenghi S, Rampoldi G, Strepparava MG. The impact of facemasks on blood donation process: The professionals' perspective. Nurs Health Sci 2022; 24:845-852. [PMID: 36097961 PMCID: PMC10092482 DOI: 10.1111/nhs.12985] [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: 07/27/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 01/28/2023]
Abstract
Facemasks represent an essential measure of prevention against the spread of COVID-19; however, they lessen the ability to convey and understand emotions through facial expressions. In blood donation settings, facemasks may interfere with professionals' tasks. This qualitative study aims to describe healthcare staff's experiences, beliefs, and attitudes toward facemask wearing and strategies used to overcome communication and relational barriers along the blood donation process. Semistructured qualitative interviews were conducted with 25 healthcare professionals (14 physicians and 11 nurses) working in Italian blood donation centers. The framework analysis method was used to organize the data and identify emerging themes. More than 70% of participants reported discomfort and a negative impact on communicating effectively with donors and building empathic relationships. The difficulty to detect early signs of adverse reactions was reported by almost all nurses, and physicians were concerned that facemasks limited the identification of donors and the detection of deferral criteria. Facemasks have changed the blood donation process, reducing the healthcare professionals' ability to build empathic relationships and communicate with donors effectively. New strategies should be developed to overcome these limitations.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Erika Raggi
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Mattia Riccelli
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Stefano Ardenghi
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Giulia Rampoldi
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy.,Department of Mental Health, Clinical Psychology Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
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18
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Kwon M, Yang W. Mask-Wearing Behaviors after Two Years of Wearing Masks Due to COVID-19 in Korea: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14940. [PMID: 36429657 PMCID: PMC9691200 DOI: 10.3390/ijerph192214940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
In Korea, wearing masks in public places has become the norm during the prolonged coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study investigated the mask-wearing behavior of Koreans (n = 433) via online mode living in Seoul and Gwangju after wearing a mask in public spaces for two years due to COVID-19. The respondents selected their face masks based on season, gender, age, occupation, mask-wearing hours, mask filter performance, mask shape, and mask color. The general discomfort caused by wearing a mask was divided into physical and speech discomfort, and it was not correlated with anxiety when not wearing a face mask. Speech discomfort caused by wearing a mask was correlated with general discomfort, clear speech, vocal pain, anxiety, and only-indoor mask-off plans. Anxiety when not wearing a mask appeared to affect both indoor and outdoor mask-off plans. The more uncomfortable and less anxious respondents were when not wearing a mask, the sooner they wanted to discontinue wearing masks indoors and outdoors. It is expected that the use of masks will continue in the future and that there may be differences in the place and time of use of masks in Korea and around the world due to new infectious diseases and fine dust. Facial masks can be worn more comfortably and conveniently if the discomfort and anxiety of wearing a mask are improved by considering various behaviors when wearing a mask in the future.
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Affiliation(s)
- Miji Kwon
- Department of Speech-Language Rehabilitation & Counseling, Gwangju University, Gwangju 61743, Korea
| | - Wonyoung Yang
- Division of Architecture, Gwangju University, Gwangju 61743, Korea
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19
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Fatfouta R, Oganian Y. Face masks drive increased rational decision-making. CURRENT PSYCHOLOGY 2022; 42:1-10. [PMID: 36373111 PMCID: PMC9638248 DOI: 10.1007/s12144-022-03895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Face masks play a pivotal role in the control of respiratory diseases, such as the novel coronavirus (COVID-19). Despite their widespread use, little is known about how face masks affect human social interaction. Using unique experimental data collected early on in the pandemic, we investigate how facial occlusion by face masks alters socio-economic exchange. In a behavioral economics study (N = 481), individuals accepted more monetary offers and lower offer amounts when interacting with a masked versus unmasked opponent. Importantly, this effect was mainly driven by faces covered with surgical masks relative to bandana-type masks. In the first weeks of mask use during the COVID-19 pandemic, motive attributions further moderated this effect: Participants who believed that mask wearers were seeking to protect others showed the highest acceptance rates. Overall, we describe a new phenomenon, the face-mask effect on socio-economic exchange, and show that it is modulated by contextual factors.
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Affiliation(s)
- Ramzi Fatfouta
- HMKW Hochschule für Medien, Kommunikation und Wirtschaft, University of Applied Sciences, Ackerstraße 76, 13355 Berlin, Germany
| | - Yulia Oganian
- Center for Integrative Neuroscience, University Medical Center Tübingen, Ottfried-Müller-Str. 25, 72076 Tübingen, Germany
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20
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Eggleston A, Tsantani M, Over H, Cook R. Preferential looking studies of trustworthiness detection confound structural and expressive cues to facial trustworthiness. Sci Rep 2022; 12:17709. [PMID: 36271230 PMCID: PMC9587250 DOI: 10.1038/s41598-022-21586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/29/2022] [Indexed: 01/18/2023] Open
Abstract
On encountering a stranger, we spontaneously attribute to them character traits (e.g., trustworthiness, intelligence) based on their facial appearance. Participants can base impressions on structural face cues-the stable aspects of facial appearance that support identity recognition-or expression cues, such as the presence of a smile. It has been reported that 6- to 8-month-old infants attend to faces that adults judge to be trustworthy in preference to faces judged untrustworthy. These results are striking because the face stimuli employed were ostensibly emotion neutral. Consequently, these preferential looking effects have been taken as evidence for innate sensitivity to structural face cues to trustworthiness. However, scrutiny of the emotion rating procedure used with adults suggests that the face stimuli employed may have been judged emotion neutral only when interleaved with more obvious examples of facial affect. This means that the faces may vary in emotional expression when compared to each other. Here, we report new evidence obtained from adult raters that the stimuli used in these studies confound trustworthiness and untrustworthiness with the presence of happiness and anger, respectively. These findings suggest that the preferential looking effects described in infants are compatible with a preference for positive facial affect and may not reflect early sensitivity to structural face cues to trustworthiness.
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Affiliation(s)
- Adam Eggleston
- grid.5685.e0000 0004 1936 9668Department of Psychology, University of York, York, YO10 5DD UK
| | - Maria Tsantani
- grid.88379.3d0000 0001 2324 0507Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Harriet Over
- grid.5685.e0000 0004 1936 9668Department of Psychology, University of York, York, YO10 5DD UK
| | - Richard Cook
- grid.5685.e0000 0004 1936 9668Department of Psychology, University of York, York, YO10 5DD UK ,grid.88379.3d0000 0001 2324 0507Department of Psychological Sciences, Birkbeck, University of London, London, UK
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21
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Haller S, Montandon ML, Rodriguez C, Giannakopoulos P. Wearing a KN95/FFP2 facemask induces subtle yet significant brain functional connectivity modifications restricted to the salience network. Eur Radiol Exp 2022; 6:50. [PMID: 36210391 PMCID: PMC9548384 DOI: 10.1186/s41747-022-00301-0] [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: 03/30/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The use of facemasks is one of the consequences of the coronavirus disease 2019 (COVID-19) pandemic. We used resting-state functional magnetic resonance imaging (fMRI) to search for subtle changes in brain functional connectivity, expected notably related to the high-level salience network (SN) and default mode network (DMN).
Methods
Prospective crossover design resting 3-T fMRI study with/without wearing a tight FFP2/KN95 facemask, including 23 community-dwelling male healthy controls aged 29.9 ± 6.9 years (mean ± standard deviation). Physiological parameters, respiration frequency, and heart rate were monitored. The data analysis was performed using the CONN toolbox.
Results
Wearing an FFP2/KN95 facemask did not impact respiration or heart rate but resulted in a significant reduction in functional connectivity between the SN as the seed region and the left middle frontal and precentral gyrus. No difference was found when the DMN, sensorimotor, visual, dorsal attention, or language networks were used as seed regions. In the absence of significant changes of physiological parameter respiration and heart rate, and in the absence of changes in lower-level functional networks, we assume that those subtle modifications are cognitive consequence of wearing facemasks.
Conclusions
The effect of wearing a tight FFP2/KN95 facemask in men is limited to high-level functional networks. Using the SN as seed network, we observed subtle yet significant decreases between the SN and the left middle frontal and precentral gyrus. Our observations suggest that wearing a facemask may change the patterns of functional connectivity with the SN known to be involved in communication, social behavior, and self-awareness.
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22
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Thomas L, von Castell C, Hecht H. How facial masks alter the interaction of gaze direction, head orientation, and emotion recognition. Front Neurosci 2022; 16:937939. [PMID: 36213742 PMCID: PMC9533556 DOI: 10.3389/fnins.2022.937939] [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: 05/06/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic has altered the way we interact with each other: mandatory mask-wearing obscures facial information that is crucial for emotion recognition. Whereas the influence of wearing a mask on emotion recognition has been repeatedly investigated, little is known about the impact on interaction effects among emotional signals and other social signals. Therefore, the current study sought to explore how gaze direction, head orientation, and emotional expression interact with respect to emotion perception, and how these interactions are altered by wearing a face mask. In two online experiments, we presented face stimuli from the Radboud Faces Database displaying different facial expressions (anger, fear, happiness, neutral, and sadness), gaze directions (−13°, 0°, and 13°), and head orientations (−45°, 0°, and 45°) – either without (Experiment 1) or with mask (Experiment 2). Participants categorized the displayed emotional expressions. Not surprisingly, masks impaired emotion recognition. Surprisingly, without the mask, emotion recognition was unaffected by averted head orientations and only slightly affected by gaze direction. The mask strongly interfered with this ability. The mask increased the influence of head orientation and gaze direction, in particular for the emotions that were poorly recognized with mask. The results suggest that in case of uncertainty due to ambiguity or absence of signals, we seem to unconsciously factor in extraneous information.
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23
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Verroca A, de Rienzo CM, Gambarota F, Sessa P. Mapping the perception-space of facial expressions in the era of face masks. Front Psychol 2022; 13:956832. [PMID: 36176786 PMCID: PMC9514388 DOI: 10.3389/fpsyg.2022.956832] [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: 05/30/2022] [Accepted: 08/05/2022] [Indexed: 11/28/2022] Open
Abstract
With the advent of the severe acute respiratory syndrome-Corona Virus type 2 (SARS-CoV-2) pandemic, the theme of emotion recognition from facial expressions has become highly relevant due to the widespread use of face masks as one of the main devices imposed to counter the spread of the virus. Unsurprisingly, several studies published in the last 2 years have shown that accuracy in the recognition of basic emotions expressed by faces wearing masks is reduced. However, less is known about the impact that wearing face masks has on the ability to recognize emotions from subtle expressions. Furthermore, even less is known regarding the role of interindividual differences (such as alexithymic and autistic traits) in emotion processing. This study investigated the perception of all the six basic emotions (anger, disgust, fear, happiness, sadness, and surprise), both as a function of the face mask and as a function of the facial expressions’ intensity (full vs. subtle) in terms of participants’ uncertainty in their responses, misattribution errors, and perceived intensity. The experiment was conducted online on a large sample of participants (N = 129). Participants completed the 20-item Toronto Alexithymia Scale and the Autistic Spectrum Quotient and then performed an emotion-recognition task that involved face stimuli wearing a mask or not, and displaying full or subtle expressions. Each face stimulus was presented alongside the Geneva Emotion Wheel (GEW), and participants had to indicate what emotion they believed the other person was feeling and its intensity using the GEW. For each combination of our variables, we computed the indices of ‘uncertainty’ (i.e., the spread of responses around the correct emotion category), ‘bias’ (i.e., the systematic errors in recognition), and ‘perceived intensity’ (i.e., the distance from the center of the GEW). We found that face masks increase uncertainty for all facial expressions of emotion, except for fear when intense, and that disgust was systematically confused with anger (i.e., response bias). Furthermore, when faces were covered by the mask, all the emotions were perceived as less intense, and this was particularly evident for subtle expressions. Finally, we did not find any evidence of a relationship between these indices and alexithymic/autistic traits.
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Affiliation(s)
- Alessia Verroca
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | | | - Filippo Gambarota
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | - Paola Sessa
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- *Correspondence: Paola Sessa,
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24
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Rinck M, Primbs MA, Verpaalen IAM, Bijlstra G. Face masks impair facial emotion recognition and induce specific emotion confusions. Cogn Res Princ Implic 2022; 7:83. [PMID: 36065042 PMCID: PMC9444085 DOI: 10.1186/s41235-022-00430-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
Face masks are now worn frequently to reduce the spreading of the SARS-CoV-2 virus. Their health benefits are undisputable, but covering the lower half of one's face also makes it harder for others to recognize facial expressions of emotions. Three experiments were conducted to determine how strongly the recognition of different facial expressions is impaired by masks, and which emotions are confused with each other. In each experiment, participants had to recognize facial expressions of happiness, sadness, anger, surprise, fear, and disgust, as well as a neutral expression, displayed by male and female actors of the Radboud Faces Database. On half of the 168 trials, the lower part of the face was covered by a face mask. In all experiments, facial emotion recognition (FER) was about 20% worse for masked faces than for unmasked ones (68% correct vs. 88%). The impairment was largest for disgust, followed by fear, surprise, sadness, and happiness. It was not significant for anger and the neutral expression. As predicted, participants frequently confused emotions that share activation of the visible muscles in the upper half of the face. In addition, they displayed response biases in these confusions: They frequently misinterpreted disgust as anger, fear as surprise, and sadness as neutral, whereas the opposite confusions were less frequent. We conclude that face masks do indeed cause a marked impairment of FER and that a person perceived as angry, surprised, or neutral may actually be disgusted, fearful, or sad, respectively. This may lead to misunderstandings, confusions, and inadequate reactions by the perceivers. We studied how facial masks impair facial emotion recognition. We used validated actors and facial expressions from the Radboud Faces Database. Masks impaired recognition of disgust, fear, surprise, sadness, and happiness. With masks, disgust was often misinterpreted as anger, and fear as surprise. These results were replicated twice in large samples.
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25
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Ross P, George E. Are Face Masks a Problem for Emotion Recognition? Not When the Whole Body Is Visible. Front Neurosci 2022; 16:915927. [PMID: 35924222 PMCID: PMC9339646 DOI: 10.3389/fnins.2022.915927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 01/10/2023] Open
Abstract
The rise of the novel COVID-19 virus has made face masks commonplace items around the globe. Recent research found that face masks significantly impair emotion recognition on isolated faces. However, faces are rarely seen in isolation and the body is also a key cue for emotional portrayal. Here, therefore, we investigated the impact of face masks on emotion recognition when surveying the full body. Stimuli expressing anger, happiness, sadness, and fear were selected from the BEAST stimuli set. Masks were added to these images and participants were asked to recognize the emotion and give a confidence level for that decision for both the masked and unmasked stimuli. We found that, contrary to some work viewing faces in isolation, emotion recognition was generally not impaired by face masks when the whole body is present. We did, however, find that when viewing masked faces, only the recognition of happiness significantly decreased when the whole body was present. In contrast to actual performance, confidence levels were found to decline during the Mask condition across all emotional conditions. This research suggests that the impact of masks on emotion recognition may not be as pronounced as previously thought, as long as the whole body is also visible.
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26
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Levitan CA, Rusk I, Jonas-Delson D, Lou H, Kuzniar L, Davidson G, Sherman A. Mask wearing affects emotion perception. Iperception 2022; 13:20416695221107391. [PMID: 35782826 PMCID: PMC9248045 DOI: 10.1177/20416695221107391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/27/2022] [Indexed: 11/21/2022] Open
Abstract
To reduce the spread of COVID-19, mask wearing has become ubiquitous in much of the
world. We studied the extent to which masks impair emotion recognition and dampen the
perceived intensity of facial expressions by naturalistically inducing positive, neutral,
and negative emotions in individuals while they were masked and unmasked. Two groups of
online participants rated the emotional intensity of each presented image. One group rated
full faces (N=104); the other (N=102) rated cropped images where only the upper face was
visible. We found that masks impaired the recognition of and rated intensity of positive
emotions. This happened even when the faces were cropped and the lower part of the face
was not visible. Masks may thus reduce positive emotion and/or expressivity of positive
emotion. However, perception of negativity was unaffected by masking, perhaps because
unlike positive emotions like happiness which are signaled more in the mouth, negative
emotions like anger rely more on the upper face.
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Affiliation(s)
- Carmel A. Levitan
- Occidental College, 1600 Campus Road, Los Angeles, California, 90041, United States
| | - Isabelle Rusk
- Occidental College, 1600 Campus Road, Los Angeles, California, 90041, United States
| | | | - Hanyun Lou
- Occidental College, 1600 Campus Road, Los Angeles, California, 90041, United States
| | - Lennon Kuzniar
- Occidental College, 1600 Campus Road, Los Angeles, California, 90041, United States
| | - Gray Davidson
- Occidental College, 1600 Campus Road, Los Angeles, California, 90041, United States
| | - Aleksandra Sherman
- Occidental College, 1600 Campus Road, Los Angeles, California, 90041, United States
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27
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Miyazaki Y, Kamatani M, Suda T, Wakasugi K, Matsunaga K, Kawahara JI. Effects of wearing a transparent face mask on perception of facial expressions. Iperception 2022; 13:20416695221105910. [PMID: 35782828 PMCID: PMC9243485 DOI: 10.1177/20416695221105910] [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: 12/22/2021] [Accepted: 05/22/2022] [Indexed: 11/17/2022] Open
Abstract
Wearing face masks in public has become the norm in many countries post-2020. Although mask-wearing is effective in controlling infection, it has the negative side effect of occluding the mask wearer’s facial expressions. The purpose of this study was to investigate the effects of wearing transparent masks on the perception of facial expressions. Participants were required to categorize the perceived facial emotion of female (Experiment 1) and male (Experiment 2) faces with different facial expressions and to rate the perceived emotion intensity of the faces. Based on the group, the participants were assigned to, the faces were presented with a surgical mask, a transparent mask, or without a mask. The results showed that wearing a surgical mask impaired the performance of reading facial expressions, both with respect to recognition and perceived intensity of facial emotions. Specifically, the impairments were robustly observed in fear and happy faces for emotion recognition, and in happy faces for perceived intensity of emotion in Experiments 1 and 2. However, the impairments were moderated by wearing a transparent mask instead of a surgical mask. During the coronavirus disease 2019 (COVID-19) pandemic, the transparent mask can be used in a range of situations where face-to-face communication is important.
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Affiliation(s)
- Yuki Miyazaki
- Department of Psychology, Fukuyama University, Fukuyama, Japan
| | - Miki Kamatani
- Graduate School of Letters, Hokkaido University, Sapporo, Japan
| | - Tomokazu Suda
- Global Research & Development Division, Unicharm Corporation, Kanonji, Japan
| | - Kei Wakasugi
- Global Research & Development Division, Unicharm Corporation, Kanonji, Japan
| | - Kaori Matsunaga
- Global Research & Development Division, Unicharm Corporation, Kanonji, Japan
| | - Jun I. Kawahara
- Graduate School of Letters, Hokkaido University, Sapporo, Japan
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28
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The cultural learning account of first impressions. Trends Cogn Sci 2022; 26:656-668. [PMID: 35697651 DOI: 10.1016/j.tics.2022.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022]
Abstract
Humans spontaneously attribute character traits to strangers based on their facial appearance. Although these 'first impressions' typically have no basis in reality, some authors have assumed that they have an innate origin. By contrast, the Trait Inference Mapping (TIM) account proposes that first impressions are products of culturally acquired associative mappings that allow activation to spread from representations of facial appearance to representations of trait profiles. According to TIM, cultural instruments, including propaganda, illustrated storybooks, art and iconography, ritual, film, and TV, expose many individuals within a community to common sources of correlated face-trait experience, yielding first impressions that are shared by many, but typically inaccurate. Here, we review emerging empirical findings, many of which accord with TIM, and argue that future work must distinguish first impressions based on invariant facial features (e.g., shape) from those based on facial behaviours (e.g., expressions).
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29
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Tsantani M, Gray KLH, Cook R. New evidence of impaired expression recognition in developmental prosopagnosia. Cortex 2022; 154:15-26. [PMID: 35728295 DOI: 10.1016/j.cortex.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/27/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Developmental prosopagnosia (DP) is a neurodevelopmental condition characterized by lifelong face recognition difficulties. To date, it remains unclear whether or not individuals with DP experience impaired recognition of facial expressions. It has been proposed that DPs may have sufficient perceptual ability to correctly interpret facial expressions when tasks are relatively easy (e.g., the stimuli are unambiguous and viewing conditions are optimal), but exhibit subtle impairments when tested under more challenging conditions. In the present study, we sought to take advantage of the COVID-19 pandemic to test this view. It is well-established that the surgical-type masks worn during the pandemic hinder the recognition and interpretation of facial emotion in typical participants. Relative to typical participants, we hypothesized that DPs may be disproportionately impaired when asked to interpret the facial emotion of people wearing face masks. We compared the ability of 34 DPs and 60 age-matched typical controls to recognize facial emotions i) when the whole face is visible, and ii) when the lower portion of the face is covered with a surgical mask. When expression stimuli were viewed without a mask, the DPs and typical controls exhibited similar levels of performance. However, when expression stimuli were shown with a mask, the DPs showed signs of subtle expression recognition deficits. The DPs were particularly prone to mislabeling masked expressions of happiness as emotion neutral. These results add to a growing body of evidence that under some conditions, DPs do exhibit subtle deficits of expression recognition.
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Affiliation(s)
- Maria Tsantani
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.
| | - Katie L H Gray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Richard Cook
- Department of Psychological Sciences, Birkbeck, University of London, London, UK; Department of Psychology, University of York, UK
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30
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Anthropomorphic Robotic Eyes: Structural Design and Non-Verbal Communication Effectiveness. SENSORS 2022; 22:s22083060. [PMID: 35459046 PMCID: PMC9024502 DOI: 10.3390/s22083060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023]
Abstract
This paper shows the structure of a mechanical system with 9 DOFs for driving robot eyes, as well as the system’s ability to produce facial expressions. It consists of three subsystems which enable the motion of the eyeballs, eyelids, and eyebrows independently to the rest of the face. Due to its structure, the mechanical system of the eyeballs is able to reproduce all of the motions human eyes are capable of, which is an important condition for the realization of binocular function of the artificial robot eyes, as well as stereovision. From a kinematic standpoint, the mechanical systems of the eyeballs, eyelids, and eyebrows are highly capable of generating the movements of the human eye. The structure of a control system is proposed with the goal of realizing the desired motion of the output links of the mechanical systems. The success of the mechanical system is also rated on how well it enables the robot to generate non-verbal emotional content, which is why an experiment was conducted. Due to this, the face of the human-like robot MARKO was used, covered with a face mask to aid in focusing the participants on the eye region. The participants evaluated the efficiency of the robot’s non-verbal communication, with certain emotions achieving a high rate of recognition.
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31
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The Effect of Surgical Masks on the Featural and Configural Processing of Emotions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042420. [PMID: 35206620 PMCID: PMC8872142 DOI: 10.3390/ijerph19042420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/27/2022]
Abstract
From the start of the COVID-19 pandemic, the use of surgical masks became widespread. However, they occlude an important part of the face and make it difficult to decode and interpret other people's emotions. To clarify the effect of surgical masks on configural and featural processing, participants completed a facial emotion recognition task to discriminate between happy, sad, angry, and neutral faces. Stimuli included fully visible faces, masked faces, and a cropped photo of the eyes or mouth region. Occlusion due to the surgical mask affects emotion recognition for sadness, anger, and neutral faces, although no significative differences were found in happiness recognition. Our findings suggest that happiness is recognized predominantly via featural processing.
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32
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Escelsior A, Amadeo MB, Esposito D, Rosina A, Trabucco A, Inuggi A, Pereira da Silva B, Serafini G, Gori M, Amore M. COVID-19 and psychiatric disorders: The impact of face masks in emotion recognition face masks and emotion recognition in psychiatry. Front Psychiatry 2022; 13:932791. [PMID: 36238943 PMCID: PMC9551300 DOI: 10.3389/fpsyt.2022.932791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Since the outbreak of the COVID-19 pandemic, reading facial expressions has become more complex due to face masks covering the lower part of people's faces. A history of psychiatric illness has been associated with higher rates of complications, hospitalization, and mortality due to COVID-19. Psychiatric patients have well-documented difficulties reading emotions from facial expressions; accordingly, this study assesses how using face masks, such as those worn for preventing COVID-19 transmission, impacts the emotion recognition skills of patients with psychiatric disorders. To this end, the current study asked patients with bipolar disorder, major depressive disorder, schizophrenia, and healthy individuals to identify facial emotions on face images with and without facial masks. Results demonstrate that the emotion recognition skills of all participants were negatively influenced by face masks. Moreover, the main insight of the study is that the impairment is crucially significant when patients with major depressive disorder and schizophrenia had to identify happiness at a low-intensity level. These findings have important implications for satisfactory social relationships and well-being. If emotions with positive valence are hardly understood by specific psychiatric patients, there is an even greater requirement for doctor-patient interactions in public primary care.
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Affiliation(s)
- Andrea Escelsior
- Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab, Clinica Psichiatrica ed SPDC, Largo Rosanna Benzi, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Bianca Amadeo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Davide Esposito
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Anna Rosina
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alice Trabucco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alberto Inuggi
- Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab, Clinica Psichiatrica ed SPDC, Largo Rosanna Benzi, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Beatriz Pereira da Silva
- Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab, Clinica Psichiatrica ed SPDC, Largo Rosanna Benzi, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Gianluca Serafini
- Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab, Clinica Psichiatrica ed SPDC, Largo Rosanna Benzi, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Gori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Mario Amore
- Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab, Clinica Psichiatrica ed SPDC, Largo Rosanna Benzi, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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