Eye Tracking of Attention to Emotion in Bipolar I Disorder: Links to Emotion Regulation and Anxiety Comorbidity

Facial emotion recognition processes according to schizotypal personality traits: An eye-tracking study

Facial emotion recognition has been shown to be impaired among patients with schizophrenia and, to a lesser extent, among individuals with high levels of schizotypal personality traits. However, aspects of gaze behavior during facial emotion recognition among the latter are still unclear. This study therefore investigated the relations between eye movements and facial emotion recognition among nonclinical individuals with schizotypal personality traits. A total of 83 nonclinical participants completed the Schizotypal Personality Questionnaire (SPQ) and performed a facial emotion recognition task. Their gaze behavior was recorded by an eye-tracker. Self-report questionnaires measuring anxiety, depressive symptoms, and alexithymia were administered. At the behavioral level, correlation analyses showed that higher SPQ scores were associated with lower surprise recognition accuracy scores. Eye-tracking data revealed that higher SPQ scores were associated with shorter dwell time on relevant facial features during sadness recognition. Regression analyses revealed that the total SPQ score was the only significant predictor of eye movements during sadness recognition, and depressive symptoms were the only significant predictor of surprise recognition accuracy. Furthermore, dwell time predicted response times for sadness recognition in that shorter dwell time on relevant facial features was associated with longer response times. Schizotypal traits may be associated with decreased attentional engagement in relevant facial features during sadness recognition and impede participants' response times. Slower processing and altered gaze patterns during the processing of sad faces could lead to difficulties in everyday social situations in which information must be rapidly processed to enable the successful interpretation of other people's behavior.

Euthymic patients with predominantly manic polarity avoid happy faces in a dot probe task

BACKGROUND

Some studies suggest a mood-congruent attentional bias in bipolar patients. However, for euthymic patients, especially in dependence on the predominant polarity, there is little and inconsistent data. A clearer understanding of emotion-related attentional biases and their relationship to dysfunctional emotion regulation could help improving the diagnostics and treatment of bipolar disorder (BD). Twenty bipolar patients in a depressive state (BP-acute-D), 32 euthymic patients with manic (BP-euth-M) or depressive (BP-euth-D) predominant polarity, and 20 healthy control participants (HC) performed a dot-probe task (DPT) with happy and sad faces presented for 250 ms or 1250 ms in two different runs. Emotion regulation strategies were assessed with two questionnaires.

RESULTS

In the short presentation condition of the DPT, BP-euth-M showed less attention for happy faces than HC (p = .03, r = - 0.48). BP-acute-D scored lower in cognitive reappraisal and putting into perspective and higher in suppression, catastrophizing, and rumination than HC. BP-euth-M scored higher in rumination and BP-euth-D lower in putting into perspective and higher in catastrophizing than HC. In BP-euth-D and HC, bias scores for sad faces in the longer presentation condition and reappraisal scores correlated positively.

CONCLUSIONS

Results of the DPT suggest an avoidance of happy faces for BP-euth-M which we interpret as a protection mechanism for triggers of mania. That individuals who apply more reappraisal show more selective attention to sad faces could on the one hand reflect a mental effort in reevaluating the sad emotional input and on the other hand a greater tolerance for it.

Cognitive attentional syndrome and metacognitive beliefs as potential treatment targets for metacognitive therapy in bipolar disorder

Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder (BD). However, relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD. Given its unique view in the explanation of psychopathological states, metacognitive therapy (MCT) might be helpful for BD. Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome (CAS) and that it is influenced and maintained by dysfunctional metacognitive beliefs, perseverative thinking, attentional biases, and dysfunctional coping strategies. In this review, literature data regarding these areas in BD are examined. Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD. Regarding attentional biases, literature data show that state-dependent, mood-changing attentional biases and a ruminative self-focused attention are present. Studies also suggest that cognitive self-consciousness is higher in BD compared to controls. It is seen that maladaptive coping strategies are frequently reported in BD, and that these strategies are associated with depression severity, negative affect and relapse risk. Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs, self-consciousness, need to control thoughts, and a lack of cognitive confidence. Also, dysfunctional metacognitive beliefs were associated with depressive symptomatology. These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD. For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions, MCT might be an alternative way to consider as a treatment option. In conclusion, taken the available data together, we propose a sequential treatment protocol for BD, mainly based on the MCT treatment plan of depressive disorders.

How Our Gaze Reacts to Another Person's Tears? Experimental Insights Into Eye Tracking Technology

Crying is an ubiquitous human behavior through which an emotion is expressed on the face together with visible tears and constitutes a slippery riddle for researchers. To provide an answer to the question "How our gaze reacts to another person's tears?," we made use of eye tracking technology to study a series of visual stimuli. By presenting an illustrative example through an experimental setting specifically designed to study the "tearing effect," the present work aims to offer methodological insight on how to use eye-tracking technology to study non-verbal cues. A sample of 30 healthy young women with normal visual acuity performed a within-subjects task in which they evaluated images of real faces with and without tears while their eye movements were tracked. Tears were found to be a magnet for visual attention in the task of facial attribution, facilitating a greater perception of emotional intensity. Moreover, the inspection pattern changed qualitatively and quantitatively, with our participants becoming fully focused on the tears when they were visible. The mere presence of a single tear running down a cheek was associated with an increased emotional inference and greater perception of sincerity. Using normalized and validated tools (Reading the Eyes in the Mind Test and the SALAMANCA screening test for personality disorders), we measured the influence of certain characteristics of the participants on their performance of the experimental task. On the one hand, a higher level of cognitive empathy helped to classify tearful faces with higher emotional intensity and tearless faces with less emotional intensity. On the other hand, we observed that less sincerity was attributed to the tearful faces as the SALAMANCA test scores rose in clusters A (strange and extravagant) and B (immature and emotionally unstable) of our sample. The present findings highlight the advantages of using eye tracking technology to study non-verbal cues and draw attention to methodological issues that should be taken into account. Further exploration of the relationship between empathy and tear perception could be a fruitful avenue of future research using eye tracking.

Eye gaze and facial displays of emotion during emotional film clips in remitted patients with bipolar disorder

Background.

Aberrant emotional reactivity is a putative endophenotype for bipolar disorder (BD), but the findings of behavioral studies are often negative due to suboptimal sensitivity of the employed paradigms. This study aimed to investigate whether visual gaze patterns and facial displays of emotion during emotional film clips can reveal subtle behavioral abnormalities in remitted BD patients.

Methods.

Thirty-eight BD patients in full or partial remission and 40 healthy controls viewed 7 emotional film clips. These included happy, sad, and neutral scenarios and scenarios involving winning, risk-taking, and thrill-seeking behavior of relevance to the BD phenotype. Eye gaze and facial expressions were recorded during the film clips, and participants rated their emotional reactions after each clip.

Results.

BD patients showed a negative bias in both facial displays of emotion and self-rated emotional responses. Specifically, patients exhibited more fearful facial expressions during all film clips. This was accompanied by less positive self-rated emotions during the winning and happy film clips, and more negative emotions during the risk-taking/thrill-related film clips.

Conclusions.

These findings suggest that BD is associated with trait-related abnormalities in subtle behavioral displays of emotion processing. Future studies comparing patients with BD and unipolar depression are warranted to clarify whether these differences are specific to BD. If so, assessments of visual gaze and facial displays of emotion during emotional film clips may have the potential to be implemented in clinical assessments to aid diagnostic accuracy.

Hybrid Eye-Tracking on a Smartphone with CNN Feature Extraction and an Infrared 3D Model

This paper describes a low-cost, robust, and accurate remote eye-tracking system that uses an industrial prototype smartphone with integrated infrared illumination and camera. Numerous studies have demonstrated the beneficial use of eye-tracking in domains such as neurological and neuropsychiatric testing, advertising evaluation, pilot training, and automotive safety. Remote eye-tracking on a smartphone could enable the significant growth in the deployment of applications in these domains. Our system uses a 3D gaze-estimation model that enables accurate point-of-gaze (PoG) estimation with free head and device motion. To accurately determine the input eye features (pupil center and corneal reflections), the system uses Convolutional Neural Networks (CNNs) together with a novel center-of-mass output layer. The use of CNNs improves the system’s robustness to the significant variability in the appearance of eye-images found in handheld eye trackers. The system was tested with 8 subjects with the device free to move in their hands and produced a gaze bias of 0.72°. Our hybrid approach that uses artificial illumination, a 3D gaze-estimation model, and a CNN feature extractor achieved an accuracy that is significantly (400%) better than current eye-tracking systems on smartphones that use natural illumination and machine-learning techniques to estimate the PoG.

Affective cognition in bipolar disorder: A systematic review by the ISBD targeting cognition task force

BACKGROUND

Impairments in affective cognition are part of the neurocognitive profile and possible treatment targets in bipolar disorder (BD), but the findings are heterogeneous. The International Society of Bipolar Disorder (ISBD) Targeting Cognition Task Force conducted a systematic review to (i) identify the most consistent findings in affective cognition in BD, and (ii) provide suggestions for affective cognitive domains for future study and meta-analyses.

METHODS

The review included original studies reporting behavioral measures of affective cognition in BD patients vs controls following the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Searches were conducted on PubMed/MEDLINE, EMBASE, and PsychInfo from inception until November 2018.

RESULTS

A total of 106 articles were included (of which nine included data for several affective domains); 41 studies assessed emotional face processing; 23 studies investigated reactivity to emotional words and images; 3 investigated explicit emotion regulation; 17 assessed implicit emotion regulation; 31 assessed reward processing and affective decision making. In general, findings were inconsistent. The most consistent findings were trait-related difficulties in facial emotion recognition and implicit emotion regulation, and impairments in reward processing and affective decision making during mood episodes. Studies using eye-tracking and facial emotion analysis revealed subtle trait-related abnormalities in emotional reactivity.

CONCLUSION

The ISBD Task Force recommends facial expression recognition, implicit emotion regulation, and reward processing as domains for future research and meta-analyses. An important step to aid comparability between studies in the field would be to reach consensus on an affective cognition test battery for BD.

Looking on the bright side and seeing it vividly: interpretation bias and involuntary mental imagery are related to risk for bipolar disorder

BACKGROUND

Involuntary mental imagery is elevated among people with bipolar disorder, and has been shown to shape biases in interpretation of ambiguous information. However, it is not clear whether biases in interpretation of ambiguous scenarios can be observed in those at risk for bipolar disorder, or whether involuntary imagery is related to such a bias.

AIMS

In the present study, we extended a prominent model of bipolar cognition to an at-risk sample. We specifically tested whether positive interpretation bias and involuntary mental imagery are linked to a greater risk of bipolar disorder.

METHOD

Young adults (N = 169) completed measures of risk for bipolar disorder (the Hypomanic Personality Scale [HPS]), interpretation bias, and involuntary mental imagery.

RESULTS

Higher scores on the HPS were significantly correlated with more positive interpretations of ambiguous scenarios (β = 0.29, p <. 01) and more frequent involuntary mental imagery (β = 0.22, p < .01). There was no evidence of an interaction between interpretation bias and mental imagery in predicting HPS score, β = .04, p = .62.

CONCLUSIONS

Further research is warranted to determine if intrusive imagery or interpretation bias influence the development of bipolar disorder over time in those at risk.

Emotion regulation strategies in bipolar disorder: A systematic and critical review

Theoretical frameworks emphasise associations between interpretations and responses to affect and bipolar disorder (BD). This review (PROSPERO CRD42016043801) investigated which emotion regulation (ER) strategies have been applied to BD, are elevated in BD compared to clinical and non-clinical controls, and are associated with clinical and functional outcomes in BD METHODS: Search terms relating to emotion regulation, coping and bipolar disorder were entered into Embase, MedLine and PsycInfo. Quantitative studies investigating relationships between ER strategies and BD were eligible for this narrative synthesis RESULTS: A large volume of research (n = 47) investigated specific ER strategies in BD. Maladaptive strategies such as rumination and dampening were elevated in BD compared to controls and these particular strategies had a detrimental impact on outcomes such as mood symptoms. BD had a similar profile of ER strategies to unipolar depression, but there was limited comparison to other clinical groups. People with BD did not generally have deficits in using adaptive strategies, as evidenced by comparisons with controls and experimental studies LIMITATIONS: Methodological heterogeneity and a lack of ecologically valid ER assessments CONCLUSIONS: Empirical literature is critiqued in line with contemporary theories of BD and of emotion regulation more generally, in order to inform future research recommendations. This includes investigation of the importance of context in the impact of ER strategies, and discrepancies between trait and state use of ER strategies, particularly through experience sampling.

Depressive Symptoms in Late Pregnancy Disrupt Attentional Processing of Negative-Positive Emotion: An Eye-Movement Study

This study investigated biases for negative-positive information in component processes of visual attention (initial shift vs. maintenance of gaze) among women in late pregnancy with or without depressive symptoms. Eye movements were recorded while participants viewed a series of picture pairs depicting negative, positive, and neutral scenes. Initial orienting (latency and percentage of first fixation) and gaze duration were computed. Compared with neutral pictures, the group with major depressive symptoms (MDS) were less able to sense the positive emotion-related pictures and were over-responsive to negative emotion-related pictures. The group with suspicious depressive symptoms (SDS) had an attention bias toward both positive and negative emotion-related pictures. The group with no depressive symptoms (NDS) had an attention bias toward positive emotion-related pictures and had an initial attention avoidance tendency for negative emotion-related pictures. The initial gaze direction bias score for negative emotion-related pictures was positively correlated with the severity of depressive symptoms. Therefore, women with a risk of perinatal depression have a significant bias toward negative stimuli. Hypervigilant emotion processing during pregnancy may increase a woman's susceptibility to depression during late pregnancy. Attention away from negative information or attention toward positive information may provide a way of buffering emotional responses.

Subtle behavioural responses during negative emotion reactivity and down-regulation in bipolar disorder: A facial expression and eye-tracking study

Abnormal processing of emotional information and regulation are core trait-related features of bipolar disorder (BD) but evidence from behavioural studies is conflicting. This study aimed to investigate trait-related abnormalities in emotional reactivity and regulation in BD using novel sensitive behavioural measures including facial expressions and eye movements. Fifteen patients with BD in full or partial remission and 16 healthy controls (HCs) were given a computerised task in which they were instructed to 'react to' unpleasant and neutral pictures or 'dampen' their emotional response to aversive pictures. Participants rated their emotional response after each picture block, and eye-movements and facial expressions were recorded. Patients generally gazed less at unpleasant and neutral pictures during emotion processing and regulation. During emotional reactivity, patients exhibited stronger facial expressions to neutral pictures, a lack of facial expressions to unpleasant pictures, and more surprised facial expressions to both neutral and unpleasant pictures compared to HCs. The results point to subtle abnormalities in visual gaze patterns and facial displays of emotion between patients with BD during emotion processing and regulation. Aberrant eye-movements and facial displays could provide a more sensitive measure of emotional reactivity in BD than traditional behavioural measures, which could aid future diagnostic accuracy.

Lack of emotional gaze preferences using eye-tracking in remitted bipolar I disorder

BACKGROUND

Bipolar disorder is associated with heightened and persistent positive emotion (Gruber in Curr Dir Psychol Sci 20:217-221, 2011; Johnson in Clin Psychol Rev 25:241-262, 2005). Yet little is known about information processing biases that may influence these patterns of emotion responding.

METHODS

The current study adopted eye-tracking methodology as a continuous measure of sustained overt attention to monitor gaze preferences during passive viewing of positive, negative, and neutral standardized photo stimuli among remitted bipolar adults and healthy controls. Percentage fixation durations were recorded for predetermined areas of interest across the entire image presentation, and exploratory analyses were conducted to examine early versus late temporal phases of image processing.

RESULTS

Results suggest that the bipolar and healthy control groups did not differ in patterns of attention bias.

CONCLUSIONS

Findings provide insight into apparently intact attention processing despite disrupted emotional responding in bipolar disorder.

Functional Connectivity Between Anterior Insula and Key Nodes of Frontoparietal Executive Control and Salience Networks Distinguish Bipolar Depression From Unipolar Depression and Healthy Control Subjects

BACKGROUND

Patients with bipolar depression are characterized by dysregulation across the full spectrum of mood, differentiating them from patients with unipolar depression. The ability to switch neural resources among the default mode network, salience network, and executive control network (ECN) has been proposed as a key mechanism for adaptive mood regulation. The anterior insula is implicated in the modulation of functional network switching. Differential connectivity between anterior insula and functional networks may provide insights into pathophysiological differences between bipolar and unipolar mood disorders, with implications for diagnosis and treatment.

METHODS

Resting-state functional magnetic resonance imaging data were collected from 98 subjects (35 unipolar, 24 bipolar, and 39 healthy control subjects). Pearson correlations were computed between bilateral insula seed regions and a priori defined target regions from the default mode network, salience network, and ECN. After r-to-z transformation, a one-way multivariate analysis of covariance was conducted to identify significant differences in connectivity between groups. Post hoc pairwise comparisons were conducted and Bonferroni corrections were applied. Receiver-operating characteristics were computed to assess diagnostic sensitivity.

RESULTS

Patients with bipolar depression evidenced significantly altered right anterior insula functional connectivity with the inferior parietal lobule of the ECN relative to patients with unipolar depression and control subjects. Right anterior insula-inferior parietal lobule connectivity significantly discriminated patients with bipolar depression.

CONCLUSIONS

Impaired functional connectivity between the anterior insula and the inferior parietal lobule of the ECN distinguishes patients with bipolar depression from those with unipolar depression and healthy control subjects. This finding highlights a pathophysiological mechanism with potential as a therapeutic target and a clinical biomarker for bipolar disorder, exhibiting reasonable sensitivity and specificity.