Several studies have shown that persons with other types of disorders, such as Autism Spectrum Disorder (ASD) and schizophrenia, also have difficulty identifying nonverbal cues of emotion.
According to Silver and colleagues80, it has been established that persons with schizophrenia have difficulty processing emotional information and perform poorly on tests of facial affect recognition80,81. Similar to TBI, impairments were more prominent for identifying negative emotions and less intense emotional expressions82. The similarities of persons with schizophrenia to TBI and ASD also extend to the neuroanatomical regions said to be involved with these affect processing deficits. It has been suggested that these impairments are associated with abnormal functioning of the “mesotemporal” regions83, including the temporal lobes and limbic system.
Emotion recognition interventions for persons with schizophrenia
Silver and colleagues80 also used the The Emotion Trainer to teach people with schizophrenia how to recognize emotions from facial expressions. They trained people with schizophrenia on the Emotion Trainer for three sessions. Before and after training, they were given three tests to determine their ability to recognize facial emotions. They used the PEAT82,92 to test emotion identification for faces presented in 40 black and white photos. In this measure, participants had to rate the intensity of emotions for each face on a scale of one through seven. In addition, they also used the ER4082 to test emotion recognition and the EmDiff to test differentiation of facial emotions93. The ER40 required participants to choose the correct emotional label that described the emotion expressed in photographs of faces. The EmDiff tested participants’ ability to determine whether two pictures had the same intensity of an emotion. The participants demonstrated significant improvement on the PEAT and ER40, demonstrating the effectiveness of the Emotion Trainer in teaching recognition of facial affect to people with schizophrenia.
Penn and Combs81 tested two intervention methods based on different hypotheses to improve facial affect recognition in people with schizophrenia. One of the interventions consisted of monetary reinforcement given for each correct response. This intervention is based on a behavioral theory, using reinforcement as a way to increase a particular response or behavior. Another intervention they used was referred to as facial feedback, a strategy based on the facial feedback hypothesis. As discussed earlier, the facial feedback hypothesis proposes that emotional experiences can be altered by changing the body state. Therefore, if a person mimics an expression with their facial muscles, this feedback about body state should elicit a feeling consistent with the expression. The authors based their intervention on the hypothesis that feelings must be experienced in order to recognize them in others.
Penn and Combs81 randomly assigned people with schizophrenia into one of four of the following groups: 1) Repeated Practice, 2) Reinforcement, 3) Facial feedback, and 4) Combination of reinforcement and facial feedback. In the Repeated Practice group, participants were shown faces and asked to identify the expressed emotions from a list. The Reinforcement group was shown the same faces, but was given 10 cents for every correct response. The Facial Feedback group was asked to identify the emotion of the faces shown, as well as imitate the emotion seen in the faces. The Combination group received 10 cents for correct responses, but also had to imitate the emotion. Participants were tested and trained with the Facial Affect Identification Task (FEIT, Kerr and Neale, 1993). This task consisted of participants labeling the appropriate emotion for 19 photos presented on videotape. In addition to this test, generalization of their learning was also tested with another measure, the Facial Emotion Discrimination Task (FEDT). This task required participants to determine if two faces portrayed the same or different emotions. Results from the FEIT test demonstrated that the monetary reinforcement, facial feedback, and combination groups did better than the repeated practice group. However, when tested on their ability to generalize what they learned on the FEDT, only the monetary reinforcement group did better. In addition, the combination group actually showed declined performance on the discrimination task when tested one week later on a follow up visit. The authors suggested that maybe the emotion discrimination task does not utilize the same skills as the labeling task, and therefore was not an appropriate measure of generalization. However, that does not explain why the monetary reinforcement group did better.
(For references please refer to Brain Injury and Emotion)