Remediation of facial emotion perception in schizophrenia: Concomitant changes in visual attention

The study examined changes in visual attention in schizophrenia following training with a social-cognitive remediation package designed to improve facial emotion recognition (the Micro-Expression Training Tool; METT). Forty out-patients with schizophrenia were randomly allocated to active training (METT; n=26), or repeated exposure (RE; n=14); all completed an emotion recognition task with concurrent eye movement recording. Emotion recognition accuracy was significantly improved in the METT group, and this effect was maintained after one week. Immediately following training, the METT group directed more eye movements within feature areas of faces (i.e., eyes, nose, mouth) compared to the RE group. The number of fixations directed to feature areas of faces was positively associated with emotion recognition accuracy prior to training. After one week, the differences between METT and RE groups in viewing feature areas of faces were reduced to trends. However, within group analyses of the METT group revealed significantly increased number of fixations to, and dwell time within, feature areas following training which were maintained after one week. These results provide the first evidence that improvements in emotion recognition following METT training are associated with changes in visual attention to the feature areas of emotional faces. These findings support the contribution of visual attention abnormalities to emotion recognition impairment in schizophrenia, and suggest that one mechanism for improving emotion recognition involves re-directing visual attention to relevant features of emotional faces.

[1]  Dennis R. Combs,et al.  Modification of affect perception deficits in schizophrenia , 2000, Schizophrenia Research.

[2]  大林 滋.  Relationship between exploratory eye movements and clinical course in schizophrenic patients , 2004 .

[3]  P. Benson,et al.  Visual scan paths in first-episode schizophrenia and cannabis-induced psychosis. , 2007, Journal of psychiatry & neuroscience : JPN.

[4]  W. Gaebel,et al.  Remediation of impairments in facial affect recognition in schizophrenia: Efficacy and specificity of a new training program , 2005, Schizophrenia Research.

[5]  M. Matsui,et al.  Limited visual search on the WAIS picture completion test in patients with schizophrenia , 1994, Schizophrenia Research.

[6]  W. Wölwer,et al.  Remediation of facial affect recognition impairments in patients with schizophrenia: a new training program , 2003, Psychiatry Research.

[7]  M. Phillips,et al.  A pilot study to investigate the effectiveness of emotion recognition remediation in schizophrenia using the micro-expression training tool. , 2006, The British journal of clinical psychology.

[8]  P. M. Guffin,et al.  The diagnostic interview for psychoses (DIP) : development, reliability and applications , 2006 .

[9]  Leanne M Williams,et al.  Visual scanpaths to positive and negative facial emotions in an outpatient schizophrenia sample , 2002, Schizophrenia Research.

[10]  A. Wheeler,et al.  An Audit of Outpatient Antipsychotic Usage in the Three Health Sectors of Auckland, New Zealand , 2004, The Australian and New Zealand journal of psychiatry.

[11]  David L. Roberts,et al.  The functional significance of social cognition in schizophrenia: a review. , 2006, Schizophrenia bulletin.

[12]  K. Nuechterlein.  Vigilance of schizophrenia and related disorders , 1991 .

[13]  M. Phillips,et al.  Visual scan paths are abnormal in deluded schizophrenics , 1997, Neuropsychologia.

[14]  P. Pattison,et al.  Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review. , 2002, Clinical psychology review.

[15]  E. Gordon,et al.  Eye movements reflect impaired face processing in patients with schizophrenia , 1999, Biological Psychiatry.

[16]  Armand J. Quick,et al.  THE QUICK TEST , 1951 .

[17]  T. Wykes,et al.  Cognitive predictors of social functioning improvements following cognitive remediation for schizophrenia. , 2006, Schizophrenia bulletin.

[18]  L. Williams,et al.  Visual scanpath dysfunction in first-degree relatives of schizophrenia probands: evidence for a vulnerability marker? , 2004, Schizophrenia Research.

[19]  E. Gordon,et al.  Schizophrenia and affective disorder show different visual scanning behavior for faces: a trait versus state-based distinction? , 2002, Biological Psychiatry.

[20]  Melissa J. Green,et al.  A social cognitive approach to emotional intensity judgment deficits in schizophrenia , 2007, Schizophrenia Research.

[21]  W. Gaebel,et al.  Visuomotor performance of schizophrenic patients and normal controls in a picture viewing task , 1987, Biological Psychiatry.

[22]  E. Gordon,et al.  Eye movement response to a facial stimulus in schizophrenia , 1992, Biological Psychiatry.

[23]  Niels G. Waller.  The Scale for the Assessment of Negative Symptoms , 1995 .

[24]  Melissa J. Green,et al.  Visual scanpaths to threat-related faces in deluded schizophrenia , 2003, Psychiatry Research.

[25]  Melissa J. Green,et al.  Visual processing of social context during mental state perception in schizophrenia. , 2008, Journal of psychiatry & neuroscience : JPN.

[26]  P. Schyns,et al.  A mechanism for impaired fear recognition after amygdala damage , 2005, Nature.

[27]  P. Ekman,et al.  Facial action coding system: a technique for the measurement of facial movement , 1978 .

[28]  M. Silver,et al.  Evaluation of a New Computer Intervention to Teach People with Autism or Asperger Syndrome to Recognize and Predict Emotions in Others , 2001, Autism : the international journal of research and practice.

[29]  A. Minassian,et al.  Visual scanning deficits in schizophrenia and their relationship to executive functioning impairment , 2005, Schizophrenia Research.

[30]  Dc Washington.  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[31]  M. Phillips,et al.  Perception of threat in schizophrenics with persecutory delusions: an investigation using visual scan paths , 2000, Psychological Medicine.

[32]  M. Phillips,et al.  Abnormal visual scan paths: a psychophysiological marker of delusions in schizophrenia , 1998, Schizophrenia Research.

[33]  R. Liberman,et al.  A controlled trial of cognitive remediation in schizophrenia. , 2002, Schizophrenia bulletin.

[34]  P. Ekman,et al.  Matsumoto and Ekman's Japanese and Caucasian Facial Expressions of Emotion (JACFEE): Reliability Data and Cross-National Differences , 1997 .

[35]  Evian Gordon,et al.  Visual scanpaths in schizophrenia: is there a deficit in face recognition? , 1999, Schizophrenia Research.

[36]  W. Gaebel,et al.  Facial-affect recognition and visual scanning behaviour in the course of schizophrenia , 1997, Schizophrenia Research.

[37]  M. Phillips,et al.  An Examination of Hypervigilance for External Threat in Individuals with Generalized Anxiety Disorder and Individuals with Persecutory Delusions Using Visual Scan Paths , 2000, The Quarterly journal of experimental psychology. A, Human experimental psychology.

[38]  D. Penn,et al.  Social perception and social skill in schizophrenia , 1998, Psychiatry Research.

[39]  S. Frangou,et al.  Which executive skills should we target to affect social functioning and symptom change? A study of a cognitive remediation therapy program. , 2004, Schizophrenia bulletin.