Jenni Leppanen

Facial expression to emotional stimuli in non-psychotic disorders: A systematic review and meta-analysis.

Facial expression of emotion is crucial to social interaction and emotion regulation; therefore, altered facial expressivity can be a contributing factor in social isolation, difficulties with emotion regulation and a target for therapy. This article provides a systematic review and meta-analysis of the literature on automatic emotional facial expression in people with non-psychotic disorders compared to healthy comparison groups. Studies in the review used an emotionally salient visual induction method, and reported on automatic facial expression in response to congruent stimuli. A total of 39 studies show alterations in emotional facial expression across all included disorders, except anxiety disorders. In depression, decreases in facial expression are mainly evident for positive affect. In eating disorders, a meta-analysis showed decreased facial expressivity in response to positive and negative stimuli. Studies in autism partially support generally decreased facial expressivity in this group. The data included in this review point towards decreased facial emotional expressivity in individuals with different non-psychotic disorders. This is the first review to synthesise facial expression studies across clinical disorders.

Interventions for caregivers of someone with an eating disorder: A meta-analysis

OBJECTIVE A variety of interventions have been developed for caregivers of people with an eating disorder either to help them cope with the burden and distress that commonly accompanies this role or to make them more effective at providing support. The aim of the study is to perform a meta-analysis of quantitative studies that have described the impact of these interventions on caregivers. METHOD Electronic databases were searched between September 2001 and September 2013. Thirteen studies were finally selected for inclusion. Pooled effect size estimates were summarized. Meta-regressions were used to determine whether type of intervention, team, measure used or risk of bias were effect modifiers of the relationship. We also summarized the content and form (amount of professional help) of the interventions. RESULTS Most interventions produced a moderate sized reduction in carer distress and a small/moderate reduction in carer burden and expressed emotion post treatment and these changes were maintained over follow-up. DISCUSSION Carer distress, burden and expressed emotion can be reduced by a variety of psychoeducational interventions and these changes are sustainable over time. The interventions themselves are easy to disseminate and deliver.

Using the Autism-Spectrum Quotient to Measure Autistic Traits in Anorexia Nervosa: A Systematic Review and Meta-Analysis

Interest in the link between Autism Spectrum Disorder (ASD) and Anorexia Nervosa (AN) has led to estimates of the prevalence of autistic traits in AN. This systematic review and meta-analysis assessed the use of the Autism-Spectrum Quotient (AQ) or abbreviated version (AQ-10) to examine whether patients with AN have elevated levels of autistic traits. Seven studies were identified and subsequent meta-analysis indicated that those with AN appear to have significant difficulties of a manner characteristic of ASD, relative to controls. Whilst this analysis supports previous indications of higher prevalence of ASD in AN, the aetiology of these traits remains unclear. Studies using more robust clinical measures of ASD within AN are needed to confirm what self-report measures appear to show.

Meta-analysis of the effects of intranasal oxytocin on interpretation and expression of emotions

HighlightsSingle dose of intranasal oxytocin has little to no effect on emotional theory of mind or emotion expression among healthy or clinical adult populations.Intranasal oxytocin improved recognition of basic emotions, particularly fear, but only among healthy populations.Intranasal oxytocin improves sensitivity to recognise anger, but only among healthy populations.Effect of oxytocin may be dependent on social boundaries. Abstract Accurate interpretation and appropriate expression of emotions are key aspects of social‐cognition. Several mental disorders are characterised by transdiagnostic difficulties in these areas and, recently, there has been increasing interest in exploring the effects of oxytocin on social‐emotional functioning. This review consists of 33 studies. Fifteen of the studies included people with autism spectrum disorder, schizophrenia, borderline personality disorder, frontotemporal dementia, anorexia nervosa, bulimia nervosa, post‐traumatic stress disorder, depression, and opioid and alcohol dependence. We conducted ten meta‐analyses examining the effects of intranasal oxytocin on expression of emotions, emotional theory of mind, sensitivity to recognise basic emotions, and recognition of basic emotions. A single dose of intranasal oxytocin significantly improved the recognition of basic emotions, particularly fear, and increased the expression of positive emotions among the healthy individuals. Oxytocin did not significantly influence theory of mind or the expression of negative emotions among the healthy individuals. Finally, intranasal oxytocin did not significantly influence interpretation or expression of emotions among the clinical populations.

New treatment approaches for severe and enduring eating disorders

OBJECTIVE The aim of this paper is to map the possibility of new treatment approaches for eating disorders. BACKGROUND Eating disorders have a protracted trajectory with over 50% of cases developing a severe and enduring stage of illness. Although a good response to family-based interventions occurs in the early phase, once the illness has become severe and enduring there is less of a response to any form of treatment. Neuroprogressive changes brought about by poor nutrition and abnormal eating patterns contribute to this loss of treatment responsivity. METHOD We have summarised the profile of symptoms at the various stages of illness and considered new treatments that might be applied. RESULTS In the enduring stage of illness in addition to problems with body image, food and eating, there are additional problems of low mood, high anxiety and compulsivity and problems in social functioning. This suggests that there are dysfunctions in circuits subsuming reward, punishment, decision-making and social processes. New approaches have been developed targeting these areas. CONCLUSION New interventions targeting both the primary and secondary symptoms seen in the enduring stage of eating disorders may improve the response to treatment.

Emotional Processing, Recognition, Empathy and Evoked Facial Expression in Eating Disorders: An Experimental Study to Map Deficits in Social Cognition

Background Difficulties in social cognition have been identified in eating disorders (EDs), but the exact profile of these abnormalities is unclear. The aim of this study is to examine distinct processes of social-cognition in this patient group, including attentional processing and recognition, empathic reaction and evoked facial expression in response to discrete vignettes of others displaying positive (i.e. happiness) or negative (i.e. sadness and anger) emotions. Method One hundred and thirty-eight female participants were included in the study: 73 healthy controls (HCs) and 65 individuals with an ED (49 with Anorexia Nervosa and 16 with Bulimia Nervosa). Self-report and behavioural measures were used. Results Participants with EDs did not display specific abnormalities in emotional processing, recognition and empathic response to others’ basic discrete emotions. However, they had poorer facial expressivity and a tendency to turn away from emotional displays. Conclusion Treatments focusing on the development of non-verbal emotional communication skills might be of benefit for patients with EDs.

Evidence for Cognitive Remediation Therapy in Young People with Anorexia Nervosa: Systematic Review and Meta-analysis of the Literature

Cognitive remediation therapy (CRT) for eating disorders has demonstrated promising findings in adult age groups, with randomised treatment trials and systematic reviews demonstrating medium to large effect sizes in improved cognitive performance. In recent years, several case series have been conducted for young people with anorexia nervosa, but these findings have not been synthesised in the form of a systematic review. This systematic review aimed to evaluate the evidence for the efficacy of CRT in child and adolescent age groups. Nine studies were identified, with a subsequent meta-analysis suggesting improvements in cognitive performance with small effect sizes. Patient feedback was positive, with low dropout rates. These findings suggest that CRT has potential as a supplementary treatment for young people with anorexia nervosa, warranting further investigation using randomised treatment trials. Copyright

Emotional Processing of Infants Displays in Eating Disorders

Aim The aim of this study is to examine emotional processing of infant displays in people with Eating Disorders (EDs). Background Social and emotional factors are implicated as causal and maintaining factors in EDs. Difficulties in emotional regulation have been mainly studied in relation to adult interactions, with less interest given to interactions with infants. Method A sample of 138 women were recruited, of which 49 suffered from Anorexia Nervosa (AN), 16 from Bulimia Nervosa (BN), and 73 were healthy controls (HCs). Attentional responses to happy and sad infant faces were tested with the visual probe detection task. Emotional identification of, and reactivity to, infant displays were measured using self-report measures. Facial expressions to video clips depicting sad, happy and frustrated infants were also recorded. Results No significant differences between groups were observed in the attentional response to infant photographs. However, there was a trend for patients to disengage from happy faces. People with EDs also reported lower positive ratings of happy infant displays and greater subjective negative reactions to sad infants. Finally, patients showed a significantly lower production of facial expressions, especially in response to the happy infant video clip. Insecure attachment was negatively correlated with positive facial expressions displayed in response to the happy infant and positively correlated with the intensity of negative emotions experienced in response to the sad infant video clip. Conclusion People with EDs do not have marked abnormalities in their attentional processing of infant emotional faces. However, they do have a reduction in facial affect particularly in response to happy infants. Also, they report greater negative reactions to sadness, and rate positive emotions less intensively than HCs. This pattern of emotional responsivity suggests abnormalities in social reward sensitivity and might indicate new treatment targets.

Biased Interpretation of Ambiguous Social Scenarios in Anorexia Nervosa

Patients with anorexia nervosa experience increased sensitivity to the risk of social rejection. The aims of this study were to assess the interpretation of ambiguous social scenarios depicting the risk of rejection and to examine the relationship between interpretation biases and clinical symptoms. Thirty-five women with anorexia nervosa and 30 healthy eaters completed clinical questionnaires, alongside a sentence completion task. This task required participants to generate completions to ambiguous social scenarios and to endorse their best completion. Responses were rated as being negative, neutral or positive. Patients endorsed more negative interpretations and fewer neutral and positive interpretations compared with healthy eaters. The frequency of endorsed negative interpretations correlated with depression, anxiety and fear of weight gain and body disturbance. A negative interpretation bias towards social stimuli is present in women with anorexia nervosa and correlates with clinical symptoms. Interventions aimed at reducing this bias could improve illness prognosis. Copyright

Effects of Intranasal Oxytocin on the Interpretation and Expression of Emotions in Anorexia Nervosa

Altered social‐emotional functioning is considered to play an important role in the development and maintenance of anorexia nervosa (AN). Recently, there has been increasing interest in investigating the role of intranasal oxytocin in social‐emotional processing. The present study aimed to investigate the effects of intranasal oxytocin on the interpretation and expression of emotions among people with AN. Thirty women with AN and 29 age‐matched healthy women took part in the present study, which used a double‐blind, placebo‐controlled, cross‐over design. The participants received a single dose of 40 IU of intranasal oxytocin in one session and a placebo spray in the other. Fifteen minutes after administration, the participants completed the Reading the Mind in the Eyes Test to assess the interpretation of complex emotions and mental states followed by a video task, which assessed expressions of facial affect when they were viewing humorous and sad film clips. The intranasal oxytocin did not significantly influence the expression or interpretation of emotions in the AN or healthy comparison groups. The AN group expressed significantly less positive emotion, spent more time looking away and reported experiencing a significantly more negative affect in response to the film clips. The finding that intranasal oxytocin had little to no effect on the interpretation or expression of emotions in either group supports the notion that the effects of oxytocin on social‐emotional processing are not straightforward and may depend on individual and environmental differences, as well as the emotion being processed. Replication of these findings is necessary to explore the effect of timing on the effects of oxytocin before firm conclusions can be drawn. Nonetheless, these findings add to the steady accumulation of evidence that people with AN have reduced emotional expression and avoidance of emotionally provoking stimuli.