Pamela J. Marsh

An Unusual attraction to the eyes in Williams-Beuren syndrome : a manipulation of facial affect while measuring face scanpaths

Introduction. This study aimed to investigate face scanpaths and emotion recognition in Williams-Beuren syndrome (WBS) and whether: (1) the eyes capture the attention of WBS individuals faster than typically developing mental age-matched controls; (2) WBS patients spend abnormally prolonged periods of time viewing the eye region; and (3) emotion recognition skills or eye gaze patterns change depending on the emotional valance of the face. Methods. Visual scanpaths were recorded while 16 WBS patients and 16 controls passively viewed happy, angry, fearful, and neutral faces. Emotion recognition was subsequently measured. Results. The eyes did not capture the attention of WBS patients faster than controls, but once WBS patients attended to the eyes, they spent significantly more time looking at this region. Unexpectedly, WBS patients showed an impaired ability to recognise angry faces, but face scanpaths were similar across the different facial expressions. Conclusions. Findings suggest that face processing is atypical in WBS and that emotion recognition and eye gaze abnormalities in WBS are likely to be more complex than previously thought. Findings highlight the need to develop remediation programmes to teach WBS patients how to explore all facial features, enhancing their emotion recognition skills and “normalising” their social interactions.

Remediation of Facial Emotion Recognition in Schizophrenia: Functional Predictors, Generalizability, and Durability

Impaired recognition of facial emotion in schizophrenia is associated with poor social functioning. Evidence shows that targeted emotion recognition training (ERT) can improve perception of facial emotions in schizophrenia for up to 1 week after training. This study investigated whether (a) improved recognition generalizes to novel faces, (b) training effects are durable over 1 month, and (c) baseline functioning levels predict the extent of improvement. Thirty-nine participants with schizophrenia received ERT using Ekmans Micro-Expression Training Tool (METT; 2003). Emotion recognition was assessed using METT face stimuli and other face stimuli not used in training (static faces shown at 100% and 50% intensity and dynamic stimuli). Baseline ratings of interpersonal and cognitive functioning were collected; a subgroup of 10 participants was followed up at 1 month posttraining. Post-METT training, participants showed improved perception of METT faces and novel faces. The subgroup followed over 1 month showed improved recognition of novel faces and dynamic stimuli 1 month after training, but not immediately after training. Baseline measures of interpersonal and social functioning and general face processing and working memory abilities (50% intensity expressions only) predicted improvement in facial affect recognition immediately after METT training. These findings suggest that the effectiveness of ERT in schizophrenia is influenced by pretraining levels of social functioning and that general face processing abilities and working memory may affect the ability to accurately process subtle facial expressions. Furthermore, improved recognition generalizes to novel faces but only over time, which might indicate an increasing awareness of facial emotion after ERT, at least in people with better baseline social functioning.

Effects of facial emotion recognition remediation on visual scanning of novel face stimuli.

Previous research shows that emotion recognition in schizophrenia can be improved with targeted remediation that draws attention to important facial features (eyes, nose, mouth). Moreover, the effects of training have been shown to last for up to one month after training. The aim of this study was to investigate whether improved emotion recognition of novel faces is associated with concomitant changes in visual scanning of these same novel facial expressions. Thirty-nine participants with schizophrenia received emotion recognition training using Ekmans Micro-Expression Training Tool (METT), with emotion recognition and visual scanpath (VSP) recordings to face stimuli collected simultaneously. Baseline ratings of interpersonal and cognitive functioning were also collected from all participants. Post-METT training, participants showed changes in foveal attention to the features of facial expressions of emotion not used in METT training, which were generally consistent with the information about important features from the METT. In particular, there were changes in how participants looked at the features of facial expressions of emotion surprise, disgust, fear, happiness, and neutral, demonstrating that improved emotion recognition is paralleled by changes in the way participants with schizophrenia viewed novel facial expressions of emotion. However, there were overall decreases in foveal attention to sad and neutral faces that indicate more intensive instruction might be needed for these faces during training. Most importantly, the evidence shows that participant gender may affect training outcomes.

An open clinical trial assessing a novel training program for social cognitive impairment in schizophrenia

Objective: Social cognition is profoundly impaired in patients with schizophrenia. This study describes ‘Mental-State Reasoning Training for Social Cognitive Impairment’ (SoCog-MSRT), a 5-week program developed to improve social cognition in patients with schizophrenia. We aimed to investigate the feasibility of implementing SoCog-MSRT in a rehabilitation setting and to evaluate whether our training methods produced improvements. Method The feasibility and benefits of SoCog-MSRT were evaluated in an open clinical trial with 14 participants with schizophrenia or schizoaffective disorder. Training comprised 10 twice-weekly sessions, for 5 weeks, with a pre- and post-training assessment. Results: There were significant improvements on: (a) a classic false-belief test of Theory of Mind (ToM); (b) inferring complex mental states from the eyes; and (c) a self-reported measure of social understanding. Some of these improvements were associated with baseline levels of working memory and premorbid Intelligence Quotient (IQ). Conclusions SoCog-MSRT can improve ToM abilities and social understanding, but individuals with poorer working memory and lower premorbid IQ may be less able to benefit from this type of training.

DYSFUNCTION IN SMOOTH PURSUIT EYE MOVEMENTS AND HISTORY OF CHILDHOOD TRAUMA

Several commentators recently have advocated the view that a deficit in the performance of a smooth pursuit eye-movement task is a biological marker of the genetic predisposition to schizophrenia. This study considered the possibility that such an impairment is due in part to experiential or acquired characteristics, and specifically, to a history of childhood trauma. A sample of 100 Australian adults performed a visual tracking task and completed a self-report measure of childhood trauma. Although the effect size was small, a relationship was found between eye-tracking performance and a childhood history of physical and emotional abuse. This finding suggests that eye-tracking performance may not be governed entirely by genetic factors, a possibility that has implications for the use of indices of smooth pursuit eye movement as a purely genetic marker of proneness to schizophrenia. Further investigation is needed to clarify the basis of the association between these deficits and childhood abuse.

The case for social-cognitive remediation in schizophrenia: a life well lived is more than remission from psychosis.

Australian & New Zealand Journal of Psychiatry, 47(6) The case for treating social-cognitive impairments in schizophrenia is compelling. The most recent Australian statistics show that most people (90.4%) with a psychotic illness have impaired social functioning, with over one-half (63.2%) showing a profound level of dysfunction in their ability to socialise, 37% feeling socially isolated, and over two-thirds unable to maintain close relationships or engage in social and recreational activities (Morgan et al., 2011). These stark statistics invite two questions: (a) why do only a little over one-third (36.5%) of consumers receive any rehabilitation and only 28.9% have an individually tailored recovery plan (Morgan et al., 2011)?; and (b) what can we do to improve this situation? Below we discuss why socialcognitive remediation (SCR) for schizophrenia is important, what the potential barriers are to translating existing programs from the research environment into the clinical setting, and the importance of strong collaborations between researchers, clinicians and consumers as a way forward.

When You Turn the other Cheek: A Preference for Novel Viewpoints of Familiar Faces

Inferences about the psychobiological processes that underlie face perception have been drawn from the spontaneous behaviour of eyes. Using a visual paired-comparison task, we recorded the eye movements of twenty adults as they viewed pairs of faces that differed in their relative familiarity. The results indicate an advantage for novel viewpoints of familiar faces over familiar viewpoints of familiar faces and novel faces. We conclude that this preference serves the face recognition system by collecting the variation necessary to build robust representations of identity.

Visual attention to facial features following emotion remediation in schizophrenia

Background: Considerable evidence attests to impaired facial emotion perception in schizophrenia, alongside abnormalities of attention evident in restricted scanning and avoidance of facial features (eyes, nose and mouth). Recent studies have successfully improved social cognition in schizophrenia with the use of targeted remediation techniques. In this study, we used a computer-based microexpression training tool (METT; Ekman, 2003) with concurrent assessment of eye movements to investigate changes in visual attention to faces following emotion remediation in schizophrenia. Methods: Twenty-six participants with schizophrenia were exposed to active training using the METT, while 14 were assigned to a repeated-exposure group. Training comprised video clips with verbal commentary detailing the difference between frequently confused emotions and directing attention to relevant facial features, and practice with feedback regarding accuracy. The repeated-exposure group viewed the video clips but were not exposed to the verbal commentary or feedback during practice. Affect recognition and concurrent eye movement recordings were collected preand posttraining in both groups to test the effects of training. Results: Active remediation training improved emotion recognition accuracy, while repeated exposure to visual stimuli did not. Participants who received METT training showed a general increase in attention to feature areas of faces posttraining. For specifi c facial expressions, attention to feature areas increased or decreased according to the instructions given during remediation. Conclusions: Training with the METT improves emotion-processing skills in schizophrenia, while repeated exposure does not. Visual attention to facial features that are important for distinguishing between facial expressions improves with METT remediation. ADHD and fi rst-episode schizophrenia show distinct scanpaths to emotional faces