The level of expressed emotion scale: a useful measure of expressed emotion in adolescents?

Research has suggested that self-report measures of expressed emotion (EE) may be employed as a proxy measure of environmental stress in the home. The appropriateness of the Level of Expressed Emotion scale as a measure of perceived expressed emotion was examined in a sample of adolescents. Participants were 239 male and 422 female adolescents with a mean age of 15.9 years (SD = 1.26). Principal component analysis and confirmatory factor analysis suggested a shortened thirty three item scale with three subscales, interpreted as Lack of Emotional Support, Irritability and Intrusiveness. The Intrusiveness and Irritability subscales were positively correlated with adolescents’ self reports of psychological symptoms. Researchers seeking adolescents’ reports of the family environment should consider the use of this shortened LEE scale.     

How clients “change emotion with emotion”: A programme of research on emotional processing

This paper reviews a body of research that has examined Pascual-Leone and Greenberg’s sequential model of emotional processing or used its accompanying measure (the Classification of Affective Meaning States). Research from 24 studies using a plurality of methods examined process–outcome relationships from micro to macro levels of observation and builds support for emotional transformation as a possible causal mechanism of change in psychotherapy. A pooled sample of 310 clinical and 130 sub-clinical cases have been studied, reflecting the process of 7 different treatment approaches in addressing over 5 different presenting clinical problems (including depression, anxiety, relational trauma, and personality disorders). The initial findings on this model support the hypothesis that emotional transformation occurs in specific canonical sequences and these show large effects in the prediction of positive treatment outcomes. This model is the first in the field of psychotherapy to show how non-linear temporal patterns of moment-by-moment process relate to the unfolding of increasingly larger changes to create good psychotherapy treatment outcomes. Finally, clinical application of the model is also considered as a template for case formulations focused on emotion.

Clinical or methodological significance of this article: This review article examines research on a specific model of emotional processing. (i) Experiencing certain key emotions during psychotherapy seems to predict good treatment outcomes, at both the session and treatment levels. (ii) There is also evidence to suggest that these productive emotional experiences unfold in an ordered pattern. Moreover, (iii) support for this way of understanding emotional processing comes from a number of very different treatment approaches and for several kinds of major disorders.     

What is the place of emotion in cognitive-behavioral approaches of obsessive-compulsive disorders?

The efficacy of behavioral techniques based on exposure and response prevention has been well validated in the treatment of obsessive-compulsive disorder. Nevertheless in a large proportion of patients the disease persists, among others due to refusal of the treatment or due to non-response. About one of two patient entering treatment seems therefore to possibly benefit from behavioral therapy (Ladouceur et al., 1999). Cognitive techniques may extend the behavioral approach, and may represent a more indirect and progressive method, and may improve patients' commitment in the therapy. However, the proportion of treatment resistant patients remains important. New techniques are therefore warranted in order to progress in the understanding and treatment of these patients. Emotion focused therapy could possibly represent an interesting approach based on the improvement of emotional awareness, the exploration and the cognitive restructuring of emotions. The different techniques are described throughout clinical case reports.     

Is emotion processing a predictor of functional outcome in schizophrenia?

Deficits in the ability to perceive facial and vocal emotion expression are common in schizophrenia. However, relatively little is known about how such deficits might affect functional outcomes. This prospective study examined cross-sectional and longitudinal relationships between perception of emotion and aspects of psychosocial functioning, including family relationships, social relationships, work functioning, and independent living/self-care in 94 clinically stabilized schizophrenia outpatients from five community-based rehabilitation programs. Emotion perception (facial emotion, voice emotion, and affect perception) and psychosocial outcome (Strauss and Carpenter Outcome Scale and Role Functioning Scale) were assessed at baseline and after 12 months of psychosocial rehabilitation. Significant associations were found between perception of emotion and work functioning/independent living both cross-sectionally and prospectively over the 12 months. Causal explanatory models suggested that perception of emotion might cause work functioning/independent living outcome over 1 year. The results remained significant when conceptual disorganization was statistically controlled. We did not find differences between men and women in the correlations between emotion perception and work functioning/independent living. Associations between social functioning/family relationships and perception of emotion were not significant. These findings suggest that emotion processing is a key determinant of work functioning/independent living for individuals with serious mental illness.     

Functional significance of men’s testosterone reactivity to social stimuli

Rapid testosterone fluctuations in response to social stimuli are observed across a wide range of species, and the highly conserved nature of these fluctuations suggests an adaptive function. This paper reviews the current literature on testosterone reactivity, primarily in human males, and illustrates how life-history theory provides an adequate theoretical framework to interpret findings. The review is structured around supporting evidence suggesting that situations implicated in mating effort either directly (e.g., interactions with a mate) or indirectly (e.g., intrasexual competition) are generally associated with a brief elevation of testosterone, while situations implicated in parenting effort (e.g., nurturant interactions with offspring) are generally associated with a decline in testosterone. Further, we discuss how these fluctuations in testosterone have been linked to future behaviors, and how situational, motivational, and physiological variables moderate the interplay between social stimuli, testosterone reactivity, and behavior. Supporting the notion that testosterone can play a causal role in modulating behavior in response to social stimuli, we also summarize recent single administration studies examining the effects of testosterone on physiology, neurobiology, and behavior. A conceptual model provides links between supported findings, and hypothesized pathways requiring future testing.     

Neural correlates of impaired emotion processing in manifest Huntington’s disease

The complex phenotype of Huntington’s disease (HD) encompasses motor, psychiatric and cognitive dysfunctions, including early impairments in emotion recognition. In this first functional magnetic resonance imaging study, we investigated emotion-processing deficits in 14 manifest HD patients and matched controls. An emotion recognition task comprised short video clips displaying one of six basic facial expressions (sadness, happiness, disgust, fear, anger and neutral). Structural changes between patients and controls were assessed by means of voxel-based morphometry. Along with deficient recognition of negative emotions, patients exhibited predominantly lower neural response to stimuli of negative valences in the amygdala, hippocampus, striatum, insula, cingulate and prefrontal cortices, as well as in sensorimotor, temporal and visual areas. Most of the observed reduced activity patterns could not be explained merely by regional volume loss. Reduced activity in the thalamus during fear correlated with lower thalamic volumes. During the processing of sadness, patients exhibited enhanced amygdala and hippocampal activity along with reduced recruitment of the medial prefrontal cortex. Higher amygdala activity was related to more pronounced amygdala atrophy and disease burden. Overall, the observed emotion-related dysfunctions in the context of structural neurodegeneration suggest both disruptions of striatal-thalamo-cortical loops and potential compensation mechanism with greater disease severity in manifest HD.     

A quantitative analysis of facial emotion recognition in obsessive–compulsive disorder

Obsessive–Compulsive Disorder (OCD) is characterized by persistent and unwanted obsessions generally accompanied by ritualistic behaviors or compulsions. Previous research proposed specific disgust facial emotion recognition deficits in patients with OCD. This research however, remains largely inconsistent. Therefore, the results of 10 studies contrasting facial emotion recognition accuracy in patients with OCD (n=221) and non-psychiatric controls (n=224) were quantitatively reviewed and synthesized using meta-analytic techniques. Patients with OCD were less accurate than controls in recognizing emotional facial expressions. Patients were also less accurate in recognizing negative emotions as a whole; however, this was largely due to significant differences in disgust and anger recognition specifically. The results of this study suggest that patients with OCD have difficulty recognizing specific negative emotions in faces and may misclassify emotional expressions due to symptom characteristics within the disorder. The contribution of state-related emotion perception biases to these findings requires further clarification.     

What is an emotion? An introduction to the study of emotions

Human emotions are hypothetic constructs based on psychological and physiological data. According to the psychoevolutionnist theories, all emotions derive from a set of discrete basic emotions, common to human and animals, genetically determined. Basic emotions are thus considered as physiological processes based on specific neuronal circuits. On the contrary, for appraisal and social theories, emotions are psychological processes resulting from the cognitive appraisal of the stimulus-event for the well-being and objectives of the subject, and are of social origin. They develop during life, especially in childhood, from interactions between the individual and his environement. According to the appraisal or constructivist theories, no sharp distinction is to be made between emotions and other manifestations of the affective life. Emotions require the global functioning of the brain, even if more specialized regions are involved. They play a fundamental role in the development of the child's psychological and social life. They mediate the subject's response to the stimulus-event, allowing more appropriate reactions than fixed instinctive ones. Nevertheless, the adaptative function of every emotion or their every component can be questioned. Emotional disturbances are major consequences of psychiatric or neurological disorders. The link between the results of neuropsychological studies of emotions based on the recognition of emotional facal expression according to the basic emotion theory, and the emotional disturbances experienced in daily life is highly questionable on account of the high complexity of human affective life.     

Relating empathy and emotion regulation: Do deficits in empathy trigger emotion dysregulation?

Emotion regulation is a crucial skill in adulthood; its acquisition represents one of the key developmental tasks in early childhood. Difficulties with adaptive emotion regulation increase the risk of psychopathology in childhood and adulthood. This is, for instance, shown by a relation between emotion regulation and aggressive behavior in childhood age, indicating emotion dysregulation as an important risk factor of aggressive behavior and potential precursor of psychopathology. Based on (1) interrelations between emotion processes and social information processing (maladaptive emotion regulation and social information processing are associated with higher levels of aggression) and (2) recent neuroscientific findings showing that empathy deficits might not only result in difficulties labeling others' emotions but one's own emotions too, we suggest that empathy deficits might serve as potential trigger of emotion dysregulation. Different studies investigating the relation between empathy and emotion regulation are presented and discussed. Discussions are based on the assumed potential of empathy deficits triggering emotion dysregulation. Furthermore, developmental neuroscientific findings on empathy and emotion regulation are highlighted which provide further insights on how these processes might relate. Finally, possible directions for future research are presented.     

His or mine? The time course of self-other discrimination in emotion processing

This electroencephalography (EEG) study investigated at which temporal processing stages self-other discrimination in emotion processing occurs. EEG was recorded in 23 healthy participants during silent reading of unpleasant, pleasant, and neutral pronoun-noun and article--noun expressions that were related to the participants themselves, related to an unknown third person, or had no self-other reference at all. Self- and other-related pronoun--noun pairs elicited larger cortical negativity relative to the processing of article--noun pairs at left posterior electrodes as early as 200 ms after stimulus onset. In the same time windows (from 200 ms to 300 ms and 300 ms to 400 ms) the emotionality of the words enhanced event-related brain potential (ERP) amplitudes at parieto-occipital electrodes. From 350 ms onwards, processing of self-related unpleasant words elicited larger frontal negativity compared to unpleasant words that were related to the other or that had no reference at all. In addition, processing of pleasant words vs. neutral or unpleasant words elicited larger positive amplitudes over parietal electrodes from 450 ms after stimulus onset, in particular when words were self-related. Our findings demonstrate that for verbal emotional stimuli, self--other discrimination first occurs at higher-order, cortical processing stages. This is consistent with the view that categorization of information according to certain stimulus aspects (self--other reference, emotionality) occurs before its meaning is integrated.     

Attention and emotion in anosognosia: evidence of implicit awareness and repression?

Accounts of anosognosia for hemiplegia have long suggested some implicit knowledge of deficit, where lack of awareness is driven by the emotionally-aversive consequences of bringing deficit-related thoughts to consciousness. The present study investigates this issue using an attentional-capture paradigm, presenting words associated with hemiplegia-related deficit. As anticipated, non-anosognosics showed reduced latencies (i.e., facilitation) for emotionally threatening words. In striking contrast, anosognosics showed increased latencies (i.e., interference), a finding which supports the claim of implicit awareness. The effect appears to be due to newly-learned associations to disability-related words: where anosognosics show a pattern of performance previously described as repression.     

What predicts the course of expressed emotion in relatives of patients with schizophrenia or related psychoses?

The expressed emotion (EE) index may not be as stable as it was once believed to be. The aim of this study was to identify variables associated with spontaneous change from low to high and from high to low levels of EE and EE subscales – critical comments (CC), hostility (H), emotional overinvolvement (EOI). Using a longitudinal, prospective study design, of 59 relatives having at least weekly face-to-face contact with 40 patients with an acute episode or relapse into schizophrenia (DSM-III-R) were interviewed by means of the Camberwell Family Interview (CFI) at admission and at 4 1/2 months after discharge. The results showed that high-high or unstable levels of CC, H or EE were associated with the patient not working or studying prior to admission. Relatives with low-high and high-high EOI patterns had more weekly face-to-face contact with the patient prior to admission than relatives with a low-low EOI pattern. Patients whose relatives had low-high CC and EE patterns were less ill at admission than patients whose relatives had low-low patterns. Higher perceived family burden was associated with, at admission, an unstable pattern of CC, and at follow-up, high-high EOI or EE patterns rather than low-low patterns. Our study suggests that it is possible to identify which relatives will have a stable and which a changing EE level, allowing for more focused intervention. Accepted: 29 June 1998     

An ERP study of vocal emotion processing in asymmetric Parkinson’s disease

Parkinson’s disease (PD) has been related to impaired processing of emotional speech intonation (emotional prosody). One distinctive feature of idiopathic PD is motor symptom asymmetry, with striatal dysfunction being strongest in the hemisphere contralateral to the most affected body side. It is still unclear whether this asymmetry may affect vocal emotion perception. Here, we tested 22 PD patients (10 with predominantly left-sided [LPD] and 12 with predominantly right-sided motor symptoms) and 22 healthy controls in an event-related potential study. Sentences conveying different emotional intonations were presented in lexical and pseudo-speech versions. Task varied between an explicit and an implicit instruction. Of specific interest was emotional salience detection from prosody, reflected in the P200 component. We predicted that patients with predominantly right-striatal dysfunction (LPD) would exhibit P200 alterations. Our results support this assumption. LPD patients showed enhanced P200 amplitudes, and specific deficits were observed for disgust prosody, explicit anger processing and implicit processing of happy prosody. Lexical speech was predominantly affected while the processing of pseudo-speech was largely intact. P200 amplitude in patients correlated significantly with left motor scores and asymmetry indices. The data suggest that emotional salience detection from prosody is affected by asymmetric neuronal degeneration in PD.     

Reduced early visual emotion discrimination as an index of diminished emotion processing in Parkinson’s disease? – Evidence from event-related brain potentials

Although Parkinson’s disease (PD) is defined by its motor symptoms, it is now well recognized that cognitive and affective domains, such as recognition of emotion from facial expressions, may also be impaired. To examine brain mechanisms involved in processing of emotion recognition from facial expressions, we obtained affective ratings and visual event-related potentials (ERPs) in response to facial expressions from 18 PD patients under dopamine-replacement therapy, and 17 healthy age- and sex-matched controls. In control subjects, the early posterior negativity (EPN) of the ERP, which is thought to reflect early perceptual emotion discrimination, was larger in response to emotional compared to neutral facial expressions. In contrast, this emotional modulation of the EPN was absent in PD patients indicating impaired early emotion discrimination. Behaviorally, PD patients showed no impairments in emotion recognition as measured by affective ratings. These findings suggest that facial emotion processing may be disrupted at an early stage of visual neural processing in PD. Absence of behavioral impairment may point to compensatory strategies of emotion recognition in medicated PD patients. Further research should clarify these dissociations between behavioral and neurophysiological levels of emotion processing in PD.     

Binge eating in binge eating disorder: a breakdown of emotion regulatory process?

Current explanatory models for binge eating in binge eating disorder (BED) mostly rely on models for bulimia nervosa (BN), although research indicates different antecedents for binge eating in BED. This study investigates antecedents and maintaining factors in terms of positive mood, negative mood and tension in a sample of 22 women with BED using ecological momentary assessment over a 1-week. Values for negative mood were higher and those for positive mood lower during binge days compared with non-binge days. During binge days, negative mood and tension both strongly and significantly increased and positive mood strongly and significantly decreased at the first binge episode, followed by a slight though significant, and longer lasting decrease (negative mood, tension) or increase (positive mood) during a 4-h observation period following binge eating. Binge eating in BED seems to be triggered by an immediate breakdown of emotion regulation. There are no indications of an accumulation of negative mood triggering binge eating followed by immediate reinforcing mechanisms in terms of substantial and stable improvement of mood as observed in BN. These differences implicate a further specification of etiological models and could serve as a basis for developing new treatment approaches for BED.     

Evaluation of cerebrovascular reactivity by ultrasonography in type 2 diabetic patients with hypertension

BACKGROUND: Cerebrovascular reactivity (CVR) reflects cerebrovascular reserve capacity, and cerebrovascular reactivity damage prognosticates a very high risk of stroke. OBJECTIVE: To evaluate CVR by detecting the increase rate of blood flow volume of middle cerebral artery (MCA) before and after breathholding in diabetic patients with hypertension, and observe the effects of hypertension on cerebrovascular reserve capacity of diabetic patients. DESIGN: Controlled observation. SETTINGS: Department of Function, Affiliated Hospital of Hebei University; Department of Special Diagnosis, the 202 Hospital of Chinese PLA. PARTICIPANTS: Inpatients or outpatients with type 2 diabetes mellitus (DM) or primary hypertension admitted to Departments of Gastroenterology and Cardiology, Affiliated Hospital of Hebei University and the 202 Hospital of Chinese PLA from April to December 2004 were involved in this experiment. Inclusive criteria: type 2 DM met the criteria of the report on diabetes diagnosis announced in 1999 by WHO expert committee, totally 88 patients were involved. Primary hypertension met the diagnosis criteria announced in 1999 by WHO/ISH, totally 42 patients were involved. Another group of 43 concurrent subjects who received physical examination served as controls. According to the disease condition, the involved patients were assigned into 3 groups: DM group (only diabetic patients), hypertension group (only hypertension patients) and DM complicated with hypertension group (diabetic patients with hypertension). Informed consent for the examination was obtained from all the involved subjects. METHODS: Before MCA of subjects was detected, bilateral carotid artery was routinely detected by high-frequency ultrasonography. Subjects were rejected when stenosis rate of unilateral internal carotid artery or common carotid artery ≥ 70%. Vessels were expanded with transcranial color Duplex Doppler by breath holding test for detecting vascular reactivity. Hypercapnia was created by BHT. The mean velocity and diameter of blood flow were detected under the quiescent condition and 25 s after breath holding with transcranial color-coded duplex sonography. The volume of blood flow of MCA was calculated according to the following formula: Volume of blood flow of MCA (mL/ min) = (the diameter of blood flow /2) 2×π×mean blood flow velocity×60. The increase rates of mean blood flow velocity and blood flow volume of patients with hypercapnia were calculated as compared with under the quiescent condition to evaluate cerebrovascular reactivity. MAIN OUTCOME MEASURES: Mean blood flow velocity, blood flow diameter and MCA blood flow volume as well as the increase rates of them. RESULTS: Among the 173 participates, 103 patients and 39 healthy controls were involved in the final analysis, and the other 31 dropped out due to not accomplishing the examination. ①Comparison of blood flow parameter of MCA under the quiescent condition: The mean blood flow velocity of DM complicated by hypertension group was significantly higher than that of DM group (P < 0.05) and control group (P < 0.05); The blood flow diameter of DM complicated by hypertension group was significantly smaller than that of control group (P < 0.01). Under the quiescent condition, significant difference was not found in the intergroup comparison of blood flow volume of MCA. ② Comparison of increase rate of blood flow parameter: In the DM group, hypertension group, DM complicated by hypertension group and control group, the increase rate of mean blood flow velocity of was （29.34±4.50）%,（29.35±4.35）%,（26.68±4.99）% and （30.99±3.54）%, respectively, the increase rate of blood flow volume of MCA was （35.32±5.08）%,（35.36±6.16）%,（31.78±7.11）% and（37.26±4.17）%, respectively, and the increase rate of blood flow diameter was （2.29±1.09）%,（2.27±0.95）%,（1.97±1.05）% and（2.36±0.46）%, respectively. The increase rate of mean blood flow velocity and that of blood flow volume of MCA in the DM complicated by hypertension group were significantly lower than those in the other 3 groups (P < 0.05). CONCLUSION: CVR is markedly lowered and cerebrovascular reserve capacity is damaged in diabetic patients with hypertension.     

Is preattentive bias predictive of autonomic reactivity in response to a stressor?

Biased processing of threatening information may play a casual role in the development of anxiety disorders. Even though empirical evidence points to the fact that preattentive bias can predict subjectively experienced distress in response to a stressor, it is still unknown whether it could be useful in predicting the physiological reactivity in response to a stressor. In the present study, the emotional Stroop task was used to measure preattentive bias. Whereas Stroop interference for masked threat words (i.e., preattentive bias) was found to be positively associated with emotional distress (self-reported) in response to a laboratory stressor, this association was reversed when the autonomic reactivity (electrodermal activity) was used as a measure of emotional response to the very same stressor. Also, neither of these effects were a function of pre-existing anxiety levels. The negative association between preattentive bias and autonomic reactivity corresponds to the autonomic inflexibility seen in clinical anxiety (or very high scores of trait anxiety) when exposed to stressful events. Results were discussed in terms of an inability to automatically inhibit the processing of threatening cues that seems to be a vulnerability marker for anxiety.     

Are effects of emotion in single words non-lexical? Evidence from event-related brain potentials

Emotional meaning impacts word processing. However, it is unclear, at which functional locus this influence occurs and whether and how it depends on word class. These questions were addressed by recording event-related potentials (ERPs) in a lexical decision task with written adjectives, verbs, and nouns of positive, negative, and neutral emotional valence. In addition, word frequency (high vs. low) was manipulated. The early posterior negativity (EPN) in ERPs started earlier for emotional nouns and adjectives than for verbs. Depending on word class, EPN onsets coincided with or followed the lexicality effects. Main ERP effects of emotion overlapped with effects of word frequency between 300 and 550 ms but interacted with them only after 500 ms. These results indicate that in all three word classes examined, emotional evaluation as represented by the EPN has a post-lexical locus, starting already after a minimum of lexical access.