Nonverbal Communication of Affect in Brain-Damaged Patients

A slide viewing technique designed to assess spontaneous nonverbal expressiveness was administered to 37 male patients including 8 left hemisphere damaged (aphasic), 10 right hemisphere damaged, 9 Parkinson's disease, 10 non brain-damaged (control) patients. Patients watched different types of affective slides while there facial/gestural responses were videotaped. Judges watching the video tapes without audio guessed the types of slide being viewed. Results indicated that aphasic patients were equal to or more expressive than controls, while right hemisphere damaged and Parkinson's disease patients were less expressive. The possibility that spontaneous non verbal expressiveness is mediated by the right cerebral hemisphere, with the left hemispere playing an inhibitory role, was discussed as a tentative explanation.     

Perception of emotions on happy/sad chimeric faces in Alzheimer disease: relationship with cognitive functions

AIMS: To investigate the ability to recognize facial emotions in patients with Alzheimer disease (AD). Happiness and sadness, fundamental emotions that are easily recognized across cultures, were evaluated. Results were further analyzed in relation to demographic, clinical, and neuropsychologic characteristics. METHODS: A test exploring recognition of facial emotions using chimeric faces based on Jaynes' happy and sad faces was administered to 71 patients with probable AD. RESULTS: The ability to identify positive and negative facial emotions was largely preserved in AD subjects. Impaired recognition of facial emotions was found in 27%. Poor test performance was associated with low scores on constructional praxis and nonverbal memory tasks. CONCLUSIONS: Decoding of emotional facial expressions seems to be differently affected in relation to patients' neuropsychologic profile, as poor test performance closely correlated with nonverbal cognitive impairment. This emotion-discrimination disorder likely characterizes the behavior of a subset of AD patients with predominant right-hemisphere dysfunction. A preserved ability to process the emotional features of faces may have an important role in the management of demented patients, and suggests the use of nonverbal communication as an integrative/alternative system. The simple test used in our study may be a useful clinical tool to explore emotional behavior in demented subjects.     

Gender differences in depression: an ethological study of nonverbal behavior during interviews.

Previous studies of gender differences in the phenomenology of depression have focused mostly on symptoms as measured by self-report questionnaires or clinician-rated scales. In this study, we examined gender differences in the interpersonal behavior of depressed patients by using ethological techniques which involve direct observation of behavior. The nonverbal behavior of 72 nondepressed volunteers and 68 patients with a DSM-III-R diagnosis of nonpsychotic unipolar depression was videorecorded during clinical interviews and scored according to an ethological scoring system including 37 behavior patterns, mostly facial expressions and hand movements. Both male and female depressed patients showed a global restriction of nonverbal expressiveness reflecting a tendency towards social withdrawal. Nonverbal expression of hostility was the only behavioral category on which depressed patients scored higher than nondepressed volunteers. Even though clinical status exerted marked effects on the ethological profile, depression did not obscure some important differences in the nonverbal behavior of males and females. As a group, depressed women showed more socially interactive behaviors than depressed men. Their modality of interacting included higher levels both of nonverbal hostility and of submissive and affiliative behaviors. These results are discussed in view of clinical data indicating a relationship between gender, style of social interaction and response to antidepressant drugs.     

Facial expressiveness in patients with schizophrenia compared to depressed patients and nonpatient comparison subjects

OBJECTIVE: Blunted affect is a major symptom in schizophrenia, and affective deficits clinically encompass deficits in expressiveness. Emotion research and ethological studies have shown that patients with schizophrenia are impaired in various modalities of expressiveness (posed and spontaneous emotion expressions, coverbal gestures, and smiles). Similar deficits have been described in depression, but comparative studies have brought mixed results. Our aim was to study and compare facial expressive behaviors related to affective deficits in patients with schizophrenia, depressed patients, and nonpatient comparison subjects. METHOD: Fifty-eight nondepressed inpatients with schizophrenia, 25 nonpsychotic inpatients with unipolar depression, and 25 nonpatient comparison subjects were asked to reproduce facial emotional expressions. Then the subjects were asked to speak about a specific emotion for 2 minutes. Each time, six cross-cultural emotions were tested. Facial emotional expressions were rated with the Facial Action Coding System. The number of facial coverbal gestures (facial expressions that are tied to speech) and the number of words were calculated. RESULTS: In relation to nonpatient comparison subjects, both patient groups were impaired for all expressive variables. Few differences were found between schizophrenia and depression: depressed subjects had less spontaneous expressions of other-than-happiness emotions, but overall, they appeared more expressive. Fifteen patients with schizophrenia were tested without and with typical or atypical antipsychotic medications: no differences could be found in study performance. CONCLUSIONS: The patients with schizophrenia and the patients with depression presented similar deficits in various expressive modalities: posed and spontaneous emotional expression, smiling, coverbal gestures, and verbal output.     

Poor perception of nonverbal social-emotional cues in relatives of schizophrenic patients

The present study compared nonverbal social perception in relatives of schizophrenic patients (n = 21) with that of normal controls (n= 19). We hypothesized that relatives would display deficits in social perception and we sought to determine the skills that are associated with this deficit. Relatives performed significantly worse than controls on the Profile of Nonverbal Sensitivity Test (PONS), despite comparable performance on skills hypothesized to be related to nonverbal social perception: visual perception, nonverbal problem solving, facial recognition, facial affect recognition, naming, social judgment, and vigilance. To further explore the relationships among these skills, we calculated correlations between the PONS score and associated skills separately within both the relative and control groups and assessed whether the values of these correlations differed between groups. Correlations that differed significantly indicated a greater association, within relatives, between slower reaction times on vigilance tasks and poor PONS performance. Further research is needed to clarify the nature of this relationship, to better characterize social perception deficits in relatives, and to determine whether these perceptual deficits are part of the genetic diathesis to schizophrenia.     

Nonverbal behavior during standardized interviews in patients with schizophrenia spectrum disorders

Several studies have consistently shown that patients with schizophrenia or schizophrenia spectrum disorders (SSD) can be distinguished from normal controls on the basis of their nonverbal behavior during standardized interviews, with considerable interactions between negative symptoms and poor facial expressivity. However, most studies have examined unmedicated patients, and gender of both interviewer and interviewee has not been taken into account. In this study we assessed the nonverbal behavior of male and female patients with SSD who were receiving second-generation antipsychotic medication (SGA) using the Ethological Coding System for Interviews (Troisi, 1998). In addition, we used a novel 5-factor model of the Positive and Negative Symptom Scale (PANSS, van der Gaag et al., 2006) to correlate nonverbal behavior with standard psychopathology ratings. Our findings strongly resembled results of previous studies into nonverbal behavior of patients with SSD, despite differences in cultural backgrounds and gender of the interviewer. Negative symptoms were inversely correlated with several of the nonverbal behavioral dimensions. Medication dose did not correlate with any one of the behavioral or psychopathological measures. Patients with SSD make less use of their nonverbal behavioral repertoire compared with controls, independent of antipsychotic treatment. Culture-specific nonverbal expressivity seems to play an additional (minor) role in distinguishing patients from healthy controls.     

Facial expressivity during the clinical interview as a predictor functional disability in schizophrenia. a pilot study

Despite the central role of nonverbal behavior in regulating social interactions, its relationship to functional disability in schizophrenia has received little empirical attention. This study aimed at assessing the relationship of patients' spontaneous facial expressivity during the clinical interview to clinician-rated and self-reported measures of functional disability. The nonverbal behavior of 28 stabilized patients with schizophrenia was analyzed by using the Ethological Coding System for Interviews (ECSI). Functional disability was assessed using the Global Assessment of Functioning (GAF) scale and the Sheehan Disability Scale (DISS). Partial correlation analysis controlling for the confounding effects of neuroleptic treatment showed that facial expressivity was correlated with the GAF score (r=0.42, P=0.03) and the scores on the subscales of the DISS measuring work (r=-0.52, P=0.005) and social (r=-0.50, P=0.007) disability. In a multiple regression model, nonverbal behavior explained variation in patients' work and social disability better than negative symptoms. The results of this pilot study suggest that deficits in encoding affiliative signals may play a role in determining or aggravating functional disability in schizophrenia. One clinical implication of this finding is that remediation training programs designed to improve nonverbal communication could also serve as a useful adjunct for improving work and social functioning in patients with schizophrenia.     

Art therapy applied to an adolescent with Asperger's syndrome

Asperger's syndrome is a neurodevelopmental disorder characterized by impairments in social interaction, restricted, repetitive and stereotyped patterns of behavior, interests, and activities. Adolescents with Asperger's syndrome have developed a compromised self-regulatory system, which leads to difficulty in many areas of functioning. Some of these areas include social, behavioral, emotional, and an increase in anxiety. Art therapy is an important activity based intervention that allows those with Asperger's syndrome to receive and learn information in a non-conventional, nonverbal, comprehensive, and expressive language. Over a 7-month period of creating art, Emma became increasingly more communicative and comfortable in areas of functioning, especially social interactions. The incorporation of visual creativity allowed her to express herself and be heard on a new level of communication. Through her artwork she was able to move from having difficulty in functioning to learning, growing, challenging herself, and making post-secondary education plans.     

Recognition of emotional facial expressions in attention-deficit hyperactivity disorder

In ADHD, impaired interpersonal relationships have been documented. They have been hypothesized to be secondary to impairment of receptive nonverbal language. Recognition of emotional facial expressions is an important aspect of receptive nonverbal language, and it has been demonstrated to be central to organization of emotional and social behavior. This study investigated the identification of facial expression of four emotions (joy, anger, disgust, and sadness) in a group of 30 children aged 7-12 years who met the DSM-IV criteria for ADHD disorder of the predominantly hyperactive-impulsive type and have no comorbid mental retardation, specific learning difficulties, developmental coordination disorder, pervasive developmental disorders, conduct disorder, bipolar disorder, or substance abuse, and in 30 matched unimpaired control children. The test used includes 16 validated photographs depicting these emotions in varying intensities constructed by morphing. Children with ADHD exhibited a general deficit in decoding emotional facial expressions, with specific deficit in identifying anger and sadness. Self-rating of the task difficulty revealed lack of awareness of decoding errors in the ADHD group as compared with control subjects. Within the ADHD group, there was a significant correlation between interpersonal problems and emotional facial expression decoding impairment, which was more marked for anger expressions. These results suggest suboptimal nonverbal decoding abilities in ADHD that may have important implications for therapy.     

Impact of training dementia caregivers in sensitivity to nonverbal emotion signals

Ninety-one mid- to late-stage dementia patients residing in nursing homes, along with their staff caregivers, participated in a study designed to assess whether training caregivers in sensitivity to nonverbal communication could enhance mood and reduce symptoms in patients and improve psychological well-being in caregivers. Patients and staff at three nursing homes comprised three groups that were randomly assigned to either a nonverbal sensitivity group, a behavioral placebo group that received instruction in the cognitive and behavioral aspects of dementia, and a wait-list control. Training consisted of 10 one-hour sessions taught by a clinical psychologist using prepared materials. Patient measures, which were taken at baseline and at 4 three-week intervals, included patient symptomatology (depression, agitation, behavioral symptoms), as reported by the staff caregivers, and positive and negative facial expressions of emotion elicited during a face-to-face interview and coded by trained research staff. Results indicated that positive affect increased sharply during the first 6 weeks after intervention in the nonverbal group, with the placebo and wait-list controls showing no change. There was also a decline in negative affect across time for all groups. Effects with respect to patient symptomatology did not reach significance. Caregivers in both training groups showed a decline in symptomatology, whereas the wait-list control group did not.     

Hemodynamic signals of mixed messages during a social exchange

This study used functional magnetic resonance imaging to characterize hemodynamic activation patterns recruited when the participants viewed mixed social communicative messages during a common interpersonal exchange. Mixed messages were defined as conflicting sequences of biological motion and facial affect signals that are unexpected within a particular social context (e.g. observing the reception of a gift). Across four social vignettes, valenced facial expressions were crossed with rejecting and accepting gestures in a virtual avatar responding to presentation of a gift from the participant. The results indicate that conflicting facial affect and gesture activated superior temporal sulcus, a region implicated in expectancy violations, as well as inferior frontal gyrus and putamen. Scenarios conveying rejection differentially activated the insula and putamen, regions implicated in embodied cognition, and motivated learning, as well as frontoparietal cortex. Characterizing how meaning is inferred from integration of conflicting nonverbal communicative cues is essential to understand nuances and complexities of human exchange.     

Facial muscle coordination in monkeys during rhythmic facial expressions and ingestive movements

Evolutionary hypotheses regarding the origins of communication signals generally suggest, particularly for the case of primate orofacial signals, that they derive by ritualization of noncommunicative behaviors, notably including ingestive behaviors such as chewing and nursing. These theories are appealing in part because of the prominent periodicities in both types of behavior. Despite their intuitive appeal, however, there are little or no data with which to evaluate these theories because the coordination of muscles innervated by the facial nucleus has not been carefully compared between communicative and ingestive movements. Such data are especially crucial for reconciling neurophysiological assumptions regarding facial motor control in communication and ingestion. We here address this gap by contrasting the coordination of facial muscles during different types of rhythmic orofacial behavior in macaque monkeys, finding that the perioral muscles innervated by the facial nucleus are rhythmically coordinated during lipsmacks and that this coordination appears distinct from that observed during ingestion.     

Nonverbal behavior during clinical interviews: similarities and dissimilarities among schizophrenia, mania, and depression

Research has shown that patients with schizophrenia and depression differ from nonclinical subjects in nonverbal behavior. In contrast, there is a paucity of studies addressing differences in nonverbal communication between diagnostic groups and as to what extent nonverbal communication feeds into standard ratings of psychopathology. Twenty-six patients with schizophrenia were compared with 24 patients with affective disorders (13 depressed, 11 manic) regarding their nonverbal behavior using the Ethological Coding System for Interviews. Symptom severity was rated using the Brief Psychiatric Rating Scale. Patients with mania displayed more illustrative gestures than did patients with schizophrenia or depression. Subtler behavioral differences between the groups occurred regarding assertive behaviors and displacement activities suggestive of hostility and motivational conflict, respectively. Distinct correlations between nonverbal communication and psychopathology ratings emerged in all three groups. Patients with schizophrenia, depression, and mania differ in nonverbal behavior. Nonverbal communication seems to be a significant contributor to clinicians' intuitive ratings.     

Utilization of nonverbal expressive behavior in cognitive therapy

Psychotherapists need to attend to their patients' nonverbal expressive behavior. This paper argues that this is best accomplished within the framework of a strict cognitive approach.     

Facial expression and experience of emotions in psychodynamic interviews with patients with PTSD in comparison to healthy subjects

BACKGROUND: The facial affective behavior of traumatized patients and of a healthy control group was compared. SAMPLING AND METHODS: Data of 15 videotaped clinical interviews of traumatized inpatients and of 15 healthy women (absence of mental/psychiatric disorder according to ICD-10) were ascertained. The affective facial expression of both groups was coded with the Emotional Facial Acting Coding System. Afterwards, the mimic analysis was correlated with gazing behavior and the emotional experience. The patients reported their traumatic experiences and the healthy women their main complaints. RESULTS: The traumatized patients showed neither a reduction of overall facial expressions nor a reduced frequency of facial affects in comparison to the healthy control group. The control group, however, showed significantly more 'genuine joy'. The traumatized patients showed significantly more anger. CONCLUSIONS: The traumatized patients did not show a significant reduction of overall facial expression. A more detailed analysis showed that on the one hand, stabilizing elements of relationships, such as genuine joy, appear significantly less on the face of traumatized patients as compared with the healthy women. On the other hand, the expression of anger was brought into the relationship significantly more often by the traumatized patients during face-to-face interaction (clinical interview). This indicates the importance of distance regulation interaction patterns of traumatized patients.     

Intention processing in communication: a common brain network for language and gestures

Human communicative competence is based on the ability to process a specific class of mental states, namely, communicative intention. The present fMRI study aims to analyze whether intention processing in communication is affected by the expressive means through which a communicative intention is conveyed, that is, the linguistic or extralinguistic gestural means. Combined factorial and conjunction analyses were used to test two sets of predictions: first, that a common brain network is recruited for the comprehension of communicative intentions independently of the modality through which they are conveyed; second, that additional brain areas are specifically recruited depending on the communicative modality used, reflecting distinct sensorimotor gateways. Our results clearly showed that a common neural network is engaged in communicative intention processing independently of the modality used. This network includes the precuneus, the left and right posterior STS and TPJ, and the medial pFC. Additional brain areas outside those involved in intention processing are specifically engaged by the particular communicative modality, that is, a peri-sylvian language network for the linguistic modality and a sensorimotor network for the extralinguistic modality. Thus, common representation of communicative intention may be accessed by modality-specific gateways, which are distinct for linguistic versus extralinguistic expressive means. Taken together, our results indicate that the information acquired by different communicative modalities is equivalent from a mental processing standpoint, in particular, at the point at which the actor's communicative intention has to be reconstructed.     

Computer-based analysis of facial action in schizophrenic and depressed patients

Summary With a newly developed computer analysis the space coordinates of light-reflecting points, attached to a subjects' face, were recorded across time with high temporal and spatial resolution. Under different experimental conditions the facial actions of 20 schizophrenics, 20 depressives and 20 normal controls were analysed. Furthermore, raters watched the synchronously recorded video versions of the subject's face and rated them as to expressivity. The findings indicate that depressive and schizophrenic patients exhibited reduced facial activity in the upper part of their face in social interaction conditions. Schizophrenic patients showed reduced facial action responsivity across different conditions and emotions. All patients were judged to be less expressive than normal controls by raters, suggesting apparent disintegrated elements in facial activity, although when computer-analysed they exhibited the same amount of facial activity.     

Some nonverbal aspects of depression and schizophrenia occurring during the interview.

Using remote control videotape recording of interviews and subsequent analysis of the record, eight measures of nonverbal behavior (principally facial) have been made in 12 schizophrenic and 13 depressive subjects shortly after admission to the hospital and again prior to discharge. They were matched with controls who were interviewed in a similar way. Additional videotape observations were made prior to the interview, when the patient was alone and subsequently when he was shown pictures designed to evoke emotional responses. It appears that some nonverbal behaviors can be used in the interview to differentiate between psychiatric patients and normals. These may also be useful as an index of clinical change since they revert toward the normal with clinical improvement. The nonverbal behaviors studied were more prominent in the interpersonal setting than when alone or when the subject was looking at pictorial stimuli. This implies that they may be elicited in response to another individual, either as a distortion of the ordinary nonverbal signaling system, or as physiological responses to a changed state of arousal induced by the interpersonal setting rather than as static characteristics of the syndrome.