K ING'S. Derek Goldsmith LONDON. College. FoundedI 82. Neuroscience & Emotion INSTITUTE OF PSYCHIATRY

Transcription

1 K ING'S College LONDON INSTITUTE OF PSYCHIATRY FoundedI 82 Neuroscience & Emotion Derek Goldsmith

2 Remediation of poor emotion processing in schizophrenia: behavioural and eye movement findings Tamara Russell MACCS June 2006

3 Outline of the Talk Briefly Pilot Study Eye movements to faces Remediation of Emotion Processing Main Study Replication Specificity of the effect Booster training Eye Movements

4 Visual scan path studies Mary Phillips, D Freeman - UK L Williams and E Gordon; Melissa Green; Carmel Loughland and K McCabe - Australia Adolphs - USA

5 Control Subject Deluded Subject Phillips & David, 1997

6 Restricted scanning + avoidance of features CONTROL SUBJECT (Green et al., 2003 Psychiatry Research, 119, ) ANGER FEAR DELUDED SCHIZOPHRENIA SUBJECT

7 Main Message Restricted/Extended scan paths (symptoms?) Avoid Facial Features (no triangle) Similar pattern seen in relatives/schizotypy

8 Emotion RecognitionTraining

9 Other training Studies Penn & Combs (2000) monetary reinforcement and facial feedback combined = better on facial affect identification (relative to practice alone or each of those conditions alone) Silver et al (2003) 2-3 days of computer-based training (designed for autistic kids) improved explicit emotion recog and valence judgments

10 Other training Studies Wolwer et al (2005) compared cog remediation with specific affect training, 6 week program. N=28 TAR, N=24 CRt, N=25 TAU. Affect recog improved in TAR but not TAU; CRT does not improve affect recognition Penn et al (2005) SCIT (manual based group intervention); 18 weekly, one-hour sessions (but modified for inpatients to five sessions a week for three months) N =7; also includes ToM. Showed changes in TOM but not emotion perception Russell et al (2006) to follow..

11 How is this study different? Computer based tool Independent, User-lead Compared to healthy controls

12 Pilot Study - Elvina Chu N=20 medicated out-patients with schizophrenia (9 Male) N = 20 age and education level matched controls (5 Male) Micro Expression Training Tool (METT) Paul Ekman (teaching and practice with feedback) DV: Pre- and post-training METT assessment (% correct) DV: non-verbal emotion matching (% correct)

13 Prior to Training

14 Emotion Matching Task

15 METT Assessment 1/15 th of a second emotion is displayed

16 The Training

17 The Micro Expression Tool (METT) Pre Training Assessment Training Practice Review Post Training Assessment F, A, H, S, D, C, Sur x 2 presentations at 1/15 th second (% correct score calculated) 4 x videos (each 30 seconds) outlining commonly confused emotions F, A, H, S, D, C, Sur x 4 presentations at 1/15 th sec with feedback (right, wrong) 4 x videos (each 30 seconds) different identities, same emotions F, A, H, S, D, C, Sur x 2 presentations at 1/15 th second (% correct score calculated)

18 Example of the METT Training www. emotionsrevealed.com

19 Post Training METT and EMT Assessments

20 Results

21 METT and EMT Pre-Training * * Controls > Patients p< * * Controls > Patients p< % correct 30 METT 20 Controls (15) Patients (15) EMT

22 METT and EMT Post-Training 90 * * * Controls > Patients p<0.001 * Controls > Patients p< % Correct 40 METT 30 Controls (15) Patients (15) EMT

23 METT and EMT Pre Cons v. Post Schiz 90 Both p< % Correct 40 METT 30 Controls (15) Patients (15) EMT

24 Results Summary Both groups improved with training Group differences apparent pre and post training (as expected) IMPORTANTLY patients after training do not differ significantly from controls before training on both tasks

25 Main Study: Replication Specificity Eye movement

26 Replication Study

27 Replication Study N=35 METT Trained Schiz N=10 METT controls All clients from Australia All outpatients, medicated bar one One-day design: Pre-training assessment, METT training, post-training assmt. Behavioural and EM data NP tests due to small Ns

28 Emotion Matching Task Number of Errors

29 Significant group differences before (p<0.001) and after (p<0.04) training, pre con versus post schiz NS (p<0.2) Errors Pre Training Errors Post T raining Mean # Errors Schiz: Sig (p<0.001) change Con: NS change (p<0.39) m ett controls mett GLM Sig Interaction, Sig both main effects

30 METT Pre and Post Assessment Task Percentage Correct

31 Significant group differences before (p<0.001) after training NS (p<0.11) Mean % Correct Pre training M ETT Post T raining M ETT Con: NS change (p<0.49) Schiz: Sig (p<0.01) change m ett controls mett GLM Trend (p<0.08) Interaction, Sig both main effects

32 Results Summary - Replication Both groups improved with training as in pilot study METT performance improved to same level as controls IMPORTANTLY patients after training do not differ significantly from controls before training (as in pilot study)

33 Is it just repetition? Comparing the METT trained individuals (N=35) with N=12 Schiz who were repeatedly exposed (RE group) but did not receive the active training components. EMT and METT Scores reported NP tests

34 Specificity of the Training Effect N=12 Schiz Repeated Exposure (Sz- RE) N = 10 Controls (C-METT) N = 35 Schiz Training (Sz-METT)

35 Emotion Matching Task Number of Errors

36 Group effect Pre training (p<0.01) but only trend for post (p<0.07) Mean Pre T raining Errors Post T raining Errors Con < RE and METT Pre (p<0.001) Con < RE and METT Post (p<0.04) RE > METT Pre (p<0.04) 5.00 Con: NS change (p<0.3) 0.00 mett re c ontrols m ett RE& METT Sig (p<0.003) change

37 METT Pre and Post Assessment Task Percentage Correct

38 Group effect Pre training (p<0.001) and post (p<0.002) Mean % Correct Pre T raining M ETT Post T raining M ETT RE < Controls Pre and Post RE < METT Post METT < Controls Pre Only (NS Pre) Con and RE: NS change (p<0.3) METT Sig (p<0.003) 0.00 mett re c ontrols m ett GLM Sig Interaction, Sig both main effects

39 Results Summary - Specificity RE seems to help with the matching task RE does not confer benefit on the micro expressions tasks

40 Eye Movement Studies

41 Methods Eye Movements METT task: 16 presentations at 5 seconds each; JACFEE images INT task: 7 emotions, 50% and 100% x 2; Ekman and Friesen images EYELINK II 250 Hz acquisition Behavioural Data (accuracy) EM parameters (for METT task only)

42 Eye Movement Task a) Behavioural Data online from EM task b) EM data from EM task

43 Behavioural Data METT task 5 seconds free viewing of METT images Verbal labelling required Score out of 14 (2x each of 7 emotions) METT Schiz (N=30) METT Controls (N=10) RE Schiz (N=11)

44 Pre training trend (p<0.06) for group difference, Post training NS Pre training Pos t training Mean # Correct (max 14) Change Conp<0.005 Schiz p< s cz training c on training

45 Effect of repetition explored with inclusion of the RE group Pre Training Pos t Training Mean # Correct (max 14) Change Con- Sig Schiz-Sig RE - NS sc z training c on training re

46 Bhvrl Data: Emotion Effects Wilcoxon test: pre v post performance for each emotion, Bonferroni correction SCZ METT: Significant change for contempt (p<0.001); trends for surprise (p<0.08), sad (p<0.05), disgust (p<0.06) happy (p<0.08) and fear (p<0.06). For anger no change (p<0.19). CON METT: sig change for contempt (p<0.006), trend for disgust (p<0.1) SCZ RE: no significant changes

47 Graph of different emotions, behavioural data from METT EM task

48 Second task (INT) Accuracy Scores Mean Accuracy (max 28) Pre Training ScM and CM trends (p<0.07) for increase RE - NS 17 Scz-METT C-METT Scz-RE Post Training

49 Eye Movement Variables 1) Global Eye Movements 2) Emotions 3) ROIs 4) Specific Training Effects Only for IMMEDIATE pre v post training

50 Global Eye Movements Mean fixation duration, mean number of saccades, mean number of fixations Pre and Post Training Irrespective of Emotion or ROI Schiz v Controls

51 Mean Fixation Duration Pre Mean Fixation Duration Post Mean Mean num ber of fixations Pre Mean num be of fixations Post Mean Number of Saccades Pre Mean Number of Saccades Post 0.00 s chiz c ont Mean Everything NS! sc hiz cont

52 Separate Emotions Fear, Anger, Happy, Sad, Disgust, Contempt, Surprise DVs: percentage of fixations in the feature areas Remember: Behavioural Data suggests improvements in majority of emotions (bar anger) for schiz and only contempt for controls

53 Mean anger pre IA fix % anger post IA fix % fear pre IA fix % fear post IA fix % happy pre IA fix % happy post IA fix % s ad pre IA fix % s ad pos t IA fix % disgust pre IA fix % disgust pos t IA fix % c ontem pt pre IA fix % c ontem pt post IA fix % s uprise pre IA fix % s urprise post IA fix % No significant Group effects pre or post Change: Schiz Fear p<0.01 Surprise trend (p<0.07) Controls: Anger p< sc hiz cont

54 Schiz Fear where are they looking? Mean fear left eye pre training IA fix % fear left eye post training IA fix % fear right eye pre training IA fix % fear right eye post training IA fix % fear nose top pre training IA fix % fear nose top post training IA fix % fear nose bottom pre training IA fix % fear nose bottom post training IA fix % fear mouth pre training IA fix % fear mouth post training IA fix %

55 Visually contrast this with Anger (where no imprnt) Mean anger left eye pre anger left eye post anger right eye pre anger right eye post anger nose top pre anger nose top post anger nose bottom pre anger nose bottom pos t anger mouth pre anger mouth post

56 Visually contrast this with Anger (CONTROLS with imprt)

57 Region of Interest Analyses Five regions of interest: right eye, left eye, nose top, nose bottom, mouth DVs: percentage of fixations in the ROI (collapsed across emotion) BETWEEN GROUP DIFFERENCES PRE AND POST TRAINING Pre training: Scz patients direct fewer percentage of fixations to the right eye compared to controls (p<0.01) Post training: STILL Scz patients direct fewer percentage of fixations to the right eye compared to controls (p<0.01)

58 ROI Analysis: % Fixations in the ROI Mean % of Fixations in that ROI M outh Pre M outh Post Nose Bottom Pre Nose Bottom Post Nose Top Pre Nose Top Post Left Eye Pre Left Eye Post Right Eye Pre Rigth Eye Post Controls > Schiz % fixation to RIGHT eye pre and post (both p<0.01) sc hiz cont

59 left eye pre training IA fix ation % left eye post training IA fix ation % right eye pre training IA fix ation % right eye pos t training fixation IA % Mean sc hiz basic group cont

60 Specific Training Effects (as relates to the training tool) The case of CONTEMPT

61 % Fixations to the Mouth for Contempt Mean % IA fixation 0.10 Contempt Pre Mouth Contempt Post Mouth Change scores: schiz (p<0.04), controls (p<0.14) schiz basic group cont

62 Overall Summary Behaviourally improvements are made on a number of verbal and non-verbal emotional tasks Training with METT confers more benefit than just Repeated exposure (but note EMT results) Eye movements show some subtle effects but overall gross changes not apparent (!?) Something strange is happening with the RIGHT EYE!!

63 How does this relate to the real world? Social Functioning Scale- pre training schiz < controls, no effect of training L-Social Anxiety Scale no difference between schiz training groups, no effect of training Sp State Anxiety Scale no difference between schiz training groups, no effect of training TASIT - no difference between schiz training groups, immediate training no effect, improvement over sessions for the METT+4 group

64 How does this relate to the real world II? Tams Questionnaire no sig differences between training groups at baseline, trend for post training increased in METT trained groups (but not RE group) - linear improvement in the METT+4 group

65 Acknowledgements Clients and control participants; SLAM staff, NISAD register Section of Neuroscience and Emotion, IOP and Macquarie Centre for Cognitive Sciences, Sydney Students and Collaborators: Elvina Chu, Melissa Green Funders: D. Goldsmith, The Royal Society, The British Academy, NISAD, MACCS

66 Client Pre Training to Anger

67 Client Post Training to Anger

68 Client Pre Training to Anger

69 Client Post Training to Anger

70 Booster Sessions of Training N=16 Schiz 5 x METT Cd-ROM Percentage pre and post each training session

71 Improvements over time with the METT training accuracy on METT assessment N = 16 Scz Mean Percentage Correct V1 Pre V2 pre V3 Pre V3 Pre V5 Pre V1 Post V2 Post V3 Pre V4 Post V5 Post Time Point

72 Results Main effect of training (p<0.04) All time points significantly different from baseline (p<0.001) Best explained by a linear trend (p<0.01)

73 OLD SLIDES

74 Future analysis EM to regions of interest for different emotions Examination of questionnaire data (social functioning indices) Examination of symptoms Other experimental tasks (EMT, RAT, TASIT)

75 Discussion Points Any comments? Bringing unconscious processes into consciousness what is the cost?

76 Main effect training (p<0.001), no interaction, no main effect of group 16 Change Scores 15 CMETTp< SMETTp< Mean (max 16) 12 Pre Training EM 11 C Scz Post Training EM Bhvl Data

77 Eye Movement Data: II ROIS Fixation Count 40 Main effect of training Main effect of ROI 30 No main effect of group or any interactions involving group 20 Training by ROI interaction. Eyes Pre Mean Fixation Count 10 Eyes Post Nose Pre Nose Post Mouth Pre 0 Scz C Mouth Post

78 Pre and Post Average No. Fixations Mean Average Fix. Pre Trend training effect (p<0.09) No group effect No interaction Change: Scz p<0.05 C -NS 13.4 Scz C Average Fix. Post Collapsed over emotion

79 Pre and Post Total Number of Fixations Mean Number of Fixations Pre Number of Fixations training effect (p<0.001) trend for group effect (p<0.1; Scz > C), sig. interaction (p<0.01) Change Scz p<0.001 C - NS 220 Scz C Post Collapsed over emotion