The transmissions in the interpersonal communication in psychotherapy is very complex as both parties are simultaneous senders and recipients of non-verbal and verbal messages. To learn more about these transmissions, it is important in psychotherapy research to link the non-verbal communication to the verbal content and to explore the communication patterns that arise over time. Non-verbal communication is multimodal and includes, for example, body/head position and movements, facial expressions, eye movements or emotional prosody. These non-verbal signals also form part of the complex interactional synchronization patterns that include reflections of emotional expression. First results will be presented of an interdisciplinary project, in which the fields of psychology and data science are brought together. The aim of the study is to analyze all sessions of video-recorded psychodynamic psychotherapy with the help of AI-based methods such as machine learning and time series analyses to investigate what is transmitted non-verbally and which nonverbal interactive behavioral patterns develop between patient and therapist.

Background: Psychopathic traits have been associated with impaired emotion recognition in criminal, clinical and community samples. A recent study however, suggested that cognitive impairment reduced the relationship between psychopathy and emotion recognition. We therefore investigated if reasoning ability and psychomotor speed were impacting emotion recognition in individuals with psychotic spectrum disorders (PSD) with and without a history of aggression, as well as in healthy individuals, more than self-rated psychopathy ratings on the Triarchic Psychopathy Measure (TriPM).

Methods: Eighty individuals with PSD (schizophrenia, schizoaffective disorder, delusional disorder, other psychoses, psychotic bipolar disorder) and documented history of aggression (PSD+Agg) were compared with 54 individuals with PSD without prior aggression (PSD-Agg) and with 86 healthy individuals on the Emotion Recognition Assessment in Multiple Modalities (ERAM test). Individuals were psychiatrically stable and in remission from possible substance use disorders. Scaled scores on matrix reasoning, averages of dominant hand psychomotor speed and self-rated TriPM scores were obtained.

Results: Associations existed between low reasoning ability, low psychomotor speed, patient status and prior aggression with total accuracy on the ERAM test. PSD groups performed worse than the healthy group. Whole group correlations between total and subscale scores of TriPM to ERAM were found, but no associations with TriPM scores within each group or in general linear models when accounting for reasoning ability, psychomotor speed, understanding of emotion words and prior aggression.

Conclusion: Self-rated psychopathy was not independently linked to emotion recognition in PSD groups when considering prior aggression, patient status, reasoning ability, psychomotor speed and emotion word understanding.

The ability to recognize and work with patients’ emotions is considered an important part of most psychotherapy approaches. Surprisingly, there is little systematic research on psychotherapists' ability to recognize other people’s emotional expressions. In this study, we compared trainee psychotherapists’ non-verbal emotion recognition accuracy to a control group of undergraduate students at two time points: at the beginning and at the end of one and a half years of theoretical and practical psychotherapy training. Emotion recognition accuracy (ERA) was assessed using two standardized computer tasks, one for recognition of dynamic multimodal (facial, bodily, vocal) expressions and one for recognition of facial micro expressions. Initially, 154 participants enrolled in the study, 72 also took part in the follow-up. The trainee psychotherapists were moderately better at recognizing multimodal expressions, and slightly better at recognizing facial micro expressions, than the control group at the first test occasion. However, mixed multilevel modeling indicated that the ERA change trajectories for the two groups differed significantly. While the control group improved in their ability to recognize multimodal emotional expressions from pretest to follow-up, the trainee psychotherapists did not. Both groups improved their micro expression recognition accuracy, but the slope for the control group was significantly steeper than the trainee psychotherapists’. These results suggest that psychotherapy education and clinical training do not always contribute to improved emotion recognition accuracy beyond what could be expected due to time or other factors. Possible reasons for that finding as well as implications for the psychotherapy education are discussed.  

Introduction: Psychotherapists’ emotional and empathic competencies have a positive influence on psychotherapy outcome and alliance. However, it is doubtful whether psychotherapy education in itself leads to improvements in trainee psychotherapists’ emotion recognition accuracy (ERA), which is an essential part of these competencies.

Methods: In a randomized, controlled, double-blind study (N = 68), we trained trainee psychotherapists (57% psychodynamic therapy and 43% cognitive behavioral therapy) to detect non-verbal emotional expressions in others using standardized computerized trainings – one for multimodal emotion recognition accuracy and one for micro expression recognition accuracy – and compared their results to an active control group one week after the training (n = 60) and at the one-year follow up (n = 55). The participants trained once weekly during a three-week period. As outcome measures, we used a multimodal emotion recognition accuracy task, a micro expression recognition accuracy task and an emotion recognition accuracy task for verbal and non-verbal (combined) emotional expressions in medical settings.

Results: The results of mixed multilevel analyses suggest that the multimodal emotion recognition accuracy training led to significantly steeper increases than the other two conditions from pretest to the posttest one week after the last training session. When comparing the pretest to follow-up differences in slopes, the superiority of the multimodal training group was still detectable in the unimodal audio modality and the unimodal video modality (in comparison to the control training group), but not when considering the multimodal audio-video modality or the total score of the multimodal emotion recognition accuracy measure. The micro expression training group showed a significantly steeper change trajectory from pretest to posttest compared to the control training group, but not compared to the multimodal training group. However, the effect vanished again until the one-year follow-up. There were no differences in change trajectories for the outcome measure about emotion recognition accuracy in medical settings.

Discussion: We conclude that trainee psychotherapists’ emotion recognition accuracy can be effectively trained, especially multimodal emotion recognition accuracy, and suggest that the changes in unimodal emotion recognition accuracy (audio-only and video-only) are long-lasting. Implications of these findings for the psychotherapy education are discussed.

Nonverbal emotion recognition accuracy (ERA) is a central feature of successful communication and interaction, and is of importance for many professions. We developed and evaluated two ERA training programs—one focusing on dynamic multimodal expressions (audio, video, audio-video) and one focusing on facial micro expressions. Sixty-seven subjects were randomized to one of two experimental groups (multimodal, micro expression) or an active control group (emotional working memory task). Participants trained once weekly with a brief computerized training program for three consecutive weeks. Pre-post outcome measures consisted of a multimodal ERA task, a micro expression recognition task, and a task about patients' emotional cues. Post measurement took place approximately a week after the last training session. Non-parametric mixed analyses of variance using the Aligned Rank Transform were used to evaluate the effectiveness of the training programs. Results showed that multimodal training was significantly more effective in improving multimodal ERA compared to micro expression training or the control training; and the micro expression training was significantly more effective in improving micro expression ERA compared to the other two training conditions. Both pre-post effects can be interpreted as large. No group differences were found for the outcome measure about recognizing patients' emotion cues. There were no transfer effects of the training programs, meaning that participants only improved significantly for the specific facet of ERA that they had trained on. Further, low baseline ERA was associated with larger ERA improvements. Results are discussed with regard to methodological and conceptual aspects, and practical implications and future directions are explored.

Social interactions require decoding of subtle rapidly changing emotional cues in others to facilitate socially appropriate behaviour. It is possible that impairments in the ability to detect and decode these signals may increase the risk for aggression. Therefore, we examined violent offenders with schizophrenia spectrum disorders (SSD) and compared these with healthy controls on a computerized paradigm of briefly presented double masked faces exhibiting 7 basic emotions. Our hypotheses were that impaired semantic understanding of emotion words and low cognitive ability would yield lowest emotion recognition. SSD exhibited lower accuracy of emotion perception than controls (46.1% compared with 64.5%, p = 0.026), even when considering the unbiased hit rate (22.4% compared with 43%, Z = 2.62, p < 0.01). Raw data showed uncommon but significant misclassifications of fear as sad, disgust as sad, sad as happy and angry as surprise. Once guessing and presentation frequencies were considered, only overall accuracy differed between SSD and healthy controls. There were significant correlations between cognitive ability, antipsychotic dose, speed and emotion accuracy in the SSD group. In conclusion, that there were no specific emotion biases in the SSD group compared to healthy controls, but particular individuals may have greater impairments in facial emotion perception, being influenced by intellectual ability, psychomotor speed and medication dosages, rather than specifically emotion word understanding. This implies that both state and trait factors influence emotion perception in the aggressive SSD group and may reveal one source of potential misunderstanding of social situations which may lead to boundary violations and aggression.

Background: Some aggressive acts committed by individuals with psychotic spectrum disorders (PSD) are understandable in the context of interpersonal conflict or goal attainment, yet others are unpredictable, arising from delusions or hallucinations (psychotically driven aggressive acts, PDA). It is unknown if there are underlying differences in cognitive or perceptive social cognition in relation to aggression motivation in PSD.

Method: We compared differences in social cognition performance between 49 individuals with PSD who had committed PDA with those exhibiting other types of aggression (n = 31) (non-PDA) and to community controls (n = 81) on the Swedish version of Double Movie for the Assessment of Social Cognition – Multiple Choice (DMASC-MC). Participants with PSD had more than 3 months of clinical stability and substance use abstention and stable antipsychotic medication doses. General intellectual ability was assessed with the information and matrix reasoning subtests of the Wechsler Intelligence Scales.

Results: The PSD group with a history of PDA exhibited lower total and perceptive social cognition scores on the DMASC-MC than the non-PDA group and controls. In addition, they also showed lower cognitive scores compared to typical controls. Lower total scores were associated with lower scores on Wechsler intelligence subtests information and matrix reasoning. Taking this into account, the PDA group still had lower social cognition scores. There were no associations of antipsychotic medication dosages, positive or negative symptoms with social cognition scores. Higher antipsychotic dosage at the time of DMASC-MC testing and social cognition scores predicted a past history of PDA.

Conclusions: We conclude that impaired social cognition, particularly perceptive social cognition, is associated with PDA in individuals with PSD.

This study presents findings about the effectiveness of two computerized training-programs for emotion recognition accuracy that were evaluated in a double-blind randomized controlled study with repeated measures design. Both trainings are effective in training emotion recognition accuracy. The trainings and results are presented in detail and practical implications are discussed.

Objective: Are there differences in working memory task related oxygenated hemoglobin (HbO) in dorsolateral prefrontal cortex in those with schizophrenia, who had committed instrumental violence as opposed to reactive aggression? Is there any relationship to the severity of such aggression?

Methods: 22 stable forensic psychiatric inpatients with schizophrenia spectrum disorders (20 schizophrenia) were rated on symptom scales. Their most severe aggressive act was rated according to Cornell’s classification of instrumental or reactive aggression. The severity of aggression was also noted. Subjects completed a computerized Corsi-block-tapping test during functional near infrared spectroscopy (fNIRS). Correlation analyses and GLM were used to identify factors that correlated with oxygenated hemoglobin signal in optodes 1 and 15 (dorsolateral prefrontal cortex DLPFC).

Results / Discussion: Spearman Rank correlations with task-minus-baseline HbO in optode 1(left DLPFC) were found for total antipsychotic daily dose and scores on block 5 of the Corsi task, as well as between daily dose and negative symptom scores. Correlations were found between baseline HbO in optode 1 and 15, as well as in task-minus-baseline.  There was no effect of type of aggression on optode 1 or 15 baseline or task-minus-baseline HbO when controlled for the above. Past severe aggression, controlled for SANS, daily dose and Corsi correct responses correlated with higher HbO at baseline in optode 15 (F=9.45 p=0.007, adj R2=0.33, p=0.032) as opposed to task related HbO. Baseline and task-minus baseline optode 1 HbO correlated only with antipsychotic dose and Corsi score.

Background: Computerized trainings for emotion recognition accuracy (ERA) have shown to be successful, however, are often lacking external validity. The use of still pictures, the focus on the face, and limited response sets limit generalizability of findings. Further, trainings often use between-subjectsdesigns and short time intervals between, or same items for ERA training and outcome measure. In response, we developed and evaluated a multi-modal ERA training in a randomized controlled trial.

Method: Seventy-two undergraduate students (M=24.7, SD=7.69, 75% women) signed up for the study; 68 completed all measurements. They were randomly assigned to the multimodal ERA training or one of two control conditions. The ERA outcome measure (ERAM; Laukka et al., 2015) assesses 12 emotions separately in three modalities (audio, video, audio-video) using 72 dynamic stimuli. The multimodal training consisted and immediate and extensive feedback using different items. The last training session and the ERA outcome measurement lay approximately one week apart.

Results and Conclusions: A repeated-measures ANOVA with baseline as covariate showed a main effect of training on the ERAM, F(2/63) = 8.04, p < .001, ηp2 = .20. Bonferroni-corrected posthoc tests revealed the change for the multimodal training was significantly superior to the control conditions (p=.001; p=.003). Detailed results per modality and descriptive statistics will be presented. Due to its multimodal and dynamic nature, delay between training and outcome measure and use of different items, the multimodal training is a promising tool for training ERA in different contexts, like clinical settings, assessment procedures or law enforcement training.