Cinemotion, a Program of Cognitive Remediation to Improve the Recognition and Expression of Facial Emotions in Schizophrenia: A Pilot Study

Abstract

Objective: Patients with schizophrenia exhibit impaired social cognition, especially in the recognition and expression of facial emotions, aspects of communication profoundly interlinked in an embodied approach of cognition. Nevertheless, many training programs have been developed that focus on either of these deficits but not both. We therefore designed a training program, Cinemotion, intended to remedy the 2 deficits and investigated its feasibility and effects in patients with schizophrenia.Design: Thirty-one patients undergoing treatment for schizophrenia and presenting deficit in emotion recognition were randomized to a group of 16 to undergo Cinemotion training, delivered in weekly group sessions, and to a control treatment group of 15. At the conclusion of training or after 10 weeks in controls, we reassessed and compared original and final results to determine improvement.Methods: Facial emotions recognition (TREF), empathy (Questionnaire of Cognitive and Affective Empathy, QCAE), and attributional style (Ambiguous Intentions Hostility Questionnaire, AIHQ) were assessed before (T0) and after (T1) the program. External evaluators also assessed ability and accuracy of Cinemotion participants to self-generate facial emotion expression in response to verbal instruction.Results: Between T0 and T1, Cinemotion participants significantly improved total TREF, sadness, disgust, and anger scores, compared to findings in control treatment group. They also improved their ability and accuracy to self-generate facial expressions, especially sadness and fear, with no significant improvement in other components of social recognition.Conclusions: Our findings show the apparent efficacy of training using the Cinemotion program to improve the recognition and expression of facial emotions in schizophrenia.

The Recovery Process for Individuals With Schizophrenia in the Context of Evidence-Based Psychotherapy and Rehabilitation

“…Social Cognitive Training improved the theory of mind, emotional expression, and recognition and avolition (Bechi et al., 2013; Gaudelus, Virgile, Geliot, The GAIA/Recos Study Team, & Franck, 2016; Gil-Sanz, Fernandez-Modamio, Bengochea-Seco, Arrieta-Rodriguez, & Perez-Fuentes 2013; Palumbo et al, 2017; Sevos et al, 2018; Souto et al, 2018; Taylor et al, 2016) (objective recovery).…”

“…Naeem et al (2015) and Vohs et al (2018) fulfilled the fidelity criteria but included no follow-up; thus, the improvement of Enactment of Treatment Skills was not very clear.Rehabilitation (RCTs): All included RCTs, which contain a rehabilitation program, fulfill the fidelity criteria. The RCTs include only a post-treatment evaluation but not a follow-up evaluation (Table 1) could have a better impact on the improvement of Enactment of Treatment Skills (Bechi et al, 2013; Bio & Gattaz, 2011; Byrne et al, 2013; Choi et al, 2018; Garrido et al, 2013; Gaudelus et al, 2016; Gharaeipour & Scott, 2012; Gil-Sanz et al, 2013; Gomar et al, 2015; Iwata et al, 2017; Kurtz et al, 2015; Ojeda et al, 2012; Palumbo et al, 2017; Pena et al., 2016; Rocha & Queiros, 2013; Sanchez et al, 2014; Sevos et al, 2018; Souto et al, 2018; Taylor et al, 2016; Thomas et al, 2018; Veltro et al, 2011). Case studies (CBT, MCT, MCTR, MERIT, and Rehabilitation): Balzan and Galletly (2015), Peyroux and Franck (2016), and Grant et al (2014) followed the fidelity criteria thoroughly.…”

“…Rehabilitation (RCTs): All included RCTs, which contain a rehabilitation program, fulfill the fidelity criteria. The RCTs include only a post-treatment evaluation but not a follow-up evaluation (Table 1) could have a better impact on the improvement of Enactment of Treatment Skills (Bechi et al, 2013; Bio & Gattaz, 2011; Byrne et al, 2013; Choi et al, 2018; Garrido et al, 2013; Gaudelus et al, 2016; Gharaeipour & Scott, 2012; Gil-Sanz et al, 2013; Gomar et al, 2015; Iwata et al, 2017; Kurtz et al, 2015; Ojeda et al, 2012; Palumbo et al, 2017; Pena et al., 2016; Rocha & Queiros, 2013; Sanchez et al, 2014; Sevos et al, 2018; Souto et al, 2018; Taylor et al, 2016; Thomas et al, 2018; Veltro et al, 2011).…”

Recognizing schizophrenia using facial expressions based on convolutional neural network

“…In a series of studies, researchers have employed the well‐known Facial Action Coding System (FACS) to convert the action units’ descriptive scores into seven emotions, including “surprised,” “contemptuous,” “fearful,” “happy,” “angry,” “sad,” and “disgusted” (Martinez et al., 2019). A previous study has demonstrated that SCZ patients often exhibit uncertainty in facial expressions compared to healthy controls (Sevos et al., 2018). Moreover, it has been reported that SCZ patients exhibit incongruent facial expressions and are significantly worse than healthy controls in their responses to emotional stimuli and during social interactions (Bersani et al., 2013).…”

“…"angry," "sad," and "disgusted" (Martinez et al, 2019). A previous study has demonstrated that SCZ patients often exhibit uncertainty in facial expressions compared to healthy controls (Sevos et al, 2018).…”