[Patient and public involvement at the German Center for Mental Health: achievements and challenges]

BACKGROUND

Patient and public involvement (PPI) describes the participation of patients and relatives, i.e., experts by experience (EE), in the research process. The PPI has not been widely adopted in the fields of medicine and clinical psychology in Germany and there is a notable absence of institutional support. The German Center for Mental Health (DZPG), which has been under construction since May 2023, aims to achieve nationwide and cross-center implementation of PPI, constituting one of its primary objectives. Participation of EE is to be implemented in the DZPG at all levels of decision-making.

OBJECTIVES

The article describes the origins, development and challenges associated with the implementation of participation structures and projects in the DZPG. The central political PPI committee in the DZPG, the Trilogue Center Council (TZR), developed a comprehensive PPI strategy for the DZPG in almost 3 years of work, before the beginning of the financial support of the DZPG. Among various measures, the strategy entails establishing a far-reaching representation for EE in all decision-making bodies of the DZPG, to involve EE as reviewers in evaluating research proposals, to integrate participatory elements into all studies of the DZGG and to foster user-initiated research endeavors. The implementation of the strategy is ensured by a cross-center PPI infrastructure, the Center for PPI, and scientific PPI consultants. The Center for PPI's tasks include supporting the voice of the EE and developing instruments and guidelines for participatory research, bringing together EE and researchers for joint DZPG projects as well as the documentation and quality assurance for participatory research. One of the particular challenges for the successful implementation of the PPI strategy is the limited experience with PPI in Germany in the field of mental health research and the widespread lack of structural implementation. Currently developed solution strategies include training for researchers and EE to communicate the benefits and pathways in the realization of PPI and thus enable shared decision-making and research. In addition, extensive access to knowledge and resources for EE will be created and uniform remuneration regulations for EE will be developed.

CONCLUSION

A PPI strategy at the DZPG has been successfully developed and is currently being implemented by the cross-center infrastructure Center for PPI.

Psychosocial therapeutic approaches for high-functioning autistic adults

Autism spectrum disorder (ASD) is characterized by impaired social interaction and communication skills, repetitive behaviors, restricted interests, and specific sensory processing. Particularly, adults with high-functioning ASD often remain unrecognized, presumably due to their high compensatory skills, but at the cost of high stress, which is often linked to anxiety and depression. This may further explain the significantly high suicide rates and reduced life expectancy among individuals with ASD. Thus, providing support to high-functioning autistic adults in managing core symptoms, as well as co-occurring anxiety and depression, appears essential. To date, only a limited number of evidence-based psychosocial therapeutic options are available, and very few of them have undergone rigorous evaluation in a clinical context. To obtain a comprehensive understanding, a systematic literature search was conducted according to the PRISMA checklist, and only studies demonstrating robust methodological quality were included and discussed in this review article. Although promising initial key factors and methods have been identified, additional evidence-based studies are imperative to ascertain the optimal treatment and evaluate the long-term outcomes for adults with high-functioning ASD.

Discrepancy of social cognition between bipolar disorders and major depressive disorders

BACKGROUND

The research landscape examining social cognition (SC) impairment in patients with major depressive disorders (MDD) and bipolar disorders (BD) is notably scarce. Presently, assessments predominantly rely on static stimuli and self-reported measures, which may not capture the dynamic dimensions of social cognition.

OBJECTIVES

This study aimed to validate the Chinese version of Movie Assessment of Social Cognition (MASC-CH) and to investigate whether MDD and BD exhibit distinct patterns of SC impairments, shedding light on potential differences between these two mood disorders.

METHODS

The study encompassed 197 participants, aged 18-65, distributed as follows: 21 BD, 20 MDD, and 156 healthy controls (HC). We focused on examining "cognitive" and "emotional" SC scores and "undermentalizing" and "overmentalizing" error patterns, with nonsocial inference as a control. Additional assessments included the Reading Mind in the Eyes Test (RMET) and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We also explored the association between depression severity (measured by the Hamilton Depressive Rating Scale, HDRS) and distinct SC dimensions between MDD and BD.

RESULTS

The MASC-CH exhibited strong validity and reliability for SC assessment. In group comparisons, BD participants scored significantly lower on MASC-CH, while the MDD group scores were not significantly different from HC. Specifically, BD individuals had notably lower cognitive SC scores and made more undermentalizing and absence of mentalizing errors than MDD and HC. Additionally, a negative correlation between HDRS score and overmentalizing was observed in BD, not in the MDD.

CONCLUSIONS

The findings indicate that depression severity scores in BD were inversely related to MASC-CH scores. In contrast, this relationship was not observed in the MDD group. These results underscore the importance of SC impairments as distinguishing characteristics of both BD and MDD. It provides valuable insights into the distinct social-cognitive profiles of both mood disorders.

Impairments in Cognitive and Emotional Empathy as Markers of General versus Specific Personality Pathology

INTRODUCTION

The alternative model for personality disorders (AMPD) of the Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-5) considers impairments in empathy a basic feature of personality disorders (PDs). In contrast, the AMPD pathological personality trait model and the categorical DSM-5 Section II PD model associate deficits in empathy to specific forms of personality pathology. The present study investigated to what extent impairments in cognitive and emotional empathy are markers of general versus specific personality pathology.

METHODS

In a clinical sample (n = 119), the Multifaceted Empathy Test was used to assess cognitive empathy, emotional empathy for positive emotions, and emotional empathy for negative emotions. Personality functioning, pathological personality traits, and DSM-5 Section II PDs were assessed via interviews and self-reports. Confirmatory factor analyses were applied to associate the three empathy facets with the three personality pathology approaches, each modeled with general personality pathology (common factor) and specific personality pathology (residuals of indicators).

RESULTS

Impairments in cognitive empathy and emotional empathy for positive emotions were significantly correlated with general personality pathology. All three empathy facets were also correlated to specific personality pathology when controlling for general personality pathology, respectively. Impairments in cognitive empathy were incrementally associated with identity and empathy (personality functioning), psychoticism (pathological personality traits), and paranoid and dependent PD (DSM-5 Section II PDs). Deficits in emotional empathy for positive emotions were incrementally associated with self-direction and intimacy (personality functioning) and detachment (pathological personality traits). Impairments in emotional empathy for negative emotions were incrementally associated with antagonism (pathological personality traits) and antisocial PD (DSM-5 Section II PDs).

CONCLUSION

The results suggest that impairments in cognitive empathy and emotional empathy for positive emotions, but not for negative emotions, are markers of general personality pathology, while deficits in the three empathy facets are also markers for specific personality pathology.

The social domains organization of mentalizing processes in adolescents: a contribution to the conceptualization of personality function and dysfunction in young people

BACKGROUND

We propose and evaluate a contribution to the conceptualization and assessment of personality functioning based on social domains and mentalizing hypotheses. Social domains are distinct social contexts, such as with acquaintances and friends, with differentiated expectations regarding participants' behaviours and social attributions. The capacity to organize social participation according to these expectations requires the ability, we suggest, to modulate mentalizing processes domain by domain. Drawing on evidence that social domain organization is impaired in borderline personality disorder (BPD) and that hypermentalizing, a heightened interpretation of others' motives, thoughts or emotions, is elevated in adolescent BPD, we hypothesized that hypermentalizing levels in adolescents will vary by social domain and that elevated BPD features will be associated with impairment of this domain organization of hypermentalizing.

METHODS

Measures including the borderline personality features scale for children (BPFSC) and the movie for the assessment of social cognition (MASC) were administered to 171 adolescents aged 12-17 recruited from public schools and community organizations in a large metropolitan area in southwestern United States. Mean hypermentalizing scores were computed for adolescent interpretations of sequences in the MASC focusing on the social domains of acquaintance, friends and romantic interactions.

RESULTS

There was a progressive increase in hypermentalizing scores across the acquaintance, friends and romantic interactions (repeated measures ANOVA, p < .001, all pairwise comparisons, p ≤ .02), which was markedly reduced in the presence of elevated BPD features (interaction term, p = .007).

CONCLUSIONS

Hypermentalizing is organized according to social domain and this organization is impaired in the presence of elevated BPD features. The findings are consistent with the proposal that personality functioning entails a social domains organization of hypermentalizing, which is impaired in personality dysfunction. Identifying mentalizing processes domain by domain has the potential to create a personalized focus for the treatment of adolescents with personality difficulties.

Mentalizing in a movie for the assessment of social cognition (MASC): the validation in a taiwanese sample

BACKGROUND

The present study evaluated the psychometrics properties of a sensitive video-based test used in the evaluation of mentalizing skills, that is, the Movie for the Assessment of Social Cognition-Taiwanese version (MASC-TW).

METHODS

We recruited two independent samples of nonclinical participants (N = 167) and adult patients with schizophrenia (N = 41). The MASC-TW and two other social cognition measures, namely the Chinese version of Theory of Mind task (ToM) and the Taiwanese version of the Diagnostic Analysis of Nonverbal Accuracy-2 (DANAV-TW-2), and an executive function measure of the Wisconsin Card Sorting Test (WCST), were administered to both groups.

RESULTS

The MASC proved to be a reliable measure of mentalizing capacity, high Cronbach's α value of 0.87. The intraclass correlation coefficient for the MASC-TW total correct scores was 0.85 across three waves of data collection. Across the entire sample, the scores on the MASC-TW were significantly correlated with verbal and nonverbal scores for the ToM task and recognition of facial and prosodic emotion on the DANAV-TW-2. Both executive function and emotion recognition emerged as noteworthy predictors of mentalizing, indicating that these two variables might play crucial roles in the development of mentalizing capacities. Finally, a receiver operating characteristic analysis revealed that in patients with schizophrenia, the MASC was the most accurate discriminator of diagnostic groups, highlighting the validity of the MASC.

CONCLUSIONS

Overall, the MASC-TW is an ecologically valid and useful tool for assessing mentalizing abilities in a Taiwanese population.

A randomized controlled trial on the digital socio-emotional competence training Zirkus Empathico for preschoolers

In this randomized controlled trial (RCT), the digital socio-emotional competence training Zirkus Empathico was tested in 74 Central European children (5.1 (0.9) years; 34 females) within a longitudinal design (three time points: T1 = pre-training; T2 = immediately following 6-week training, T3 = 3-month follow-up). The pre-registered primary outcome was empathy, secondary outcomes included emotion recognition, prosocial behavior, and behavioral problem reduction; furthermore, children's neural sensitivity to facial expressions quantified with event-related potentials. Compared to controls (N = 38), Zirkus Empathico participants (N = 36) showed increases in empathy (d = 0.28 [-0.17, 0.76]), emotion recognition (d = 0.57 [0.01, 1.06]), prosocial behavior (d = 0.51 [0.05, 0.99]) and reduced behavioral problems (d = 0.54 [0.08, 1.03]). They also showed larger P3 amplitudes to happy vs. angry and neutral facial expressions post-training. Thus, Zirkus Empathico may be a promising digital training for social competence in preschoolers.

Ethnic discrimination unlearned: experience in the repeated Trust Game reduces trust bias

Introduction

Discrimination toward ethnic minorities is a persistent societal problem. One reason behind this is a bias in trust: people tend to trust their ingroup and comparatively distrust outgroups.

Methods

In this study, we investigated whether and how people change their explicit trust bias with respect to ethnicity based on behavioral interactions with in- and outgroup members in a modified Trust Game.

Results

Subjects' initial explicit trust bias disappeared after the game. The change was largest for ingroup members who behaved unfairly, and the reduction of trust bias generalized to a small sample of new in- and outgroup members. Reinforcement learning models showed subjects' learning was best explained by a model with only one learning rate, indicating that subjects learned from trial outcomes and partner types equally during investment.

Discussion

We conclude that subjects can reduce bias through simple learning, in particular by learning that ingroup members can behave unfairly.

Reward responsiveness in autism and autistic traits - Evidence from neuronal, autonomic, and behavioural levels

Autism has been linked to atypicalities in reward processing, especially in the social domain. However, results are heterogeneous, and their interpretation is hindered by the use of personally non-relevant social rewards. In this study we investigated behavioural (reaction times), neuronal (event-related potentials), and autonomic (pupil sizes) responses to personally relevant social rewards, money, and neutral outcomes in 26 autistic and 53 non-autistic subjects varying in levels of autistic traits. As hypothesised and preregistered, autism and autistic traits did not differently influence responses to social, monetary, or neutral outcomes on either response level. While groups did not differ in behaviour (reaction times), autism was linked to generally enhanced brain responses in early anticipation and larger pupil constrictions in reward reception. Together, these results suggest that when using personally relevant stimuli, autism is linked to generally preserved, although less neuronally efficient processing of rewards. Considering the role of social relevance in reward processing, we propose an interpretation of contradictory evidence from clinical practice and empirical research.

It's who, not what that matters: Personal relevance and early face processing

The faces of our friends and loved ones are among the most pervasive and important social stimuli we encounter in our everyday lives. We employed EEG to investigated the time line of personally relevant face processing and potential interactions with emotional facial expressions by presenting female participants with photographs of their romantic partner, a close friend, and a stranger, displaying fearful, happy and neutral facial expressions. Our results revealed elevated activity to the partner's face from 100 ms after stimulus onset as evident in increased amplitudes of P1, EPN, P3 and LPC components, while there were no effects of emotional expressions, and no interactions. Our findings indicate the prominent role of personal relevance in face processing; the time course of effects further suggests that it might not rely solely on the core face processing network, but might start even before the stage of structural face encoding. Our results suggest a new direction of research in which face processing models should be expanded to adequately capture the dynamics of the processing of real-life, personally relevant faces.

Doctoral researchers' mental health and PhD training satisfaction during the German COVID-19 lockdown: results from an international research sample

Academia has been facing a mental health crisis particularly affecting early career researchers (ECRs). Moreover, the COVID-19 pandemic posed an unprecedented burden on the mental health of many individuals. Therefore, we cross-sectionally investigated how doctoral researchers (N = 222) evaluate their mental health status and satisfaction with their PhD training before and during the pandemic. As compared to self-reported, retrospective evaluations about the pre-pandemic state, we found decreased satisfaction with PhD training and overall well-being. The whole sample exhibited high levels of personal and work-related burnout, a fifth indicated clinically meaningful levels of depressive symptoms and almost 25% experienced severe loneliness. When exploring predictors of depression, anxiety, and burnout, we identified low satisfaction with PhD training as the most prominent predictor for poor mental health, suggesting a link between the doctoral work and their mental health status. Females vs. males and doctoral researchers in individual doctorate vs. structured PhD programs reported higher symptoms of burnout. Our study replicates previous findings of poor mental health in doctoral researchers and indicates further decreases of mental wellbeing under the influence of the pandemic. Systematic adjustments in academia are required to improve the mental health of ECRs.

Mothers need more information to recognise associated emotions in child facial expressions

Parenting requires mothers to read social cues and understand their children. It is particularly important that they recognise their child's emotions to react appropriately, for example, with compassion to sadness or compersion to happiness. Despite this importance, it is unclear how motherhood affects women's ability to recognise emotions associated with facial expressions in children. Using videos of an emotionally neutral face continually and gradually taking on a facial expression associated with an emotion, we quantified the amount of information needed to match the emotion with the facial expression. Mothers needed more information than non-mothers to match the emotions with the facial expressions. Both mothers and non-mothers performed equally on a control task identifying animals instead of emotions, and both groups needed less information when recognising the emotions associated with facial expressions in adolescents than pre-schoolers. These results indicate that mothers need more information for to correctly recognise typically associated emotions in child facial expressions but not for similar tasks not involving emotions. A possible explanation is that child facial expressions associated with emotions may have a greater emotional impact on mothers than non-mothers leading to task interference but possibly also to increased compassion and compersion.

Developmental Delays in Socio-Emotional Brain Functions in Persons with an Intellectual Disability: Impact on Treatment and Support

Intellectual disability is a neurodevelopmental disorder with a related co-occurrence of mental health issues and challenging behaviors. In addition to purely cognitive functions, socio-emotional competencies may also be affected. In this paper, the lens of developmental social neuroscience is used to better understand the origins of mental disorders and challenging behaviors in people with an intellectual disability. The current concept of intelligence is broadened by socio-emotional brain functions. The emergence of these socio-emotional brain functions is linked to the formation of the respective neuronal networks located within the different parts of the limbic system. Thus, high order networks build on circuits that process more basic information. The socio-emotional skills can be assessed and complement the results of a standardized IQ-test. Disturbances of the brain cytoarchitecture and function that occur at a certain developmental period may increase the susceptibility to certain mental disorders. Insights into the current mental and socio-emotional functioning of a person may support clinicians in the calibration of treatment and support. Acknowledging the trajectories of the socio-emotional brain development may result in a more comprehensive understanding of behaviors and mental health in people with developmental delays and thus underpin supports for promotion of good mental health in this highly vulnerable population.

Subjective and objective difficulty of emotional facial expression perception from dynamic stimuli

This study aimed to discover predictors of subjective and objective difficulty in emotion perception from dynamic facial expressions. We used a multidimensional emotion perception framework, in which observers rated the perceived emotion along a number of dimensions instead of choosing from traditionally-used discrete categories of emotions. Data were collected online from 441 participants who rated facial expression stimuli in a novel paradigm designed to separately measure subjective (self-reported) and objective (deviation from the population consensus) difficulty. We targeted person-specific (sex and age of observers and actors) and stimulus-specific (valence and arousal values) predictors of those difficulty scores. Our findings suggest that increasing age of actors makes emotion perception more difficult for observers, and that perception difficulty is underestimated by men in comparison to women, and by younger and older adults in comparison to middle-aged adults. The results also yielded an increase in the objective difficulty measure for female observers and female actors. Stimulus-specific factors–valence and arousal–exhibited quadratic relationships with subjective and objective difficulties: Very positive and very negative stimuli were linked to reduced subjective and objective difficulty, whereas stimuli of very low and high arousal were linked to decreased subjective but increased objective difficulty. Exploratory analyses revealed low relevance of person-specific variables for the prediction of difficulty but highlighted the importance of valence in emotion perception, in line with functional accounts of emotions. Our findings highlight the need to complement traditional emotion recognition paradigms with novel designs, like the one presented here, to grasp the “big picture” of human emotion perception.

Preschoolers’ Sensitivity to Negative and Positive Emotional Facial Expressions: An ERP Study

The study examined processing differences for facial expressions (happy, angry, or neutral) and their repetition with early (P1, N170) and late (P3) event-related potentials (ERPs) in young children (N = 33). EEG was recorded while children observed sequentially presented pairs of facial expressions, which were either the same (repeated trials) or differed in their emotion (novel trials). We also correlated ERP amplitude differences with parental and child measures of socio-emotional competence (emotion recognition, empathy). P1 amplitudes were increased for angry and happy as compared to neutral expressions. We also detected larger P3 amplitudes for angry expressions as compared to happy or neutral expressions. Repetition effects were evident at early and late processing stages marked by reduced P1 amplitudes for repeated vs. novel happy expressions, but enhanced P3 amplitudes for repeated vs. novel facial expressions. N170 amplitudes were neither modulated by facial expressions nor their repetition. None of the repetition effects were associated with measures of socio-emotional competence. Taken together, negative facial expressions led to increased neural activations in early and later processing stages, indicative of enhanced saliency to potential threating stimuli in young children. Processing of repeated facial expression seem to be differential for early and late neural stages: Reduced activation was detected at early neural processing stages particularly for happy faces, indicative of effective processing for an emotion, which is most familiar within this age range. Contrary to our hypothesis, enhanced activity for repeated vs. novel expression independent of a particular emotion were detected at later processing stages, which may be linked to the creation of new memory traces. Early and late repetition effects are discussed in light of developmental and perceptual differences as well as task-specific load.

Motherhood and theory of mind: increased activation in the posterior cingulate cortex and insulae

Despite growing evidence on effects of parenthood on social understanding, little is known about the influence of parenthood on theory of mind (ToM), the capacity to infer mental and affective states of others. It is also unclear whether any possible effects of parenthood on ToM would generalise to inferring states of adults or are specific to children. We investigated neural activation in mothers and women without children while they predicted action intentions from child and adult faces. Region-of-interest analyses showed stronger activation in mothers in the bilateral posterior cingulate cortex, precuneus (ToM-related areas) and insulae (emotion-related areas). Whole-brain analyses revealed that mothers compared to non-mothers more strongly activated areas including the left angular gyrus and the ventral prefrontal cortex but less strongly activated the right supramarginal gyrus and the dorsal prefrontal cortex. These differences were not specific to child stimuli but occurred in response to both adult and child stimuli and might indicate that mothers and non-mothers employ different strategies to infer action intentions from affective faces. Whether these general differences in affective ToM between mothers and non-mothers are due to biological or experience-related changes should be subject of further investigation.

Regulating negative emotions of others reduces own stress: Neurobiological correlates and the role of individual differences in empathy: Regulating others reduces own stress

BACKGROUND

While witnessing the suffering of other people results in personal distress, it is not clear whether regulating others' emotions in such situations also comes at an emotional cost for the observer.

METHODS

this novel study included 62 subjects and used a newly developed functional Magnetic Resonance Imaging (fMRI) paradigm to investigate mechanisms of self and other emotion regulation via reappraisal while the subject and an interaction partner outside the scanner were facing the same distressing situation simultaneously. The relationship between distress levels and individual differences in emotional and cognitive empathy were also assessed.

RESULTS

We found that individuals exhibited especially high levels of personal distress when relating with a partner while both being exposed to aversive photographs and that especially highly empathetic individuals were prone to such personal distress. Moreover, when engaging in social emotion regulation, personal distress was reduced in the observer at a similar rate as in self emotion regulation. FMRI analyses revealed increased activation for other vs. self emotion regulation in the precuneus and the left temporo-parietal junction, which are commonly engaged in social cognition. Furthermore, this activation was associated with lower self-reported stress and decreased sympathetic autonomic activity. While regulating others, precuneus activation exhibited a distinctive functional connectivity profile with parietal emotion regulation regions.

CONCLUSIONS

This study demonstrates benefits of actively regulating another person's emotions for reducing one's own distress and identifies the precuneus as an important node for social emotion regulation. Given the novelty of the study design, the results are of exploratory and preliminary nature.

Increased child‐evoked activation in the precuneus during facial affect recognition in mothers

Successful parenting requires constant inferring of affective states. Especially vital is the correct identification of facial affect. Previous studies have shown that infant faces are processed preferentially compared to adult faces both on the behavioural and the neural level. This study specifically investigates the child‐evoked neural responses to affective faces and their modulation by motherhood and attention to affect. To do so, we used a paradigm to measure neural responses during both explicit and implicit facial affect recognition (FAR) in mothers and non‐mothers using child and adult faces. Increased activation to child compared to adult faces was found for mothers and non‐mothers in face processing areas (bilateral fusiform gyri) and areas associated with social understanding (bilateral insulae and medial superior frontal gyrus) when pooling implicit and explicit affect recognition. Furthermore, this child‐evoked activation was modulated by motherhood with an increase in mothers compared to non‐mothers in the left precuneus. Additionally, explicitly recognising the affect increased child‐evoked activation in the medial superior frontal gyrus in both mothers and non‐mothers. These results suggest preferential treatment of affective child over adult faces, modulated by motherhood and attention to affect.

Towards a mechanistic understanding of mindfulness-based stress reduction (MBSR) using an RCT neuroimaging approach: Effects on regulating own stress in social and non-social situations

Although much research has shown that mindfulness-based interventions (MBIs) can reduce psychological stress, it is less clear if effects generalize to everyday social situations, which range among the largest stress triggers. Furthermore, mechanisms of MBIs have not been fully established. Emotion regulation (ER) has been suggested as one key mechanism, yet the role of cognitive reappraisal and acceptance strategies is still under debate. To address these questions, a neuroimaging-based randomized controlled trial (RCT) was performed (n=68), comparing mindfulness-based stress reduction (MBSR) with a reading/listening intervention (READ), using a novel dyadic paradigm for self and other emotion regulation under stress as primary outcome on behavior and brain levels and established empathy measures (clinicatrials.gov NCT03035669). Compared to READ, MBSR led to self-reported stress reduction through both cognitive reappraisal and acceptance only when regulating self and not when regulating others' distress. In addition, MBSR led to increased brain activation over time for regulating own (parietal cortex) and others' (precuneus, TPJ) emotions through cognitive reappraisal and acceptance, albeit this effect was also seen for the reading intervention for regulating own stress via reappraisal. Brain changes did not scale with subjective stress reduction and amount of meditation practice. More distant generalization effects of MBSR on socio-emotional functioning (cognitive empathy and compassion) could also not be shown. This study identified both cognitive reappraisal and acceptance as two ER mechanisms of MBSR, but indicates that effects do not extend to social settings.

Affective and cognitive theory of mind in posttraumatic stress, major depressive, and somatic symptom disorders: Association with childhood trauma

OBJECTIVES

Childhood trauma constitutes a major risk factor for adult psychopathology, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and somatic symptom disorder (SSD). One potential mechanism linking childhood trauma to adult psychopathology may be alterations in theory of mind (ToM). Given the lack of transdiagnostic studies on the association between childhood trauma and ToM, further research is needed to elucidate whether and how childhood trauma relates to ToM impairments across and within diagnostic boundaries.

DESIGN

A cross-sectional study design was applied.

METHODS

A total of 137 individuals with varying levels of childhood trauma took part in this study, encompassing individuals with PTSD (n = 33), MDD (n = 33), SSD (n = 36), and healthy volunteers (HVs; n = 35). To assess ToM performance and childhood trauma, the Movie for the Assessment of Social Cognition was administered along with the Childhood Trauma Questionnaire.

RESULTS

Only individuals with PTSD, but not individuals with MDD or SSD, showed a worse ToM performance compared to HVs. In the whole sample, childhood trauma correlated negatively with ToM performance. Exploratory group-specific analyses revealed higher levels of childhood trauma to be associated with more excessive ToM errors in individuals with SSD, and notably with an enhanced ToM performance in individuals with MDD.

CONCLUSIONS

Our results indicate associations between childhood trauma and ToM impairments in a large, transdiagnostic sample. Provided replication in future studies, our findings suggest ToM capacities as a promising treatment target for individuals exposed to severe childhood trauma, at least or particularly with a diagnosis of PTSD.

PRACTITIONER POINTS

Our results suggest that individuals with a history of severe childhood trauma, at least or particularly with a clinical diagnosis of posttraumatic stress disorder, may benefit from therapeutic approaches targeting theory of mind capacities. Our findings indicate that higher levels of childhood trauma may be linked to a specific 'hypermentalizing' bias in somatic symptom disorder. Our findings further point towards an association between higher levels of childhood trauma and a heightened - rather than a diminished - sensitivity towards interpersonal cues in major depressive disorder. Provided further confirmatory evidence, our findings may support diagnosis-specific approaches in ameliorating theory of mind abilities in individuals with different mental disorders and a history of severe childhood trauma.

Empathy Modulates the Effects of Acute Stress on Anxious Appearance and Social Behavior in Social Anxiety Disorder

Patients suffering from social anxiety disorder (SAD) fear social interaction and evaluation, which severely undermines their everyday life. There is evidence of increased prosocial behavior after acute social stress exposure in healthy individuals, which may be interpreted as stress-regulating "tend-and-befriend" behavior. In a randomized controlled trial, we measured empathic abilities in a first diagnostic session. In the following experimental session, we investigated how patients with SAD (n = 60) and healthy control participants (HC) (n = 52) respond to an acute social stressor (Trier Social Stress Test for groups) or a non-stressful control condition, and whether empathic abilities and acute social stress interact to modulate anxious appearance and social behavior in a social conversation test. Salivary cortisol, heart rate, and subjective stress response were repeatedly measured. The anxious appearance and social behavior of participants were rated by the conversation partner. SAD patients demonstrated stronger subjective stress responses while the biological responses did not differ from HC. Moreover, patients performed worse overall in the conversation task, which stress additionally undermined. Finally, we found that both emotional and cognitive empathy buffered the negative effects of acute stress on social behavior in SAD, but not in HC. Our data highlight the importance of empathic abilities for SAD during stressful situations and call for multimodal clinical diagnostics. This may help to differentiate clinical subtypes and offer better-tailored treatment for patients. General Scientific Summary: This study shows that high levels of cognitive and emotional empathy can buffer the negative effects of acute stress on social behavior in social anxiety disorder (SAD). Empathic abilities may be included as an additional diagnostic resource marker for SAD.

A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum

Most adults on the autism spectrum have co-occurring mental health conditions, creating a high demand for mental health services – including psychotherapy – in autistic adults. However, autistic adults have difficulties accessing mental health services. The most-reported barriers to accessing treatment are therapists’ lack of knowledge and expertise surrounding autism, as well as unwillingness to treat autistic individuals. This study was conducted by a participatory autism research group and examined 498 adult-patient psychotherapists on knowledge about autism and self-perceived competency to diagnose and treat autistic patients without intellectual disability compared to patients with other diagnoses. Psychotherapists rated their education about autism in formal training, and competency in the diagnosis and treatment of patients with autism, lowest compared to patients with all other diagnoses surveyed in the study, including those with comparable prevalence rates. Many therapists had misconceptions and outdated beliefs about autism. Few had completed additional training on autism, but the majority were interested in receiving it. Greater knowledge about autism was positively linked to openness to accept autistic patients. The results point to an alarming gap in knowledge necessary for adequate mental health care for individuals with autism.

Increased activation in the bilateral anterior insulae in response to others in pain in mothers compared to non-mothers

Empathy allows us to share emotions and encourages us to help others. It is especially important in the context of parenting where children's wellbeing is dependent on their parents' understanding and fulfilment of their needs. To date, little is known about differences in empathy responses of parents and non-parents. Using stimuli depicting adults and children in pain, this study focuses on the interaction of motherhood and neural responses in areas associated with empathy. Mothers showed higher activation to both adults and children in pain in the bilateral anterior insulae, key regions of empathy for pain. Additionally, mothers more strongly activated the inferior frontal, superior temporal and the medial superior frontal gyrus. Differences between adult and child stimuli were only found in occipital areas in both mothers and non-mothers. Our results suggest a stronger neural response to others in pain in mothers than non-mothers regardless of whether the person is a child or an adult. This could indicate a possible influence of motherhood on overall neural responses to others in pain rather than motherhood specifically shaping child-related responses. Alternatively, stronger responses to others in pain could increase the likelihood for women to be in a relationship and subsequently to have a child.

Effects of glucocorticoid and noradrenergic activity on implicit and explicit facial emotion recognition in healthy young men

The ability to recognize emotions from facial expressions is crucial for social interaction. Only few studies have examined the effect of stress hormones on facial emotion recognition, although stressful events affect social interactions on a daily basis. Those studies that examined facial emotion recognition mostly used explicit prompts to trigger consciously controlled processing. However, facial emotions are processed mainly implicitly in real life. Therefore, we investigated separate and combined effects of noradrenergic and glucocorticoid stimulation on implicit and explicit facial emotion recognition. One hundred and four healthy men (mean age = 24.1 years ±SD 3.5) underwent the Face Puzzle task to test implicit and explicit facial emotion recognition after receiving either 10 mg hydrocortisone or 10 mg yohimbine (an alpha 2-adrenergic receptor antagonist that increases noradrenergic activity) or 10 mg hydrocortisone/10 mg yohimbine combined or placebo. Salivary cortisol and salivary alpha amylase (sAA) were measured during the experiment. Compared to the placebo condition hydrocortisone significantly increased salivary cortisol and yohimbine significantly increased sAA. Participants were better and faster in explicit than in implicit facial emotion recognition. However, there was no effect of separate and combined noradrenergic and glucocorticoid stimulation on implicit and explicit facial emotion recognition performance compared to placebo. Our results do not support an essential role of the glucocorticoid and noradrenergic system in FER in young healthy men.

Evaluation of an algorithm for optical pulse detection in children for application to the Pepper robot

To engage in socio-emotional interactions, children with autism spectrum conditions (ASC) need support to understand and convey emotions. In our approach, a humanoid robot (Pepper, Softbanks Robotics) acts as a tutor for the child within autism care. The robot, equipped with multimodal sensor technology to acquire the emotional feedback of the child, stimulates the child to perform tasks, adapted to its current arousal state. By in-, or decreasing the difficulties of implemented training modules, the child can be given the appropriate task according to its emotional state. The child’s arousal is measured with different techniques implemented in and on the robot: emotion detection based on audio recordings of the speech signal and camera detected facial expressions, or heart rate. To this end, the remote Photoplethysmography (rPPG) signal from camera recordings of the subjects’ face is acquired. While its unintrusive measurement is an advantage, a major drawback for rPPG is its proneness to motion and light artefacts requiring de-noising steps. A wavelet transform based on log-Gabor wavelets and a filter bank with 32 filters was implemented. The signal was filtered with a prior filter and afterwards with a Markov chain in order to extract the underlying pulse rate. Within an initial study, five children were observed watching videos with different co-notated emotions. As reference for the heart rate (HR), a wristband (empatica E4) was used. The captured emotions of all subjects were annotated to identify low and high arousal parts and positive and negative emotions. Extracted HR from rPPG-data indicated a correlation with the annotated emotions.

Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.

Pupillary Responses to Faces Are Modulated by Familiarity and Rewarding Context

Observing familiar (known, recognisable) and socially relevant (personally important) faces elicits activation in the brain’s reward circuit. Although smiling faces are often used as social rewards in research, it is firstly unclear whether familiarity and social relevance modulate the processing of faces differently, and secondly whether this processing depends on the feedback context, i.e., if it is different when smiles are delivered depending on performance or in the absence of any action (passive viewing). In this preregistered study, we compared pupillary responses to smiling faces differing in subjective familiarity and social relevance. They were displayed in a passive viewing task and in an active task (a speeded visual short-term memory task). The pupils were affected only in the active task and only by subjective familiarity. Contrary to expectations, smaller dilations were observed in response to more familiar faces. Behavioural ratings supported the superior rewarding context of the active task, with higher reward ratings for the game than the passive task. This study offers two major insights. Firstly, familiarity plays a role in the processing of social rewards, as known and unknown faces influence the autonomic responses differently. Secondly, the feedback context is crucial in reward research as positive stimuli are rewarding when they are dependent on performance.

Neural correlates of RDoC-specific cognitive processes in a high-functional autistic patient: a statistically validated case report

The level of functioning of individuals with autism spectrum disorder (ASD) varies widely. To better understand the neurobiological mechanism associated with high-functioning ASD, we studied the rare case of a female patient with an exceptional professional career in the highly competitive academic field of Mathematics. According to the Research Domain Criteria (RDoC) approach, which proposes to describe the basic dimensions of functioning by integrating different levels of information, we conducted four fMRI experiments targeting the (1) social processes domain (Theory of mind (ToM) and face matching), (2) positive valence domain (reward processing), and (3) cognitive domain (N-back). Patient’s data were compared to data of 14 healthy controls (HC). Additionally, we assessed the subjective experience of our case during the experiments. The patient showed increased response times during face matching and achieved a higher total gain in the Reward task, whereas her performance in N-back and ToM was similar to HC. Her brain function differed mainly in the positive valence and cognitive domains. During reward processing, she showed reduced activity in a left-hemispheric frontal network and cortical midline structures but increased connectivity within this network. During the working memory task patients’ brain activity and connectivity in left-hemispheric temporo-frontal regions were elevated. In the ToM task, activity in posterior cingulate cortex and temporo-parietal junction was reduced. We suggest that the high level of functioning in our patient is rather related to the effects in brain connectivity than to local cortical information processing and that subjective report provides a fruitful framework for interpretation.

Rapid Neural Representations of Personally Relevant Faces

The faces of those most personally relevant to us are our primary source of social information, making their timely perception a priority. Recent research indicates that gender, age and identity of faces can be decoded from EEG/MEG data within 100 ms. Yet, the time course and neural circuitry involved in representing the personal relevance of faces remain unknown. We applied simultaneous EEG-fMRI to examine neural responses to emotional faces of female participants' romantic partners, friends, and a stranger. Combining EEG and fMRI in cross-modal representational similarity analyses, we provide evidence that representations of personal relevance start prior to structural encoding at 100 ms, with correlated representations in visual cortex, but also in prefrontal and midline regions involved in value representation, and monitoring and recall of self-relevant information. Our results add to an emerging body of research that suggests that models of face perception need to be updated to account for rapid detection of personal relevance in cortical circuitry beyond the core face processing network.

How Much of Me Do I See in Other Minds? Modulating Egocentricity in Emotion Judgments by tDCS

When inferring the mental states of others, individuals’ judgments are influenced by their own state of mind, an effect often referred to as egocentricity. Self–other differentiation is key for an accurate interpretation of other’s mental states, especially when these differ from one’s own states. It has been suggested that the right supramarginal gyrus (rSMG) is causally involved in overcoming egocentricity in the affective domain. In a double-blind randomized study, 47 healthy adults received anodal (1 mA, 20 min) or sham transcranial direct current stimulation (tDCS) to the rSMG prior to performing a newly developed paradigm, the self–other facial emotion judgment (SOFE) task. In this task, participants made judgments of facial emotional expressions while having been previously confronted with congruent or incongruent emotion-inducing situations. To differentiate between emotional and cognitive egocentricity, participants additionally completed an established visual perspective-taking task. Our results confirmed the occurrence of emotional egocentric biases during the SOFE task. No conclusive evidence of a general role of the rSMG in emotional egocentricity was found. However, active as compared to sham tDCS induced descriptively lower egocentric biases when judging incongruent fearful faces, and stronger biases when judging incongruent happy faces, suggesting emotion-specific tDCS effects on egocentric biases. Further, we found significant tDCS effects on cognitive egocentricity. Results of the present study expanded our understanding of emotional egocentricity and point towards emotion-specific patterns of the underlying functionality.

Imitation and recognition of facial emotions in autism: a computer vision approach

Background

Imitation of facial expressions plays an important role in social functioning. However, little is known about the quality of facial imitation in individuals with autism and its relationship with defining difficulties in emotion recognition.

Methods

We investigated imitation and recognition of facial expressions in 37 individuals with autism spectrum conditions and 43 neurotypical controls. Using a novel computer-based face analysis, we measured instructed imitation of facial emotional expressions and related it to emotion recognition abilities.

Results

Individuals with autism imitated facial expressions if instructed to do so, but their imitation was both slower and less precise than that of neurotypical individuals. In both groups, a more precise imitation scaled positively with participants’ accuracy of emotion recognition.

Limitations

Given the study’s focus on adults with autism without intellectual impairment, it is unclear whether the results generalize to children with autism or individuals with intellectual disability. Further, the new automated facial analysis, despite being less intrusive than electromyography, might be less sensitive.

Conclusions

Group differences in emotion recognition, imitation and their interrelationships highlight potential for treatment of social interaction problems in individuals with autism.

Exploring Influences on Theory of Mind Impairment in Opioid Dependent Patients

Theory of mind (ToM) is an aspect of social cognition impaired in different addictive disorders, including opioid addiction. This study aimed at replicating ToM deficits in opioid dependent patients undergoing opioid maintenance treatment (OMT) and exploring the influence of substance use related variables, executive functions and childhood maltreatment on ToM in opioid dependent patients. 66 opioid dependent patients were tested using the Movie for Assessment of Social Cognition (MASC) and compared with the data of healthy controls. Furthermore, the opioid dependent patients underwent testing for executive functions and filled in the Childhood Trauma Questionnaire (CTQ). Performance on the MASC was significantly poorer in the opioid dependence group than in the control group, even when recent additional drug use and psychiatric comorbidities were controlled for. No correlations were found between ToM and substance use related factors. Aspects of ToM performance in opioid dependent patients correlated significantly with different EF domains. ToM correlated significantly with the CTQ scales for physical maltreatment. The results confirm impaired ToM in opioid dependent patients and highlight executive functions and childhood maltreatment as influential factors. The lack of associations between ToM and substance use related variables and the association with childhood maltreatment suggest that ToM impairments might be a risk factor predating substance abuse.

Distance to the Neutral Face Predicts Arousal Ratings of Dynamic Facial Expressions in Individuals With and Without Autism Spectrum Disorder

Arousal is one of the dimensions of core affect and frequently used to describe experienced or observed emotional states. While arousal ratings of facial expressions are collected in many studies it is not well understood how arousal is displayed in or interpreted from facial expressions. In the context of socioemotional disorders such as Autism Spectrum Disorder, this poses the question of a differential use of facial information for arousal perception. In this study, we demonstrate how automated face-tracking tools can be used to extract predictors of arousal judgments. We find moderate to strong correlations among all measures of static information on one hand and all measures of dynamic information on the other. Based on these results, we tested two measures, average distance to the neutral face and average facial movement speed, within and between neurotypical individuals (N = 401) and individuals with autism (N = 19). Distance to the neutral face was predictive of arousal in both groups. Lower mean arousal ratings were found for the autistic group, but no difference in correlation of the measures and arousal ratings could be found between groups. Results were replicated in an high autistic traits group. The findings suggest a qualitatively similar perception of arousal for individuals with and without autism. No correlations between valence ratings and any of the measures could be found, emphasizing the specificity of our tested measures. Distance and speed predictors share variability and thus speed should not be discarded as a predictor of arousal ratings.

Social cognition in adolescent females with borderline personality traits

OBJECTIVES

Social cognitive impairment is considered to be a psychopathological cornerstone in adolescent females with borderline personality disorder. The aim is to compare the social cognitive performance in adolescent females with borderline personality traits and healthy adolescent females, and to assess the social cognitive performance in relation to the severity of borderline personality features.

DESIGN

A case-control study was conducted on 30 adolescent females who fulfilled the diagnostic criteria of DSM-IV of borderline personality traits, compared to 30 matched healthy volunteer adolescent females.

METHODS

Borderline Personality Questionnaire (BPQ) was used to rate borderline personality features. Reading the Mind in the Eyes test (RMET) and Movie for the Assessment of Social Cognition (MASC) were applied to assess social cognitive abilities.

RESULTS

The scores of RMET and some domains of MASC showed a highly significant difference between the patient and control groups. Scores of RMET and some domains of MASC showed significant correlation with impulsiveness, emptiness, relationship patterns, and quasi-psychotic states subscales of BPQ.

CONCLUSIONS

Adolescent females with borderline personality traits had lower social cognitive performance compared to healthy adolescent females. The intensity of this social cognitive deficit was evident to be related to impulsivity, emptiness, pattern of relationships, and quasi-psychotic states.

Understanding versus feeling the emotions of others: How persistent and recurrent depression affect empathy

Empathy refers to the ability to understand the emotions of others. It encompasses a cognitive component of decoding a mental state, and an affective component that relates to an emotional response. Deficits in empathy have been associated with social dysfunction in depression. It is further assumed that impairments are aggravated when depression takes a chronic course. Existing evidence in the literature, however, is scarce and heterogeneous. The present study investigated empathy in patients with persistent and recurrent depression as well as in healthy controls (N = 102). Empathy measurements included both self-report (Interpersonal Reactivity Index, IRI) as well as a laboratory task (Multifaceted Empathy Task, MET). A mixed model analyses of covariance, which accounted for differences in executive functioning, found no evidence for impaired cognitive empathy in depression. All three groups performed equally well in understanding mental states. However, both IRI and MET confirmed the hypothesis of significant deficits in affective empathy. Patients reported higher personal distress than controls, and showed lower affective responses towards positive emotions in others. There was no difference between patient groups. Childhood maltreatment was further related to reduced affective empathy. The present results contribute to our understanding of social dysfunction in depression, since loss of emotional reactivity to the feelings of others is considered to reduce the desire to engage in social interaction, thus leading to isolation and aggravation of depression.

Neurobiological mechanisms of social cognition treatment in high-functioning adults with autism spectrum disorder

BACKGROUND

The promise of precision medicine for autism spectrum disorder (ASD) hinges on developing neuroscience-informed individualized interventions. Taking an important step in this direction, we investigated neuroplasticity in response to an ecologically-valid, computer-based social-cognitive training (SCOTT).

METHODS

In an active control group design, 48 adults with ASD were randomly assigned to a 3-month SCOTT or non-social computer training. Participants completed behavioral tasks, a functional and structural magnetic resonance imaging session before and after the training period.

RESULTS

The SCOTT group showed social-cognitive improvements on close and distant generalization tasks. The improvements scaled with reductions in functional activity and increases in cortical thickness in prefrontal regions.

CONCLUSION

In sum, we provide evidence for the sensitivity of neuroscientific methods to reflect training-induced social-cognitive improvements in adults with ASD. These results encourage the use of neuroimaging data to describe and quantify treatment-related changes more broadly.

The Influence of Reward on Facial Mimicry: No Evidence for a Significant Effect of Oxytocin

Recent findings suggest a role of oxytocin on the tendency to spontaneously mimic the emotional facial expressions of others. Oxytocin-related increases of facial mimicry, however, seem to be dependent on contextual factors. Given previous literature showing that people preferentially mimic emotional expressions of individuals associated with high (vs. low) rewards, we examined whether the reward value of the mimicked agent is one factor influencing the oxytocin effects on facial mimicry. To test this hypothesis, 60 male adults received 24 IU of either intranasal oxytocin or placebo in a double-blind, between-subject experiment. Next, the value of male neutral faces was manipulated using an associative learning task with monetary rewards. After the reward associations were learned, participants watched videos of the same faces displaying happy and angry expressions. Facial reactions to the emotional expressions were measured with electromyography. We found that participants judged as more pleasant the face identities associated with high reward values than with low reward values. However, happy expressions by low rewarding faces were more spontaneously mimicked than high rewarding faces. Contrary to our expectations, we did not find a significant direct effect of intranasal oxytocin on facial mimicry, nor on the reward-driven modulation of mimicry. Our results support the notion that mimicry is a complex process that depends on contextual factors, but failed to provide conclusive evidence of a role of oxytocin on the modulation of facial mimicry.

Distinct Functional Connectivity Signatures of Impaired Social Cognition in Multiple Sclerosis

Objective: Multiple sclerosis (MS) is characterized by impairments in basic cognitive functions such as information processing speed as well as in more complex, higher-order domains such as social cognition. However, as these deficits often co-occur, it has remained challenging to determine whether they have a specific pathological basis or are driven by shared biology.

Methods: To identify neural signatures of social cognition deficits in MS, data were analyzed from n = 29 patients with relapsing–remitting MS and n = 29 healthy controls matched for age, sex, and education. We used neuropsychological assessments of information processing speed, attention, learning, working memory, and relevant aspects of social cognition (theory of mind, emotion recognition (ER), empathy) and employed neuroimaging of CNS networks using resting-state functional connectivity.

Results: MS patients showed significant deficits in verbal learning and memory, as well as implicit ER. Performance in these domains was uncorrelated. Functional connectivity analysis identified a distinct network characterized by significant associations between poorer ER and lower connectivity of the fusiform gyrus (FFG) with the right lateral occipital cortex, which also showed lower connectivity in patients compared to controls. Moreover, while ER was correlated with MS symptoms such as fatigue and motor/sensory functioning on a behavioral level, FFG connectivity signatures of social cognition deficits showed no overlap with these symptoms.

Conclusions: Our analyses identify distinct functional connectivity signatures of social cognition deficits in MS, indicating that these alterations may occur independently from those in other neuropsychological functions.

Characterizing Couple Dysfunction in Borderline Personality Disorder

Relationship dysfunction is a key criterion of borderline personality disorder (BPD). Nevertheless, little is known about the characteristics of romantic relationship functioning in BPD. In this study, couples in which the women were diagnosed with BPD (BPD couples) and healthy control couples (HC) were compared in their perceived relationship characteristics (e.g., relationship quality) and interpersonal experience variables (e.g., attachment). The hypothesis was tested that insecure attachment styles account for group differences in relationship characteristics. Variables were measured by self-report. Romantic relationships were appraised as more negative and conflictual by both members of BPD couples compared to HC. The perception of women with BPD was often more negative than that of their male partners, indicating potential biases in BPD patients' relationship evaluation. Insecure attachment styles only partially explained group differences in relationship characteristics, showing that attachment style is one, but not the only predictor of decreased relationship functioning in BPD couples.

Affective states influence emotion perception: evidence for emotional egocentricity

Research in social cognition has shown that our own emotional experiences are an important source of information to understand what other people are feeling. The current study investigated whether individuals project their own affective states when reading other's emotional expressions. We used brief autobiographical recall and audiovisual stimuli to induce happy, neutral and sad transient states. After each emotion induction, participants made emotion judgments about ambiguous faces displaying a mixture of happiness and sadness. Using an adaptive psychophysics procedure, we estimated the tendency to perceive the faces as happy under each of the induced affective states. Results demonstrate the occurrence of egocentric projections, such that faces were more likely judged as happy when participants reported being happy as compared to when they were sad. Moreover, the degree of emotional egocentricity was associated with individual differences in perspective-taking, with smaller biases being observed in individuals with higher disposition to take the perspective of others. Our findings extend previous literature on emotional egocentricity by showing that self-projection occurs when we make emotion attributions based on the other's emotional expressions, and supports the notion that perspective-taking tendencies play a role in the ability to understand the other's affective states.

Towards the automatic detection of social biomarkers in autism spectrum disorder: introducing the simulated interaction task (SIT)

Social interaction deficits are evident in many psychiatric conditions and specifically in autism spectrum disorder (ASD), but hard to assess objectively. We present a digital tool to automatically quantify biomarkers of social interaction deficits: the simulated interaction task (SIT), which entails a standardized 7-min simulated dialog via video and the automated analysis of facial expressions, gaze behavior, and voice characteristics. In a study with 37 adults with ASD without intellectual disability and 43 healthy controls, we show the potential of the tool as a diagnostic instrument and for better description of ASD-associated social phenotypes. Using machine-learning tools, we detected individuals with ASD with an accuracy of 73%, sensitivity of 67%, and specificity of 79%, based on their facial expressions and vocal characteristics alone. Especially reduced social smiling and facial mimicry as well as a higher voice fundamental frequency and harmony-to-noise-ratio were characteristic for individuals with ASD. The time-effective and cost-effective computer-based analysis outperformed a majority vote and performed equal to clinical expert ratings.

A Multidimensional View on Social and Non-Social Rewards

Social rewards are a broad and heterogeneous set of stimuli including for instance smiling faces, gestures, or praise. They have been widely investigated in cognitive and social neuroscience as well as psychology. Research often contrasts the neural processing of social rewards with non-social ones, with the aim to demonstrate the privileged and unique nature of social rewards or to examine shared neural processing underlying them. However, such comparisons mostly neglect other important dimensions of rewards that are conflated in those types of rewards: primacy, temporal proximity, duration, familiarity, source, tangibility, naturalness, and magnitude. We identify how commonly used rewards in both social and non-social domains may differ in respect to these dimensions and how their interaction calls for careful consideration of alternative interpretations of observed effects. Additionally, we propose potential solutions on how to adapt the multidimensional view to experimental research. Altogether, these methodological considerations aim to inform and improve future experimental designs in research utilizing rewarding stimuli, especially in the social domain.

Developing a Diagnostic Algorithm for the Music-Based Scale for Autism Diagnostics (MUSAD) Assessing Adults with Intellectual Disability

Initial studies have presented the Music-based Scale for Autism Diagnostics (MUSAD) as a promising DSM-5-based observational tool to identify autism spectrum disorder (ASD) in adults with intellectual disability (ID). The current study is the first to address its clinical utility in a new sample of 124 adults with ID (60.5% diagnosed with ASD). The derived diagnostic algorithm differentiated well between individuals with and without ASD (sensitivity 79%, specificity 74%, area under the curve = 0.81). Inter-rater reliability, assessed by the scorings of four independent experts in 22 consensus cases, was excellent (ICC = 0.92). Substantial correlations with scores from other ASD-specific measures indicated convergent validity. The MUSAD yields accurate and reliable scores, supporting comprehensive ASD diagnostics in adults with ID.

Impaired empathy but no theory of mind deficits in adult attention deficit hyperactivity disorder

OBJECTIVE

The cognitive capacity to change perspective is referred to as theory of mind (ToM). ToM deficits are detectable in a variety of psychiatric and neurological disorders. Since executive abilities are closely associated with ToM skills, we suspected that due to a common neuropsychological basis, ToM deficits exist in treatment-naïve adults with attention-deficit/hyperactivity disorder (ADHD).

METHODS

Performance of treatment-naïve adults with ADHD (N = 30) in tasks assessing executive functions (Trail Making Test, Stroop color-word test, and Test Battery for Attentional Performance), empathy skills (Cambridge Behaviour Scale), and ToM (Movie for Assessment of Social Cognition) was compared with that of a healthy control group (N = 30) matched according to basic demographic variables.

RESULTS

Compared to healthy controls, treatment-naïve adults with ADHD showed deficits in various executive functions and the ability to empathize (all p < .05). However, no performance differences were found with regard to ToM (all n.s.).

CONCLUSIONS

Since studies in juveniles with ADHD often show impaired ToM performance, it is conceivable that ToM deficits may become attenuated due to neuronal development in adolescence. Furthermore, our findings imply that ToM impairments, even when present in adult ADHD, appear to be independent of executive deficits and might be explained by comorbid disorders.

Visual and Proprioceptive Influences on Tactile Spatial Processing in Adults with Autism Spectrum Disorders

Children with autism spectrum disorders (ASDs) often exhibit altered representations of the external world. Consistently, when localizing touch, children with ASDs were less influenced than their peers by changes of the stimulated limb's location in external space [Wada et al., Scientific Reports 2015, 4(1), 5985]. However, given the protracted development of an external-spatial dominance in tactile processing in typically developing children, this difference might reflect a developmental delay rather than a set suppression of external space in ASDs. Here, adults with ASDs and matched control-participants completed (a) the tactile temporal order judgment (TOJ) task previously used to test external-spatial representation of touch in children with ASDs and (b) a tactile-visual cross-modal congruency (CC) task which assesses benefits of task-irrelevant visual stimuli on tactile localization in external space. In both experiments, participants localized tactile stimuli to the fingers of each hand, while holding their hands either crossed or uncrossed. Performance differences between hand postures reflect the influence of external-spatial codes. In both groups, tactile TOJ-performance markedly decreased when participants crossed their hands and CC-effects were especially large if the visual stimulus was presented at the same side of external space as the task-relevant touch. The absence of group differences was statistically confirmed using Bayesian statistical modeling: adults with ASDs weighted external-spatial codes comparable to typically developed adults during tactile and visual-tactile spatio-temporal tasks. Thus, atypicalities in the spatial coding of touch for children with ASDs appear to reflect a developmental delay rather than a stable characteristic of ASD. Autism Res 2019, 12: 1745-1757. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: A touched limb's location can be described twofold, with respect to the body (right hand) or the external world (right side). Children and adolescents with autism spectrum disorder (ASD) reportedly rely less than their peers on the external world. Here, adults with and without ASDs completed two tactile localization tasks. Both groups relied to the same degree on external world locations. This opens the possibility that the tendency to relate touch to the external world is typical in individuals with ASDs but emerges with a delay.