Visual attention to facial features following emotion remediation in schizophrenia

Background: Considerable evidence attests to impaired facial emotion perception in schizophrenia, alongside abnormalities of attention evident in restricted scanning and avoidance of facial features (eyes, nose and mouth). Recent studies have successfully improved social cognition in schizophrenia with the use of targeted remediation techniques. In this study, we used a computer-based microexpression training tool (METT; Ekman, 2003) with concurrent assessment of eye movements to investigate changes in visual attention to faces following emotion remediation in schizophrenia. Methods: Twenty-six participants with schizophrenia were exposed to active training using the METT, while 14 were assigned to a repeated-exposure group. Training comprised video clips with verbal commentary detailing the difference between frequently confused emotions and directing attention to relevant facial features, and practice with feedback regarding accuracy. The repeated-exposure group viewed the video clips but were not exposed to the verbal commentary or feedback during practice. Affect recognition and concurrent eye movement recordings were collected preand posttraining in both groups to test the effects of training. Results: Active remediation training improved emotion recognition accuracy, while repeated exposure to visual stimuli did not. Participants who received METT training showed a general increase in attention to feature areas of faces posttraining. For specifi c facial expressions, attention to feature areas increased or decreased according to the instructions given during remediation. Conclusions: Training with the METT improves emotion- processing skills in schizophrenia, while repeated exposure does not. Visual attention to facial features that are important for distinguishing between facial expressions improves with METT remediation.1 pag