Behavioral Training May Help MS Patients Recognize Facial Expressions

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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An intervention that involves training to recognize facial expressions, and also mimicking these expressions, may help people with multiple sclerosis (MS) who have trouble recognizing facial affect, according to data from a small clinical trial.

These findings were reported in the study “Emotional processing intervention (EMOPRINT): A blinded randomized control trial to treat facial affect recognition deficits in multiple sclerosis,” which was published in the journal Multiple Sclerosis and Related Disorders.

MS can cause cognitive problems, including difficulty with social cognition — the processes the brain uses to recognize social cues, such as facial expressions. Consequently, people with MS may experience trouble recognizing facial affects and identifying the emotions of others, which can cause difficulties in interpersonal interactions.

“Improving facial recognition may improve interpersonal relationships and lead to better outcomes at home and in the workplace,” Helen Genova, PhD, the study’s first author and associate director of the Center for Autism Research at the Kessler Foundation, said in a press release.

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The Kessler Foundation sponsored a clinical trial called EMOPRINT (NCT03373344) to test an intervention that aims to improve facial affect recognition in MS patients.

In the trial, 21 people with MS underwent an intervention to improve facial affect recognition. During sessions, participants would be given specific instructions and tasks related to identifying expressions — for example, sorting pictures of faces by expression — and also perform mimicry, where they would be shown an expression and asked to emulate it themselves. Participants undertook 12 sessions, each lasting 30 to 60 minutes, twice per week over five weeks.

The intervention “is focused on improving facial affect recognition via two sets of skills: identifying prototypical facial gestures associated with six universal emotions and using mimicry as a way to increase awareness of emotional experiences in oneself and others,” the researchers wrote.

Another 15 trial participants underwent a placebo intervention involving tasks unrelated to recognizing emotions, for instance, sorting pictures of faces by age, or writing while looking in a mirror. Both groups were predominantly female, with a mean age of around 53 years.

Before and after the intervention, participants’ ability to recognize different emotions was tested with a simple assessment: they were shown a face on a computer screen portraying one of six emotions (happy, sad, afraid, surprised, angry, or ashamed), and asked to identify the feeling being expressed.

Prior to the intervention, both groups showed no difference in their ability to recognize emotions. Afterwards, however, participants given the active intervention were significantly better at identifying expressions than those receiving the placebo intervention.

Assessments of memory, life quality, and emotional functioning did not differ between the groups before or after the intervention.

“Participants randomized to the intervention showed marked improvements in facial affect recognition ability … following the intervention compared to those in the control group,” the researchers wrote.

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All participants in the intervention group filled out a questionnaire about their experiences, though three of the responses were lost due to a filing error. On the remaining 18 questionnaires, all but one study participant reported finding the intervention to be helpful in general, and 14 (77.8%) said they use the skills they had learned in the intervention while interacting with other people in their day-to-day lives.

The researchers noted the study is limited by its small sample size, but stressed the findings support further research into interventions that may help people with MS participate more meaningfully in interpersonal interactions.

“The success of EMOPRINT in this MS study is an important first step toward the larger-scale, longer-term studies of social cognition we need to study these potential effects,” said Genova.

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