Labelling Facial Affect in Context in Adults with and without TBI

Turkstra, L., S. G. Kraning, S. K. Riedeman, B. Mutlu, M. Duff, and S. VanDenHeuvel. “Labelling Facial Affect in Context in Adults With and Without TBI”. Brain Impairment, 2017, pp. 49-61.


Several studies have documented impaired affect recognition in adults with moderate or severe TBI (Babbage et al., 2011; Bornhofen & McDonald, 2008a; Rosenberg, McDonald, Dethier, Kessels, & Westbrook, 2014). Affect recognition impairments have been found to have a negative effect on the rehabilitation of other cognitive functions, such as executive functions (Spikman et al., 2013); may negatively affect post-rehabilitation social life (Bornhofen & McDonald, 2008a; Radice-Neumann, Zupan, Babbage, & Willer, 2007); and may be treatable (Bornhofen & McDonald, 2008b; Neumann, Babbage, Zupan, & Willer, 2015; Statucka & Walder, 2013). Thus, evaluation of affect recognition is an important element of neurorehabilitation.

Most studies of affect recognition ask respondents to label expressions of emotions on faces in isolation. While experiments using isolated faces have provided rich information on emotion processing in typical children and adults and revealed deficits in patients with TBI (Croker & McDonald, 2005; Neumann, Zupan, Malec, & Hammond, 2014; Rigon, Turkstra, Mutlu, & Duff, 2016; Rosenberg et al., 2014; Schmidt, Hanten, Li, Orsten, & Levin, 2010; Tonks, Williams, Frampton, Yates, & Slater, 2007; Watts & Douglas, 2006; Williams & Wood, 2010b; Zupan & Neumann, 2014), faces alone do not capture the rich visual, cultural, and social contexts in which we interpret affective displays in everyday life (Barrett, Mesquita, & Gendron, 2011). Context is important to consider because tests using faces alone may overestimate everyday performance (e.g., if in real life, an individual tends to be distracted by context cues) or underestimate it (e.g., when affect is ambiguous, and real-world context cues add useful information). There is evidence that context exerts a strong influence on recognition and interpretation of affect when that context is visual, as when a face is superimposed on a complex scene (de Gelder et al., 2006); verbal, as when faces are presented after written comments (Schwarz, Wieser, Gerdes, Muhlberger, & Pauli, 2013); or social, such as faces presented with other faces in the periphery that vary in affect (Mumenthaler & Sander, 2012). To date, studies of emotion in context have used artificially constructed stimuli (e.g., a face superimposed on a photograph of a scene). The ecological validity of artificially constructed stimuli, and hence their clinical utility, is questionable because the images generally are unlike faces and scenes one might encounter in everyday life. An alternative may be to use photographs of natural scenes that include people with different emotional expressions, which may more closely approximate what is actually encountered in everyday life.

In addition to using everyday scenes, allowing respondents to state what they see rather than choosing from amongst a limited set of options may allow us to capture subtler variations in emotion and capture richer descriptions of recognised emotion. Most affect recognition studies to date have constrained response options to the six ‘basic’ emotions characterised by Ekman (1992): happy, sad, angry, disgusted, afraid, and surprised. These emotions are thought to be universal across ages and cultures, and identifiable by facial configuration cues (Ekman, 1992; Russell, 1994). Whilst studies of basic emotion recognition have been informative, in real-life contexts, we may be more likely to interpret affect cues as reflecting more than just basic emotions. For example, some affective displays can be interpreted as reflecting social emotions that are interpretable only in the context of social information, including information in the social context and interactions with others as well as inferences about others’ mental states (i.e., Theory of Mind; Adolphs, Baron-Cohen, & Tranel, 2002; Buck, 1988). Interpretations that reference context and mental states are evidence of the inherent human desire to attribute agency to others (and even to inanimate objects) (Brune, 2001), and thus may be a core feature of human social interaction.

Social emotions can be negative, such as guilt and despair; or positive, such as admirationand pride (Tamietto, Adenzato, Geminiani, & de Gelder, 2007). Social and basic emotions have different developmental trajectories (Klapwijk et al., 2013) and may decline disproportionately with age (Rakoczy, Harder-Kasten, & Sturm, 2012). There also is some evidence that they are differentially impaired in some clinical populations, including schizophrenia (Bora, Eryavuz, Kayahan, Sungu, & Veznedaroglu, 2006), epilepsy (Broicher et al., 2012), multiple sclerosis (Charvet et al., 2014), and Huntington’s Disease (Eddy, Sira Mahalingappa, & Rickards, 2012). Whilst the term ‘social emotions’ has not been used often in the TBI literature, there is strong evidence of impairments recognising ‘complex emotions’ that involve Theory of Mind and can be characterised as social (e.g., sarcasm) (Channon, Pellijeff, & Rule, 2005; Martin & McDonald, 2005; McDonald, 1992, 2000; McDonald et al., 2013; McDonald & Flanagan, 2004; Turkstra, McDonald, & Kaufmann, 1996). Thus, we may be better able to characterise affect recognition in adults with TBI if we consider not only basic emotions but also social emotions.

Another way to gain a more nuanced understanding of affect recognition is to consider cognitive-state terms, defined as terms referring to what a person is thinking rather than feeling (e.g., cautious, insincere, knowledgeable) (Adrian, Clemente, Villanueva, & Rieffe, 2005). Cognitive-state terms have a different developmental trajectory from either basic or social emotion terms (Bretherton & Beeghly, 1982), and also may be differentially impaired in adults with TBI. For example, Byom & Turkstra (2012) found that typical adults used more emotional terms and fewer cognitive-state terms as topic intimacy increased, whereas adults with TBI did not. Examining each of these three characterisations of emotion – basic emotions, social emotions, and cognitive-state terms – can inform both our understanding of affect recognition in individuals with TBI and also our approach to assessment and intervention.

In summary, tasks using isolated faces and basic emotion choices may give an incomplete account of what respondents are actually thinking when they see a facial expression in everyday life. This limitation has major implications both for our understanding of affect recognition in the real world and for clinical management. As a first step in developing methods to evaluate everyday affect recognition in individuals with TBI, we conducted two studies. First, we asked a group of undergraduate students to label photographs of faces in context or in isolation, using an open-response format (Study 1). We hypothesised that students would be more likely to use basic emotion labels when they saw faces alone, and social emotion labels than when they saw faces embedded in visual scenes. Second, to explore the clinical utility of using context-based, open-ended tasks, we administered the same stimuli to a pilot sample of young adults with TBI (Study 2) and scored their responses using a coding scheme developed from Study I data. As the pilot study was exploratory, we had no specific hypothesis, although the previously cited evidence of impaired affect recognition and Theory of Mind suggested that responses of adults with TBI would differ qualitatively from those of healthy comparison adults (e.g., might not be classifiable using the categories from Study 1).

DOI: 10.1017/brimp.2016.29


	doi = {10.1017/brimp.2016.29},
	url = {},
	year = 2016,
	month = {dec},
	publisher = {Cambridge University Press ({CUP})},
	volume = {18},
	number = {1},
	pages = {49--61},
	author = {Lyn S. Turkstra and Sarah G. Kraning and Sarah K. Riedeman and Bilge Mutlu and Melissa Duff and Sara VanDenHeuvel},
	title = {Labelling Facial Affect in Context in Adults with and without {TBI}},
	journal = {Brain Impairment}