The visitor in Barry Willer's office at the University at Buffalo was frustrated and deeply depressed.
The man's wife had sustained a relatively mild traumatic brain injury, and he was doing all he could to support her. But despite his best efforts, the man's wife described him to friends as being "indifferent." He was at his wits' end.
Willer, UB professor of psychiatry and a specialist in traumatic brain injury (TBI), listened to this scenario with great interest. He was pilot testing a computer-based diagnostic and treatment program he and a graduate student had developed for brain-injured adults to help them regain their emotional lives.
Willer had the man's wife take the test, which requires participants to view photos of faces expressing a variety of emotions and then name each emotion.
Persons with no brain injury easily can distinguish frightened from annoyed, or disappointed from gleeful. But when a sad, or angry, or surprised face appeared on the screen, the man's wife saw only "indifferent."
It was eye-opening for the man and his wife and a rewarding moment for Willer. "His wife didn't know she wasn't recognizing his emotions," Willer recounts, "and he had no idea what was going on."
Interpreting and expressing emotion are defining characteristics of being human. The psychiatric rehabilitation community confirmed in recent years that as many as 50 percent of TBI patients had lost this ability. In the past, people with TBI who reacted inappropriately, such as joking at a funeral, or didn't react at all, were considered to have behavior problems. This capacity to understand and respond to emotions now is known as affect recognition.
Based on his promising pilot-study results, Willer has received a $600,000 grant from the National Institute on Disability and Rehabilitation Research (NIDDR) to carry out a three-year controlled trial of his affect recognition training program. It is the first structured intervention designed to treat this disability among those with brain injury.
Recruitment currently is underway at the Carolinas Healthcare System in Charlotte, N.C., Brock University in St. Catherines, Ont., and Massey University in Wellington, New Zealand. Willer and his co-primary investigator, Machiko Tomita, Ph.D., clinical associate professor of rehabilitation sciences, are overseeing the three sites.
Willer's interest in affect recognition was inspired by the PBS series "The Secret Life of the Brain." One of the episodes showed a man watching a horrific scene from a "slasher" movie that would make most viewers cringe. But this man simply was puzzled, recounts Willer, because he couldn't produce the fear emotion and therefore did not understand what was happening. "I was watching that and I thought, 'My gosh! I see that all the time in brain injury."
That television program on the brain set the wheels of Willer's research group in motion. No one had yet developed a program to treat affect recognition. Working with graduate students Barbra Zupan and Dawn Neumann, Willer took two interventions shown to be successful in helping autistic children recognize emotions, modified them to be appropriate for adults with brain injury and tested them in the pilot study.
These interventions, which now are being tested in the three-year trial, are titled "facial affect recognition" (FAR), and "stories of emotional inference" (SEI). Tim Bleiler, an instructional designer in the UB medical school, has put both interventions into a single piece of software ready for the multi-site trial. The new investigation will randomize 108 participants with TBI into one of these two groups or to a control training group (CTG).
Participations in the FAR group, as the facial-affect-recognition name implies, will focus on specific elements of the face. "The research suggests that the majority of the information we gather about somebody else's emotional state is based on their facial expression," said Willer. "We gather a little from the voice, we gather a little from body language, but the majority comes from the face."
FAR participants will view faces on a computer screen equipped with cues that direct them to concentrate on specific elements of each face… "Look at the eyes. What are the eyes doing? What is the mouth doing?" …and asks them to name the emotion.
"To know what the other person is feeling," noted Willer, "You have to know what you're feeling. Individuals who don't know how to recognize anger won't recognize it in themselves, and in fact can't produce it. If you hold a mirror in front of them and say, 'Show me an angry face,' it's really interesting to watch them moving their face around and trying to come up with an angry face, and they can't."