Remediation of facial emotion perception in schizophrenia: concomitant changes in visual attention

The study examined changes in visual attention in schizophrenia following training with a social-cognitive remediation package designed to improve facial emotion recognition (the Micro-Expression Training Tool; METT). Forty out-patients with schizophrenia were randomly allocated to active training (METT; n=26), or repeated exposure (RE; n=14); all completed an emotion recognition task with concurrent eye movement recording. Emotion recognition accuracy was significantly improved in the METT group, and this effect was maintained after one week. Immediately following training, the METT group directed more eye movements within feature areas of faces (i.e., eyes, nose, mouth) compared to the RE group. The number of fixations directed to feature areas of faces was positively associated with emotion recognition accuracy prior to training. After one week, the differences between METT and RE groups in viewing feature areas of faces were reduced to trends. However, within group analyses of the METT group revealed significantly increased number of fixations to, and dwell time within, feature areas following training which were maintained after one week. These results provide the first evidence that improvements in emotion recognition following METT training are associated with changes in visual attention to the feature areas of emotional faces. These findings support the contribution of visual attention abnormalities to emotion recognition impairment in schizophrenia, and suggest that one mechanism for improving emotion recognition involves re-directing visual attention to relevant features of emotional faces.