Affect recognition training after traumatic brain injury : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand

Abstract

Impairment in facial affect recognition is prevalent after moderate to severe traumatic brain injury (TBI), and may underlie some problems in social functioning. Tentative work indicates that emotion recognition can improve with training, but the effectiveness of these programmes remains unclear. Little is known about whether broader cognitive deficits underlie facial affect recognition impairment. Less is known about baseline cognitive variables that predict treatment response and the relationship between changes in cognitive functioning and improvement in facial affect recognition after treatment. The present research formed part of a multi-centre randomised controlled trial examining the efficacy of two affect recognition training programmes designed to improve emotion recognition in adults with moderate to severe TBI. Study One reports outcome data from the main trial. Seventy people with TBI and facial affect recognition difficulties were randomly assigned to nine sessions of one of three treatments: Faces, focusing on facial affect recognition, Stories, determining emotions from social context, and a control group. Participants completed tests assessing cognition, emotion recognition, community integration, interpersonal behaviour and empathy, and informants completed interpersonal and social functioning measures. Participants were assessed five times: initial screening, pre- and post-treatment, and at three- and six-month follow-up. Significant improvement was seen in the Faces group on the primary facial affect recognition outcome measure (DANVA2-Adult Faces). These gains were sustained at six months. No significant differences between treatment groups and the control group were found on interpersonal and social functioning measures. Study Two had 75 participants with facial affect recognition difficulties and investigated the relationship between facial affect recognition impairment and cognitive functioning. Greater facial affect recognition failures were related particularly to working memory, processing speed, and nonverbal memory. No relationship was found with executive functioning. Study Three explored the relationship between baseline cognitive variables, changes in cognitive functioning, and long term treatment response. Only older age was predictive of a better long-term response to Faces treatment. Improvement of facial affect recognition was not mediated by changes in cognitive functioning. This research provides further evidence that retraining is possible for affect recognition difficulties after traumatic brain injury.