What are the CANTAB social cognition tasks?
On the face of it, ERT and EBT appear analogous as they both assess a participant’s ability to recognize emotion in facial expressions. In both tasks, an image of a face appears for a very short period of time and then participants must select which emotion the face was conveying. The fundamental difference between the two tasks is that ERT requires participants to select between six basic emotions whereas EBT involves a decision between two emotions.
Consequently, ERT is able to detect deficits in the ability to identify a range of emotional facial expressions at different intensities, with the key measurement being accuracy of emotion perception. By limiting the choice to two possible emotions, EBT is able to detect specific biases in emotion perception, using the bias point, i.e. the point at which their perception switches from one emotion to the other, as the key measure.
How have researchers used ERT?
Using ERT in schizophrenia
Difficulty in the perception of emotions is a widely recognised feature of schizophrenia, and likely contributes to deficits in social cognition that are often present before the onset of psychosis.
In patients with treatment-resistant schizophrenia, the number of facial expressions correctly identified in ERT was significantly correlated with their global functioning (GAF score; rho=0.65) (Gica et al., 2019). ERT performance also showed no change over a six-month period, demonstrating that this is a stable deficit in patients.
In support of the idea that emotion deficits contribute to social deficits in schizophrenia, emotion recognition accuracy and latency were shown to be significantly impaired in participants at ultra-high risk of psychosis compared with healthy controls (Glenthøj et al., 2018). Recognition of anger, disgust and fear were significantly worse in the ultra-high risk participants, suggesting that detection of negative emotions is a key deficit associated with schizophrenia risk groups.
Using ERT in autism spectrum disorder
Part of the diagnostic criteria for autism spectrum disorder is impairment in social interactions and communication, and difficulty identifying the emotions of other people may contribute to these social deficits.
In young people (aged 6-16), participants with autism spectrum disorder were less accurate than controls on ERT (Griffiths et al., 2017). This reduced accuracy in identifying expressions was observed across all emotions and all levels of emotional intensity, demonstrating a global deficit in recognition of all six basic emotions that is not limited to ambiguous expressions.
How have researchers used EBT?
Using EBT in participants with depressive symptoms
A negative perceptual bias has been hypothesised to contribute to the negative mood experienced in depression.
In one study, 193 healthy participants were split into two groups based on depression symptom (BDI) scores: low mood and healthy (Penton-Voak et al., 2012). There was a significant difference in bias point on EBT Happy-Sad between the two groups, suggesting that a negativity bias detected by EBT is associated with depressive symptoms.
A more recent study also explored the relationship between EBT bias point and depressive symptoms (Penton-Voak et al., 2018). A correlation between bias point and depressive symptoms was found, such that a lower bias point, indicating a bias towards identifying sadness, was related to a higher score for depressive symptoms.
Using EBT in other mood disorders
Similar to the sadness bias in depression, increased aggressive behaviour may relate to a bias towards perceiving aggression in facial expressions.
Penton-Voak et al. (2013) reports the results of a series of studies investigating the relationship between emotion perception bias and aggression. Two studies recruited healthy volunteers, and the third included a group of adolescents recruited from a youth program who had a history of aggressive behaviour. In all studies, EBT Happy-Angry was assessed at baseline and follow-up. Those who showed a decrease in state anger at follow-up (assessed by self-report in the healthy groups and observer report in the aggression group) also demonstrated a shift in bias point towards happiness, indicating that EBT bias point is sensitive to this shift in aggression.
Another study used EBT Happy-Angry and compared bias points in youth with disruptive mood dysregulation disorder (DMDD) to healthy youth (Stoddard et al., 2016). DMDD participants had a lower bias point than control youths, demonstrating a tendency towards perceiving anger in these participants who exhibit severe temper outbursts.
When to use EBT or ERT?
In conclusion, EBT and ERT measure slightly different aspects of social cognition. Therefore, the choice of task is dependant primarily on the population group and hypothesis of the study: if global emotion detection is of interest, usually in groups where social interaction is impaired, ERT would be best, whilst the tendency to perceive one specific emotion over another in mood-related disorders is best assessed using EBT.
Want to find out whether to use ERT or EBT for your study?
Attwood, A.S, Easey, K.E., Dalili, M.N., Skinner, A.L., Woods, A., Crick, L., Ilett, E., Penton-Voak, I.S. & Munafò, M.R. (2017) State anxiety and emotional face recognition in healthy volunteers. Royal Society Open Science; 4(5):160855. http://dx.doi.org/10.1098/rsos.160855
Gica, S., Poyraz, B.C. & Gulec, H. (2019) Are emotion recognition deficits in patients with schizophrenia states or traits? A 6-month follow-up study. Indian Journal of Psychiatry; 61(1):45-52. http://dx.doi.org/10.4103/psychiatry.IndianJPsychiatry_307_18
Glenthøj, L.B., Fagerland, B., Hjorthøj, C., Jepsen, J.R.M., Bak, N., Kristensen, T.D., Wenneberg, C., Krakauer, K., Roberts, D.L. & Nordentoft, M. (2016) Social cognition in patients at ultra-high risk for psychosis: What is the relation to social skills and functioning? Schizophrenia Research: Cognition; 5:21-27. https://dx.doi.org/10.1016/j.sccog.2016.06.004
Griffiths, S., Jarrold, C., Penton-Voak. I.S., Woods, A.T., Skinner, A.L. & Munafò M.R. (2019) Impaired Recognition of Basic Emotions from Facial Expressions in Young People with Autism Spectrum Disorder: Assessing the Importance of Expression Intensity. Journal of Autism and Developmental Disorders; 49(7):2768-2778. https://doi.org/10.1007/s10803-017-3091-7
Penton-Voak, I.S., Adams, S., Button, K.S., Fluharty, M., Dalili, M., Browning, M., Holmes, E., Harmer, C. & Munafò, M.R. (2018) Emotional recognition training modifies neural response to emotional faces but does not improve mood in healthy volunteers with high levels of depressive symptoms. bioRxiv; 335042. https://dx.doi.org/10.1101/335042
Penton-Voak, I.S., Bate, H., Lewis, G. & Munafò, M.R. (2012) Effects of emotion perception training on mood in undergraduate students: Randomised controlled trial. The British Journal of Psychiatry; 201(1):71-72. https://doi.org/10.1192/bjp.bp.111.107086
Penton-Voak, I.S., Thomas, J., Gage, S.H., McMurran, M., McDonald, S., & Munafò, M.R. (2013) Increasing Recognition of Happiness in Ambiguous Facial Expressions Reduces Anger and Aggressive Behaviour. Psychological Science; 24(5):688-697. https://doi.org/10.1177/0956797612459657
Stoddard, J., Sharif-Askary B., Harkins, E.A., Frank, H.R., Brotman, M.A., Penton-Voak. I.S., Maoz, K., Bar-Haim, Y., Munafò , M., Pine, D.S. & Leibenluft, E. (2016) An Open Pilot Study of Training Hostile Interpretation Bias to Treat Disruptive Mood Dysregulation Disorder. Journal of Child and Adolescent Psychopharmacology; 26(1):49-57. https://doi.org/10.1089/cap.2015.0100
Millie Lowther and Rachel Lee