Emotion Recognition Training in Antisocial Violent Offenders With Psychopathic Traits

Impaired recognition of affective facial expressions has been conclusively linked to antisocial and psychopathy. However, little is known about the modifiability of this deficit. This study aims to investigate whether and under which circumstances the proposed perceptual insensitivity can be addressed with a brief implicit training approach.

Study Overview

• Status: Unknown
• Conditions: Violent Aggressive Behavior; Psychopathy; Emotional Problem
• Intervention / Treatment: Behavioral: SEE Training; Behavioral: GAZE Training

• Study Type: Interventional
• Enrollment (Anticipated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Michael Schönenberg, PhD; Phone Number: 004970712978355; Email: michael.schoenenberg@uni-tuebingen.de
• Study Contact Backup: Name: Martin Hautzinger, Prof.

Study Locations

• Germany
  • Baden Würrtemberg
    • Tübingen, Baden Würrtemberg, Germany, 72074
      • Recruiting
      • University of Tubingen
      • Contact: Michael Schönenberg, PhD; Phone Number: 004970712978355; Email: michael.schoenenberg@uni-tuebingen.de

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• Confirmed ASPD diagnosis
• PCL-Score available
• arrested for committing violent crimes

Exclusion Criteria:

• Insufficient knowledge of the German language
• Diagnosed with schizophrenia
• Substance abuse
• Neurological disease (e.g. epilepsy)
• Mental retardation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: SEE Training; The training sequence comprises four weekly sessions using a modified dote-probe paradigm (fearful vs. neutral expression).	Behavioral: SEE Training; Participants are first presented with a fixation cross which indicates the beginning of a trial and is immediately followed by a bilateral presentation of a neutral and a fearful image (face) of the same model identity. The fearful expression is always replaced by an arrow pointing to the left or the right which remaines active until the participant indicates via button-press which direction the arrow is pointing to. The model identity, the position of the fearful cue and the arrow probe direction are pseudo-randomized across trials with no more than three identical sequential occurrences on each parameter. Each session consists of 360 trials in total, with 120 distinct trial types and three repetitions. Participants are trained with neutral and 75% fearful expressions only in the first session; the intensity of the fearful cue is successively decreased by 15% at every subsequent session.
Active Comparator: GAZE Training; The GAZE training sequence comprises four weekly sessions using a modified dote-probe paradigm (averted vs. directed gaze).	Behavioral: GAZE Training; Participants are first presented with a fixation cross, which indicates the beginning of a trial and is immediately followed by a bilateral presentation of a direct gaze-image (neutral face) and an image of a neutral face (same model identity) displaying deviated gaze. The averted gaze-face is always replaced by an arrow pointing to the left or the right which remaines active until the participant indicates via button-press which direction the arrow is pointing to. The model identity, the position of the fearful cue and the arrow probe direction are pseudo-randomized across trials with no more than three identical sequential occurrences on each parameter. Each session consists of 360 trials in total, with 120 distinct trial types and three repetitions. Participants are trained with direct and 100% averted gaze images only in the first session; the intensity of the deviated gaze cue is successively decreased by 20% at every subsequent session.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Animated morph task	Morphed images are presented, beginning with the neutral face that progresses into one of the six affective expressions. This procedure creates the impression of an animated clip depicting the development of facial emotive expressions. Participants are instructed to press a button as soon as they are able to identify the emerging expression.	change from pre-treatment to post-treatment after 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Unconscious processing of affective facial expressions during interocular suppression in a breaking Continuous flash suppression paradigm	Change in processing of unaware/unconsciously perceived emotional stimuli as assessed by number of faces correctly identified	pre-treatment, after 8 weeks (post-treatment)
Eye-Tracking	Change in recognition and visual processing of emotional faces as indicated by raw scores and group means for dwell time, total dwell time, and time to first AOI (mouth/eye region) hit	pre-treatment, after 8 weeks (post-treatment)
Ambivalence Task	Change in interpretation of ambiguous emotional faces as indicated by number of hostile judgments	pre-treatment, after 8 weeks (post-treatment)
Emotional search paradigm	Assessment of implicit perceptual biases for and explicit categorization of facial expression in an emotional search paradigm (change pre- to post-intervention)	pre-treatment, after 8 weeks (post-treatment)
Affective prosody	Change in recognition of non-verbal emotional aspects of language as assessed by number of correct classifications	pre-treatment, after 8 weeks (post-treatment)
Multifaceted empathy test	Assessment of cognitive and emotional empathy (change pre- to post-intervention)	pre-treatment, after 8 weeks (post-treatment)

Collaborators and Investigators

• Sponsor: University Hospital Tuebingen
• Collaborators: German Research Foundation
• Investigators: Principal Investigator: Michael Schönenberg, PhD, University Hospital Tuebingen

Publications and helpful links

General Publications

• Gibbon S, Khalifa NR, Cheung NH, Vollm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev. 2020 Sep 3;9(9):CD007668. doi: 10.1002/14651858.CD007668.pub3.
• Schonenberg M, Christian S, Gausser AK, Mayer SV, Hautzinger M, Jusyte A. Addressing perceptual insensitivity to facial affect in violent offenders: first evidence for the efficacy of a novel implicit training approach. Psychol Med. 2014 Apr;44(5):1043-52. doi: 10.1017/S0033291713001517. Epub 2013 Jul 1.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2017
• Primary Completion (Anticipated): March 1, 2019
• Study Completion (Anticipated): December 31, 2019

Study Registration Dates

• First Submitted: December 12, 2017
• First Submitted That Met QC Criteria: December 18, 2017
• First Posted (Actual): December 26, 2017

Study Record Updates

• Last Update Posted (Actual): December 26, 2017
• Last Update Submitted That Met QC Criteria: December 18, 2017
• Last Verified: December 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Aggression
• Other Study ID Numbers: SCHO 1448/3-1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No