Emotion Recognition Training in Antisocial Violent Offenders With Psychopathic Traits

Study Overview
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Brief Summary
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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.

Official Title
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Emotion Recognition Training in Antisocial Violent Offenders With Psychopathic Traits

Conditions
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Psychopathy, Emotional Problem, Violent Aggressive Behavior

Intervention / Treatment
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* Behavioral: SEE Training
* Behavioral: GAZE Training


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SEE Training<br>The training sequence comprises four weekly sessions using a modified dote-probe paradigm (fearful vs. neutral expression). | Behavioral: SEE Training<br>* 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.<br>|
| Active Comparator: GAZE Training<br>The GAZE training sequence comprises four weekly sessions using a modified dote-probe paradigm (averted vs. directed gaze). | Behavioral: GAZE Training<br>* 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.<br>|

What is the study measuring?
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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) |