Emotion perception after moderate-severe traumatic brain injury: The valence effect and the role of working memory, processing speed, and nonverbal reasoning

Abstract

Objective: Traumatic brain injury (TBI) impairs emotion perception. Perception of negative emotions (sadness, disgust, fear, and anger) is reportedly affected more than positive (happiness and surprise) ones. It has been argued that this reflects a specialized neural network underpinning negative emotions that is vulnerable to brain injury. However, studies typically do not equate for differential difficulty between emotions. We aimed to examine whether emotion recognition deficits in people with TBI were specific to negative emotions, while equating task difficulty, and to determine whether perception deficits might be accounted for by other cognitive processes.

Method: Twenty-seven people with TBI and 28 matched control participants identified 6 basic emotions at 2 levels of intensity (a) the conventional 100% intensity and (b) "equated intensity"-that is, an intensity that yielded comparable accuracy rates across emotions in controls.

Results: (a) At 100% intensity, the TBI group was impaired in recognizing anger, fear, and disgust but not happiness, surprise, or sadness and performed worse on negative than positive emotions. (b) At equated intensity, the TBI group was poorer than controls overall but not differentially poorer in recognizing negative emotions. Although processing speed and nonverbal reasoning were associated with emotion accuracy, injury severity by itself was a unique predictor.

Conclusions: When task difficulty is taken into account, individuals with TBI show impairment in recognizing all facial emotions. There was no evidence for a specific impairment for negative emotions or any particular emotion. Impairment was accounted for by injury severity rather than being a secondary effect of reduced neuropsychological functioning.