The perception of emotion by schizophrenic patients. P L Joseph, D A Sturgeon and J Leff BJP 1992, 161:603-609. Access the most recent version at DOI: 10.1192/bjp.161.5.603
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BritishJournalof Psychiatry(1992),161, 603-609
The Perception
of Emotion
by Schizophrenic
Patients
PHILIP L. A. JOSEPH, DAVID A. STURGEON and JULIAN LEFF Studies which have examined the perception of emotion by schizophrenicpatients have producedconflictingresults,an outcomewhichmay, inpart, bedueto difficultiesin presenting a realisticportrayalof emotion. This study exposed 32 schizophrenicpatients in remission and ten controlsto five videotapedscenes of emotional situationsplayed by actors. The schizophrenicpatients were divided into three groups, namely those living with high-EE relatives,thoselivingwith low-EErelativesandthoselivingalone,inorderto test the hypothesis that patientsin a high-EEenvironmentare lessableto identifyemotionallychargedsituations. Measuresof electrodermalactivity and self-ratingsof tensionwere recordedconcomitantly. The schizophrenicpatients in all groupswere as adept at identifyingemotionsas were the controls.There was no differencebetweenthe groupsinelectrodermalactivityandsubjective tensionfor allvideoscenes,exceptfor the one which portrayedthe only pleasantinteraction; the high-EEgroupwas significantlymorearousedon bothmeasures,whichwere independent of each other.
The most characteristic disorder in schizophrenia is often taken to be a reduction in the capacity to experience and communicate emotion, associated with a deficient perception of emotion in other people's
speech and facial expressions
of emotional situations to schizophrenic in-patients (56°lo of whom werelong stay)who wereaskedto rate the emotional content of the scenes they watched
by an adjective check-list. These authors found that the schizophrenic group judged the scenes differently from the controls. They found no association between the general level of patients' morbidity and their scores. Some schizophrenics are unduly sensitive to inter personal contact and are more at risk of relapse when living with a critical, hostile, or overinvolved relative (Brown et al, 1962, 1972; Vaughn & Leff, 1976a). There is no evidence from epidemiological studies or from Present State Examination (PSE) data that either high or low expressed emotion (BE) in a relative
(Cutting,
1985). Many studies which have examined the perception of emotion in others by people with schizophrenia have used the judgement of facial expression in photographs
(Izard, 1959; Dougherty
et al, 1974;Muzekari & Bates, 1977;Walker et al, 1980; Cutting, 1981). Although these studies have found discrepancies between the ability of schizo phrenic patients and normal controls to assess emotion, this could be in either a positive or negative direction (La Russo, 1978; hard, 1959).Furthermore, there is much debate as to whether the impaired emotional assessment in schizophrenic patients is due to the acute stage of their illness (Cutting, 1981), flattening of affect (McPherson et al, 1970, 1975), or an impoverished social environment (Walker et al, 1980). Most of the research in this field has required subjects to judge emotion from photographs of faces. This technique involves a series of abstractions which distance the procedure from real life. In practice, people rely heavily on context, on changes in expression over time, and on cues from posture and gesture to make these judgements (Leff, 1977). It
is
possible
that
a
reduction
in
contextual
cues
renders the judgement of emotions particularly difficult for people with schizophrenia in view of the postulated ‘¿concreteness' of thought processes in this condition (Goldstein, 1944). One of the few studies to use more realistic material is that by Cramer et al (1989).
These
researchers
played
audiovisual
tapes
is prompted
by different
types of schizophrenia.
Moreover, the successful conversion of high to low EE in their relatives is accompanied
by a fall in
relapse rate in the patient group (Leff, 1989). Kuipers & Bebbington (1988)have given detailed consideration to the theoretical and clinical implications of EE research in schizophrenia. One question which merits study is whether schizophrenic patients withdraw from highly charged emotional
atmospheres
within
the family
as a
protective mechanism; that is, whether social with drawal and isolation are not only symptoms but also coping strategies. In high-EE homes the patient is presumed to be withdrawing from a preponderance of critical comments,
hostility, or overinvolvement.
However, not all schizophrenic people who live with
high-EE
relatives
do
reduce
the
amount
of
social contact they have with relatives; some remain in high contact (more than 35 hours per week) and thus maintain an increased vulnerability to relapse.
603
604
JOSEPH ET AL
One possibility is that these patients continue to expose themselves to high-risk relapse situations
(b) Schizophrenic patients living in high contact with high-EE relatives are less able to rate their
because they somehow fail to recognise the critical
subjective feelings of tension in response to emotionally charged situations than patients who live in high contact with low-EE relatives, patients who live alone, and non-schizophrenic controls. (c) Schizophrenic patients who live in high contact with high-EE relatives are more psychophysio logically aroused than patients who live in high
or hostile attitude of the relative; perhaps they fail to recognise an internal emotion ‘¿cue',in response to their relative's attitude, which in other patients might lead to withdrawal from a high-EE
environment. One tested hypothesis concerning psychosocial stress and relapse rate is the mediating role of physiological arousal. Tarrier et al (1979, 1988) measured skin conductance responses (SCRs) of schizophrenic patients in the presence and the absence of their relatives. They demonstrated that when a low-EE relative entered the room in which the patient's skin conductance was being recorded, the non-specific SCRS decreased, but that when the relative was high EE no decrease occurred. Sturgeon et al (1984) also demonstrated significantly higher SCR frequencies when patients were inter viewed with a high-EE, rather than a low-EE, relative. Patients in the study of Tarrier et al (1988) also completed self-rating scales describing their level of tension. These self-reports suggested higher tension levels in patients with high-EE relatives and the ability of low-EE relatives to reduce tension levels. There was also a significantly higher tonic level of skin conductance in patients with high-EE relatives, a result which supports the findings of Sturgeon et al (1984). Interestingly, an increase in SCR frequency is not correlated with critical comments or with overinvolved statements (Sturgeon et al, 1981), suggesting that their effects may be reflected more in the tonic than the phasic level of SCRs. However, a successful social intervention pro gramme, in which EE was reduced in an experimental group of patients in high contact with high-EE relatives and the relapse rate decreased substantially
contact with low-EE relatives,
patients
who
live alone, and non-schizophrenic controls. In designing this study, we were influenced by previous work on relatives' EE and schizophrenia: in particular, the evidence that patients in remission have an increased likelihood of relapse if exposed to relatives' high-EE attitudes. We wished to study patients in remission to determine whether impaired
emotional judgement is a consequence of the psy chotic state or is an enduring characteristic of patients. Furthermore, we wished to present emotional interactions in a manner that was as close to patients'
real experience as possible. Live representations were ruled out because of the impossibility of standardising the scenes from subject to subject. Videotapes of genuine families could not be used, as they would
violate confidentiality. Consequently, we employed videotaped scenes played by actors. Given the above limitations, these portrayals provided the maximum amount of context possible to enable the subjects to
make their judgements. We chose to include a group of ‘¿loners' among our subjects because they had succeeded in leaving their families of origin. It is a reasonable assumption that some of this group left home because of the discomfort of living with high-EE relatives, although this cannot be assessed retrospectively with any accuracy. However, an approximation can be made by enquiring into their reasons for leaving home.
(Leff et al, 1982), was not associated with a decrease
in the patients' SCR rate, which turned out to be independently related to relapse. It was postulated that some patients are more psychophysiologically vulnerable than others and that this interacts with high levels of EE. Tarrier et al(1988) have reviewed this research. The study reported here tested the following hypotheses:
(a) Schizophrenic patients living in high contact with high-EE relatives are less able to assess emotion accurately than patients who live in high contact with low-EE relatives, patients who live alone, and non-schizophrenic controls.
Method Thirty-two
patients and ten controls
were included in the
study. The patients were all schizophrenics, currently in remission, and diagnosed when psychotic by the PSE in conjunction with the CATEGOprogram (Wing eta!, 1974). They were divided into three groups on the basis of their living arrangements. Ten patients were classified as ‘¿loners', either living alone or in a non-cohabiting relationship with
others, for example in a hostel. The other 22 patients werelivingwith relatives,and the key relativein eachcase was interviewed by means of the modified form of the CamberwellFamilylnterview(Vaughn&Leff, l976b; Brown
& Rutter, 1966)in order to provide a measure of EE. Twelve patients were high EE, ten were low EE, and all were selected as being in high face-to-face
contact
with their
PERCEPTION OF EMOTION BY SCHIZOPHRENICS relatives, i.e. over 35 hours per week. All were receiving neuroleptic medication.
605
out by the appropriate contrasts in the ONEWAY program of SPSS.
In common with other studies (e.g. Sturgeon et a!, 1984),
there were no significant differences between the groups regarding
demographic
characteristics
All subjects
Results
and the course of
their schizophrenic illness. The controls were employees of the hospital from a range of occupations, matched for age and sex. were shown a video containing
six scenes
(A—E),the sixth being a repetition of the first, to control for habituation. The scenes were created specifically for this study by professional actors who had been instructed by the authors in the nature of the emotions they were expected to portray. Scene A showed a mother nagging her reluctant son to take more exercise; scene B, a young man complimenting his girlfriend on her cooking; scene C, a wife admonishing her husband for withdrawing to his room; scene D, an angry father chastising his daughter; and scene E, an exasperated mother criticising her son for missing his
Three scores were obtained for each video scene, a measure of electrodermal activity, a self-rating of relaxation-tension, and an emotional profile derived from the presence or
absence of ticks on the adjective check-list. The adjectives
selectedby the subjectswereranked in order of frequency. The scores for the sixth scene were found not to differ significantly from the first scene and have therefore been discounted. Emotional profile The two adjectives chosen with greatest frequency for each video scene are shown in Table 1. There is remarkably
little
meals. The scenes were shown to subjects in random order.
difference between the groups. The number of adjectives
After each scenethe subjects wereasked to study a list of
employedby eachgroupperscenedidnot differsignificantly.
adjectives and tick off those which described the emotions being shown by the main actor in each scene. The main actor was always the ‘¿relative' who was expressing a predetermined range of emotions to the ‘¿patient'. The list
Controls
of adjectives was constructed
by showing the videos initially
to normal subjects who were asked to supply their own description of the emotions portrayed. From these open ended responses, a list of the most commonly supplied emotive adjectives was selected, 13 in all. The 13 adjectives were: concerned, interfering, happy, ashamed, encouraging, angry, relaxed,
worried,
sad, scornful,
interested,
disap
proving, and surprised. The subjects could choose as many adjectives as they liked, and were not required to rank them in order
of importance,
thus
creating
an emotional
profile
for each scene. The subjects were then asked to rate how they felt on a 10-centimetre, visual analogue scale labelled ‘¿Relaxed—Tense', a higher score indicating greater tension. Throughout the viewing period, skin conductance levels were recorded by instrumentation and procedure similar to those described by Sturgeon et a! (1984). Domed silver/silver-chloride electrodes were taped onto the middle phalanx of the first and second fingers of the subject's non-preferred hand, using ‘¿KY' jelly as the electrolyte medium. A bipolar electrode placement was employed. Skin
conductance was monitored by a constant-voltage (0.5 V) system with automatic
back-off.
Skin-conductance
levels
and the frequency of non-specific SCRs with an amplitude of at least 0.02 pS were obtained from the polygraph record. Following the video, subjects were interviewed by means of a 25-item questionnaire which focused on their contact with family, friends, and work. This gave a measure of sociability, a higher score indicating a greater degree of social withdrawal.
used an average of 3.9, ‘¿loners' 3.7, low-EE
patients 3.8, and high-EE patients 4.0. These results show that the schizophrenic patients were able to identify accurately the emotional tone expressed on
the video scene, if we assume that the controls were making an accurate description.
An attempt wasmadeto identifymoresubtledifferences in the way the groups described the emotions displayed in the video scenes. The adjectival responses of all schizophrenics and controls were given a value of 1 if chosen and 0 if not chosen, and were then subjected to a linear discriminant
function analysis by SPSSx. This analysis failed to discrimi nate among the groups according to the adjectival responses. A hierarchical cluster analysis was then performed by a ‘¿city block' measure, again with SPSSx. The results were illustrated by a vertical icicle plot and a dendrogram of average linkage between groups. There was no clear clustering of cases according to groups, and where clustering did occur the subjects were drawn from all groups. Subjects were ranked according to the hierarchy established
by the cluster analysis. This ranking was compared with the order of subjects as based on their scores for sociability, Table 1 The two most frequentlychosenadjectivesby schizo phrenicsandcontrolsto describethe emotionsexpressed in videos A—E Video‘Loners'Low-EEHigh-EEControlsAconcerned worriedworrieddisapprovingconcerned worriedconcerned worriedBencouraging interestedencouraging interestedencouraging interestedCangry happyencouraging
Statistical
analysis
disapprovingworried disapprovingconcerned worriedashamed worriedDdisapproving
The repeated-measures analysis of variance was performed through the MANOVA command on the Statistical Package
for the Social Sciences (SPSS). The Pillais criterion was used for tests of significance.
Univariate
tests were carried
angryangry disapprovingdisapproving angryangry disapprovingEdisapproving worriedangry worriedworriedangryconcemed disapproving
606
JOSEPH ET AL 14
which ranged from 7 to 24. The results showed no significant
correlation
(rho = —¿0.13NS).
Self-ratings of relaxation-tension
Self-ratingsweremadeimmediatelyafter eachvideoscene.
I
The mean scores are represented graphically in Fig. 1. The statistical analysis of the scores was as follows. Firstly, a multivariate analysis of variance was performed to determine interaction between the video scenes and the groups. There was no significant
group
d.f. = 12, ill, P=0.4, produced
by video-scene
interaction
(F=
1.1,
significamly
different
scores
across
groups
(F=3.4, d.f.=4, 35, P
References Reprints/ permissions You can respond to this article at Downloaded from
This article cites 0 articles, 0 of which you can access for free at: http://bjp.rcpsych.org/content/161/5/603#BIBL To obtain reprints or permission to reproduce material from this paper, please write to [email protected] http://bjp.rcpsych.org/letters/submit/bjprcpsych;161/5/603 http://bjp.rcpsych.org/ on October 12, 2014 Published by The Royal College of Psychiatrists
To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/site/subscriptions/
BritishJournalof Psychiatry(1992),161, 603-609
The Perception
of Emotion
by Schizophrenic
Patients
PHILIP L. A. JOSEPH, DAVID A. STURGEON and JULIAN LEFF Studies which have examined the perception of emotion by schizophrenicpatients have producedconflictingresults,an outcomewhichmay, inpart, bedueto difficultiesin presenting a realisticportrayalof emotion. This study exposed 32 schizophrenicpatients in remission and ten controlsto five videotapedscenes of emotional situationsplayed by actors. The schizophrenicpatients were divided into three groups, namely those living with high-EE relatives,thoselivingwith low-EErelativesandthoselivingalone,inorderto test the hypothesis that patientsin a high-EEenvironmentare lessableto identifyemotionallychargedsituations. Measuresof electrodermalactivity and self-ratingsof tensionwere recordedconcomitantly. The schizophrenicpatients in all groupswere as adept at identifyingemotionsas were the controls.There was no differencebetweenthe groupsinelectrodermalactivityandsubjective tensionfor allvideoscenes,exceptfor the one which portrayedthe only pleasantinteraction; the high-EEgroupwas significantlymorearousedon bothmeasures,whichwere independent of each other.
The most characteristic disorder in schizophrenia is often taken to be a reduction in the capacity to experience and communicate emotion, associated with a deficient perception of emotion in other people's
speech and facial expressions
of emotional situations to schizophrenic in-patients (56°lo of whom werelong stay)who wereaskedto rate the emotional content of the scenes they watched
by an adjective check-list. These authors found that the schizophrenic group judged the scenes differently from the controls. They found no association between the general level of patients' morbidity and their scores. Some schizophrenics are unduly sensitive to inter personal contact and are more at risk of relapse when living with a critical, hostile, or overinvolved relative (Brown et al, 1962, 1972; Vaughn & Leff, 1976a). There is no evidence from epidemiological studies or from Present State Examination (PSE) data that either high or low expressed emotion (BE) in a relative
(Cutting,
1985). Many studies which have examined the perception of emotion in others by people with schizophrenia have used the judgement of facial expression in photographs
(Izard, 1959; Dougherty
et al, 1974;Muzekari & Bates, 1977;Walker et al, 1980; Cutting, 1981). Although these studies have found discrepancies between the ability of schizo phrenic patients and normal controls to assess emotion, this could be in either a positive or negative direction (La Russo, 1978; hard, 1959).Furthermore, there is much debate as to whether the impaired emotional assessment in schizophrenic patients is due to the acute stage of their illness (Cutting, 1981), flattening of affect (McPherson et al, 1970, 1975), or an impoverished social environment (Walker et al, 1980). Most of the research in this field has required subjects to judge emotion from photographs of faces. This technique involves a series of abstractions which distance the procedure from real life. In practice, people rely heavily on context, on changes in expression over time, and on cues from posture and gesture to make these judgements (Leff, 1977). It
is
possible
that
a
reduction
in
contextual
cues
renders the judgement of emotions particularly difficult for people with schizophrenia in view of the postulated ‘¿concreteness' of thought processes in this condition (Goldstein, 1944). One of the few studies to use more realistic material is that by Cramer et al (1989).
These
researchers
played
audiovisual
tapes
is prompted
by different
types of schizophrenia.
Moreover, the successful conversion of high to low EE in their relatives is accompanied
by a fall in
relapse rate in the patient group (Leff, 1989). Kuipers & Bebbington (1988)have given detailed consideration to the theoretical and clinical implications of EE research in schizophrenia. One question which merits study is whether schizophrenic patients withdraw from highly charged emotional
atmospheres
within
the family
as a
protective mechanism; that is, whether social with drawal and isolation are not only symptoms but also coping strategies. In high-EE homes the patient is presumed to be withdrawing from a preponderance of critical comments,
hostility, or overinvolvement.
However, not all schizophrenic people who live with
high-EE
relatives
do
reduce
the
amount
of
social contact they have with relatives; some remain in high contact (more than 35 hours per week) and thus maintain an increased vulnerability to relapse.
603
604
JOSEPH ET AL
One possibility is that these patients continue to expose themselves to high-risk relapse situations
(b) Schizophrenic patients living in high contact with high-EE relatives are less able to rate their
because they somehow fail to recognise the critical
subjective feelings of tension in response to emotionally charged situations than patients who live in high contact with low-EE relatives, patients who live alone, and non-schizophrenic controls. (c) Schizophrenic patients who live in high contact with high-EE relatives are more psychophysio logically aroused than patients who live in high
or hostile attitude of the relative; perhaps they fail to recognise an internal emotion ‘¿cue',in response to their relative's attitude, which in other patients might lead to withdrawal from a high-EE
environment. One tested hypothesis concerning psychosocial stress and relapse rate is the mediating role of physiological arousal. Tarrier et al (1979, 1988) measured skin conductance responses (SCRs) of schizophrenic patients in the presence and the absence of their relatives. They demonstrated that when a low-EE relative entered the room in which the patient's skin conductance was being recorded, the non-specific SCRS decreased, but that when the relative was high EE no decrease occurred. Sturgeon et al (1984) also demonstrated significantly higher SCR frequencies when patients were inter viewed with a high-EE, rather than a low-EE, relative. Patients in the study of Tarrier et al (1988) also completed self-rating scales describing their level of tension. These self-reports suggested higher tension levels in patients with high-EE relatives and the ability of low-EE relatives to reduce tension levels. There was also a significantly higher tonic level of skin conductance in patients with high-EE relatives, a result which supports the findings of Sturgeon et al (1984). Interestingly, an increase in SCR frequency is not correlated with critical comments or with overinvolved statements (Sturgeon et al, 1981), suggesting that their effects may be reflected more in the tonic than the phasic level of SCRs. However, a successful social intervention pro gramme, in which EE was reduced in an experimental group of patients in high contact with high-EE relatives and the relapse rate decreased substantially
contact with low-EE relatives,
patients
who
live alone, and non-schizophrenic controls. In designing this study, we were influenced by previous work on relatives' EE and schizophrenia: in particular, the evidence that patients in remission have an increased likelihood of relapse if exposed to relatives' high-EE attitudes. We wished to study patients in remission to determine whether impaired
emotional judgement is a consequence of the psy chotic state or is an enduring characteristic of patients. Furthermore, we wished to present emotional interactions in a manner that was as close to patients'
real experience as possible. Live representations were ruled out because of the impossibility of standardising the scenes from subject to subject. Videotapes of genuine families could not be used, as they would
violate confidentiality. Consequently, we employed videotaped scenes played by actors. Given the above limitations, these portrayals provided the maximum amount of context possible to enable the subjects to
make their judgements. We chose to include a group of ‘¿loners' among our subjects because they had succeeded in leaving their families of origin. It is a reasonable assumption that some of this group left home because of the discomfort of living with high-EE relatives, although this cannot be assessed retrospectively with any accuracy. However, an approximation can be made by enquiring into their reasons for leaving home.
(Leff et al, 1982), was not associated with a decrease
in the patients' SCR rate, which turned out to be independently related to relapse. It was postulated that some patients are more psychophysiologically vulnerable than others and that this interacts with high levels of EE. Tarrier et al(1988) have reviewed this research. The study reported here tested the following hypotheses:
(a) Schizophrenic patients living in high contact with high-EE relatives are less able to assess emotion accurately than patients who live in high contact with low-EE relatives, patients who live alone, and non-schizophrenic controls.
Method Thirty-two
patients and ten controls
were included in the
study. The patients were all schizophrenics, currently in remission, and diagnosed when psychotic by the PSE in conjunction with the CATEGOprogram (Wing eta!, 1974). They were divided into three groups on the basis of their living arrangements. Ten patients were classified as ‘¿loners', either living alone or in a non-cohabiting relationship with
others, for example in a hostel. The other 22 patients werelivingwith relatives,and the key relativein eachcase was interviewed by means of the modified form of the CamberwellFamilylnterview(Vaughn&Leff, l976b; Brown
& Rutter, 1966)in order to provide a measure of EE. Twelve patients were high EE, ten were low EE, and all were selected as being in high face-to-face
contact
with their
PERCEPTION OF EMOTION BY SCHIZOPHRENICS relatives, i.e. over 35 hours per week. All were receiving neuroleptic medication.
605
out by the appropriate contrasts in the ONEWAY program of SPSS.
In common with other studies (e.g. Sturgeon et a!, 1984),
there were no significant differences between the groups regarding
demographic
characteristics
All subjects
Results
and the course of
their schizophrenic illness. The controls were employees of the hospital from a range of occupations, matched for age and sex. were shown a video containing
six scenes
(A—E),the sixth being a repetition of the first, to control for habituation. The scenes were created specifically for this study by professional actors who had been instructed by the authors in the nature of the emotions they were expected to portray. Scene A showed a mother nagging her reluctant son to take more exercise; scene B, a young man complimenting his girlfriend on her cooking; scene C, a wife admonishing her husband for withdrawing to his room; scene D, an angry father chastising his daughter; and scene E, an exasperated mother criticising her son for missing his
Three scores were obtained for each video scene, a measure of electrodermal activity, a self-rating of relaxation-tension, and an emotional profile derived from the presence or
absence of ticks on the adjective check-list. The adjectives
selectedby the subjectswereranked in order of frequency. The scores for the sixth scene were found not to differ significantly from the first scene and have therefore been discounted. Emotional profile The two adjectives chosen with greatest frequency for each video scene are shown in Table 1. There is remarkably
little
meals. The scenes were shown to subjects in random order.
difference between the groups. The number of adjectives
After each scenethe subjects wereasked to study a list of
employedby eachgroupperscenedidnot differsignificantly.
adjectives and tick off those which described the emotions being shown by the main actor in each scene. The main actor was always the ‘¿relative' who was expressing a predetermined range of emotions to the ‘¿patient'. The list
Controls
of adjectives was constructed
by showing the videos initially
to normal subjects who were asked to supply their own description of the emotions portrayed. From these open ended responses, a list of the most commonly supplied emotive adjectives was selected, 13 in all. The 13 adjectives were: concerned, interfering, happy, ashamed, encouraging, angry, relaxed,
worried,
sad, scornful,
interested,
disap
proving, and surprised. The subjects could choose as many adjectives as they liked, and were not required to rank them in order
of importance,
thus
creating
an emotional
profile
for each scene. The subjects were then asked to rate how they felt on a 10-centimetre, visual analogue scale labelled ‘¿Relaxed—Tense', a higher score indicating greater tension. Throughout the viewing period, skin conductance levels were recorded by instrumentation and procedure similar to those described by Sturgeon et a! (1984). Domed silver/silver-chloride electrodes were taped onto the middle phalanx of the first and second fingers of the subject's non-preferred hand, using ‘¿KY' jelly as the electrolyte medium. A bipolar electrode placement was employed. Skin
conductance was monitored by a constant-voltage (0.5 V) system with automatic
back-off.
Skin-conductance
levels
and the frequency of non-specific SCRs with an amplitude of at least 0.02 pS were obtained from the polygraph record. Following the video, subjects were interviewed by means of a 25-item questionnaire which focused on their contact with family, friends, and work. This gave a measure of sociability, a higher score indicating a greater degree of social withdrawal.
used an average of 3.9, ‘¿loners' 3.7, low-EE
patients 3.8, and high-EE patients 4.0. These results show that the schizophrenic patients were able to identify accurately the emotional tone expressed on
the video scene, if we assume that the controls were making an accurate description.
An attempt wasmadeto identifymoresubtledifferences in the way the groups described the emotions displayed in the video scenes. The adjectival responses of all schizophrenics and controls were given a value of 1 if chosen and 0 if not chosen, and were then subjected to a linear discriminant
function analysis by SPSSx. This analysis failed to discrimi nate among the groups according to the adjectival responses. A hierarchical cluster analysis was then performed by a ‘¿city block' measure, again with SPSSx. The results were illustrated by a vertical icicle plot and a dendrogram of average linkage between groups. There was no clear clustering of cases according to groups, and where clustering did occur the subjects were drawn from all groups. Subjects were ranked according to the hierarchy established
by the cluster analysis. This ranking was compared with the order of subjects as based on their scores for sociability, Table 1 The two most frequentlychosenadjectivesby schizo phrenicsandcontrolsto describethe emotionsexpressed in videos A—E Video‘Loners'Low-EEHigh-EEControlsAconcerned worriedworrieddisapprovingconcerned worriedconcerned worriedBencouraging interestedencouraging interestedencouraging interestedCangry happyencouraging
Statistical
analysis
disapprovingworried disapprovingconcerned worriedashamed worriedDdisapproving
The repeated-measures analysis of variance was performed through the MANOVA command on the Statistical Package
for the Social Sciences (SPSS). The Pillais criterion was used for tests of significance.
Univariate
tests were carried
angryangry disapprovingdisapproving angryangry disapprovingEdisapproving worriedangry worriedworriedangryconcemed disapproving
606
JOSEPH ET AL 14
which ranged from 7 to 24. The results showed no significant
correlation
(rho = —¿0.13NS).
Self-ratings of relaxation-tension
Self-ratingsweremadeimmediatelyafter eachvideoscene.
I
The mean scores are represented graphically in Fig. 1. The statistical analysis of the scores was as follows. Firstly, a multivariate analysis of variance was performed to determine interaction between the video scenes and the groups. There was no significant
group
d.f. = 12, ill, P=0.4, produced
by video-scene
interaction
(F=
1.1,
significamly
different
scores
across
groups
(F=3.4, d.f.=4, 35, P
