THE DEVELOPMENT PROCESS OF A PSYCHOTHERAPEUTIC GAME FOR FACIAL EXPRESSION RECOGNITION IN PATIENTS WITH SCHIZOPHRENIA: A PILOT STUDY

Facial expressions of emotion are the foundation of social interaction and the ability to distinguish them is an important social skill. Indeed, nonverbal cues are often more important than verbal content in conveying emotional information that is crucial for developing successful relationships (Ellis et al., 1997).

A deficit in emotion recognition has been found to be a characteristic feature of schizophrenic pathology. Evidence for this comes from numerous studies that have used facial expressions of emotion as stimuli. (Heimberg, Gur, Erwin, Shtasel, & Gur, 1992).

Accumulated research indicates that therapy tools, computer and internet-based assessment have the potential to increase the cost-effectiveness of current psychotherapeutic interventions by streamlining the input and processing of client data from therapeutic sessions, reducing therapist contact time and increasing patients participation in therapeutic activities in non-clinical settings. (Kaltenthaler & Cavanagh, 2010).

This work presents the design process and development of “Feeling Master”, a new psychotherapeutic interactive game for facial emotion recognition. Feeling Master is the prototype of an individual interactive and multi-sensory psychotherapeutic game played with a tablet. It aims at training facial emotion recognition. Designed as a modular game, once the difficulty has been chosen, the patient will have to guess correctly the answers to the questions posed or, depending on the activity, simply match an emotion to the corresponding face. Additionally, therapists will be able to manage information regarding patients’ data, see patients’ performance, and configure future sessions and activities.

A unique feature of “Feeling Master” is the use of cartoon stimuli. It is widely recognized that cartoons have a strong advantage in expressing emotions and feelings. “Compared to human facial images, cartoon images have their characteristics, i.e. firstly, the cartoon facial expressions can be extreme.

Increasing evidence suggests that in contrast to atypical real-face processing, individuals with autistic spectrum disorders (ASD) do not differ from typically developing controls in cartoon-face processing. Furthermore, training studies have suggested that children with autism show improvements in emotion recognition when programs include cartoons stimuli rather than photographs of real faces (Silver & Oakes, 2001). Both autism and schizophrenia are characterized in part by pervasive social dysfunction that impairs the ability to initiate and maintain reciprocal interaction (APA, 1994).

Notwithstanding, to date, no study has attempted to explore the performance in emotion recognition of individuals with schizophrenia when programs include cartoons stimuli.

To simplify the development of our cartoon characters, we used the famous LEGO Minifigures illustrations. The excellent synthesis of the facial features such as the eyes, eyebrows, and mouth done by LEGO gave us the possibility to customize the character’s facial expression in a simple manner.

To assess this new interactive application, we conducted a pilot study with schizophrenia patients and healthy control volunteers at a psychiatric rehabilitation center (Parc Sanitari Sant Joan de Déu, Barcelona, Catalonia, Spain), to verify the usability and the acceptance of the game.