The threat in a smile

Survivors of abuse, abandonment and neglect, who struggle to process kind facial expressions such as a smile, could stand to benefit from a novel therapy tool developed by a mental health researcher with expertise in mood disorders.

Patients suffering from anxiety or depression - such as incest survivors and people with attachment disorders – can harbour highly self-critical attitudes and can feel threatened by compassionate facial expressions, often responding with fear or grief. This can have crippling consequences for patients' recovery, who in turn are limited in their ability to form meaningful relationships with others and find it hard to relate to their environment.

Published in Plos One journal, Dr Kirsten McEwan from the School of Medicine, has developed a facial stimulus set to assess the degree to which individuals who score highly in self-criticism, depression and anxiety may struggle to process and receive compassion. This research found that individuals who score highly in self-criticism did indeed struggle to process and pay attention to compassionate emotions. This could be a maintaining factor in mood disorders and a block to therapeutic interventions.

This research involved national and international collaborations and is the outcome of Dr Kirsten McEwan's PhD project at the University of Derby which was jointly supervised by Professor Paul Gilbert of the Mental Health Research Unit, and Drs Sigrid Lipka and Frances Maratos of the University of Derby.

Further to this work, the team received funding from the Leverhulme Foundation to develop a 'compassion game' that trains individuals to recognise kindness and compassion. This was achieved using a visual search task to re-train the automatic, unconscious biases towards threatening stimuli commonly shown by people with mood disorders.

In the compassion game participants in a study were asked to identify the compassionate faces amid a number of images of actors displaying critical expressions. Speaking of the findings, Dr McEwan said:

"We found that the more self-critical participants were, the less able they were to find kind and compassionate faces when amongst an array of more critical expressions. Conversely, participants of a less self-critical disposition demonstrated an enhanced awareness of kind faces.

"The new facial stimulus set was used in a Cognitive Bias Modification Task (CBMT) comprising an online 'Compassion Game'. Participants practiced this CBMT compared with a control condition online for two weeks. We found significant improvements across a variety of self-reported well-being outcome measures including self-criticism, depression, anxiety and stress. The aim of the game is to desensitise patients to compassionate images and rid them of threatening feelings."

The inspiration for this research came from anecdotal evidence taken from clinicians at Derbyshire Healthcare NHS Foundation Trust, who observed that difficulties in processing the emotions of others were a big hindrance to patient recovery. In popular culture, this problem is exemplified in Good Will Hunting – a film which portrays a troubled young genius, who struggles to come to terms with an abuse-filled past, and rejects therapy and friendship from those outside his own friendship circle.

Dr Sigrid Lipka, University Reader in Psychology at the University of Derby, said: "Kirsten's work, conducted as part of her PhD at the University of Derby, is a great example of psychological research bringing together various areas of psychology in an interdisciplinary and international collaboration. It is innovative research with real potential for creating considerable practical impact in clinical mental health settings."

There is increasing evidence to show that the ability to process compassion from others triggers the release of natural chemicals such as endorphins and opiates which aides a significant reduction in anxiety, depression and self-criticism, and regulates how threatened patients feel during therapy.

"The NHS is currently grappling with the challenge of making unprecedented efficiency savings whilst improving the nation's mental health – this computer-based intervention offers the potential to deliver a cheap and easily accessible treatment for depression and anxiety in a non-stigmatising environment," concluded Dr McEwan.

The new facial stimulus set is available to researchers by contacting Dr McEwan. The paper, entitled 'Facial expressions depicting compassionate and critical emotions: The development & validation of a new emotional face stimulus set', is published and can be accessed in Plos One journal.