M120. Negative Functional Outcomes of Diminished Emotional Expression in Schizophrenia: The Case of Smiling in Face-To-Face Interactions

Abstract

Abstract Background: Diminished facial expressiveness is a consistent finding in schizophrenia, which appears to be most pronounced for positive facial expressions (ie, smiling). As an affiliative signal, smiling has the potential to be a behavioral marker of negative symptoms and could be associated with functional outcomes. However, most studies investigated facial expressions in people with schizophrenia in nonaffiliative contexts and rarely in face-to-face interactions. Furthermore, only few studies have looked at the social consequences of reduced facial expressiveness. We hypothesized that people with schizophrenia in an affiliative face-to-face interaction (1) would display less smiling than controls and that (2) low-expressive patients compared to high-expressive patients would exhibit more negative symptoms, lower social competence, and receive more negative social evaluations. Methods: The sample consisted of 52 patients with a schizophrenia spectrum disorder and 39 healthy controls. All participants engaged in an affiliative role play with a study confederate. Independent sets of raters then coded these interactions for the amount of smiling (using the Facial Expression Coding System [FACES; Kring & Sloan, 2007]), social competence, and desire for future interactions with the participant. Moreover, in the patient sample, we assessed psychotic symptoms, depressive symptoms, and social role functioning with structured interviews. We performed a median split within the patient sample, distinguishing low- and high-expressive patients with respect to amount of smiling and tested for differences between the resulting groups on all dependent measures. We also tested for differences between the 2 patient groups and controls, where measures were available. Results: Compared to controls, participants with a schizophrenia spectrum disorder exhibited significantly lower levels of smiling (d = −0.56), significantly lower social competence (d = −0.68), and were evaluated as less desirable for future interactions (d = −0.58). However, only participants in the low but not in the high-expressive patient group differed from controls on these 3 variables. Low-expressive patients differed from high-expressive patients with respect to negative symptoms (d = 0.72), social functioning (d = −0.63), social competence (d = −0.66), and desire for future interactions (d = −0.80). No differences between the 2 patient groups were found on other symptom dimensions (eg, positive, disorganized, depression), any sample characteristics, and medication dose. Conclusion: Our findings corroborate emerging evidence suggesting that diminished smiling behavior in schizophrenia is a behavioral substrate of negative symptoms in face-to-face interactions and indicative of negative functional outcomes. Our results highlight the need for developing treatments that foster affiliative interaction skills in schizophrenia.