Abstract
Background: Very little research thus far has examined the decision making that underlies inappropriate social behavior (ISB) post-TBI (traumatic brain injury). Objectives: To verify the usefulness of a new instrument, the Social Responding Task, for investigating whether, in social decision making, individuals with TBI, who present inappropriate social behavior (ISB), have difficulty anticipating their own feelings of embarrassment and others’ angry reactions following an ISB. Methods: Seven subjects with TBI presenting with inappropriate social behavior (TBI-ISB), 10 presenting with appropriate social behavior (TBI-ASB), and 15 healthy controls were given 12 hypothetical scenarios three times, each time ending with a different behavioral response. Subjects were asked to gauge the likelihood of their displaying the behavior in that situation (part A) and of it being followed by an angry reaction from the other or by feelings of embarrassment in themselves (part B). Results: TBI-ISB subjects scored higher than TBI-ASB and healthy controls on a scale of likelihood of displaying an ISB. Results regarding expectations of angry reactions from others and feelings of embarrassment after an ISB were similar among groups. Negative correlations between endorsement of an inappropriate behavior and anticipation of negative emotional consequences were significant for both TBI-ASB and control subjects, but not for TBI-ISB subjects. Conclusions: Results suggest that the TBI-ISB participants were likely to endorse an ISB despite being able to anticipate a negative emotional response in themselves or others, suggesting that there were other explanations for their poor behavior. A self-reported likely response to hypothetical social scenarios can be a useful approach for studying the neurocognitive processes behind the poor choices of individuals with TBI-ISB, but the task needs further validation studies. A comprehensive discussion follows on the underlying mechanisms affecting social behaviors after a TBI.
Highlights
Given that each social situation presented in the scenarios had its own contextual and socio-affective elements that could have exerted different types of influence on behavioral decisions, we calculated the percentage of participants in each group who responded according to the four anchor points of the scale (0 = not at all likely; 1 = unlikely; 2 = likely; 3 = very likely) for each scenario, in order to compare the groups on every social situation and generate more specific hypotheses about the pattern of performance
A statistically significant difference was found in the endorsement of inappropriate behaviors in participants who endorsed the inappropriate behavior (Part A) of the task across the three groups (χ2 (2, n = 32) = 8.78, p = 0.012), revealing that the traumatic brain injury (TBI)-inappropriate social behavior (ISB) group scored higher than the TBI with appropriate social behaviors (TBI-ASB) group (U = 11.50, z = −2.30, p = 0.21, r = 41) and the control subjects (U = 14.50, z = −2.69, p = 0.007, r = 48)
The present study offers a more systematic approach than descriptive clinical measures for better understanding of the difficulties experienced in social situations by persons with TBI who have inappropriate social behaviors
Summary
Several studies have described adults with damage to ventromedial frontal cortices who developed abnormal social conduct and inadequate decision making and planning that repeatedly led to negative consequences [1,2]. These individuals’ generally well-preserved intellectual abilities contrasted with abnormality in their processes of emotion and feeling, such as not experiencing embarrassment induced by specific social contexts [3]. These deficits led to the development of Damasio’s somatic marker hypothesis [4], which proposes that a deficit in emotion and feeling plays an important role in impaired decision making. Very little research far has examined the decision making that underlies inappropriate social behavior (ISB) post-TBI (traumatic brain injury)
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