Emotional Facial Expressions Research Articles

Differential effects of attachment security on visual fixation to facial expressions of emotion in 14-month-old infants: an eye-tracking study.

Models of attachment and information processing suggest that the attention infants allocate to social information might occur in a schema-driven processing manner according to their attachment pattern. A major source of social information for infants consists of facial expressions of emotion. We tested for differences in attention to facial expressions and emotional discrimination between infants classified as securely attached (B), insecure-avoidant (A), and insecure-resistant (C). Sixty-one 14-month-old infants participated in the Strange Situation Procedure and an experimental task of Visual Habituation and Visual Paired-Comparison Task (VPC). In the Habituation phase, a Low-Arousal Happy face (habituation face) was presented followed by a VPC task of 6 trials composed of two contrasting emotional faces always involving the same actress: the one used in habituation (trial old face) and a new one (trial new face) portraying changes in valence (Low-Arousal Angry face), arousal (High-Arousal Happy face), or valence + arousal (High-Arousal Angry face). Measures of fixation time (FT) and number of fixations (FC) were obtained for the habituation face, the trial old face, the trial new face, and the difference between the trial old face and the trial new face using an eye-tracking system. We found a higher FT and FC for the trial new face when compared with the trial old face, regardless of the emotional condition (valence, arousal, valence + arousal contrasts), suggesting that 14-month-old infants were able to discriminate different emotional faces. However, this effect differed according to attachment pattern: resistant-attached infants (C) had significantly higher FT and FC for the new face than patterns B and A, indicating they may remain hypervigilant toward emotional change. On the contrary, avoidant infants (A) revealed significantly longer looking times to the trial old face, suggesting overall avoidance of novel expressions and thus less sensitivity to emotional change. Overall, these findings corroborate that attachment is associated with infants' social information processing.

Abstract 123: Emotional Prosody and Facial Expressions Differentially Augment Comprehension of Discourse for Left and Right Hemisphere Stroke Survivors

Deficits in spoken discourse comprehension are common after left hemisphere (LH) and right hemisphere (RH) stroke. Thus, it is important to identify factors that facilitate comprehension and enhance communication between stroke survivors and their care partners. Emotional prosody and facial expression cues can facilitate comprehension, but this may depend on an intact RH. To determine if such cues are facilitatory to LH and RH stroke survivors, we compared discourse comprehension between the groups across 3 conditions. We hypothesized that RH participants would not benefit as much from these cues as LH participants due to concomitant impairments in recognition of prosody and facial expression. We assessed 72 stroke survivors within 3 months of unilateral ischemic stroke, including 40 LH (15 female; aged 62±13 yrs) and 32 RH (17 female; aged 68±10 yrs), and 29 healthy controls (19 female; aged 72±15 yrs). Participants listened to a series of recorded spoken descriptions of scenarios and selected 1 picture from 4 to match each scenario. Targets and foils were balanced across spatial positions. Each description was presented in 3 conditions: read with neutral prosody (Trial 1), read with emotional prosody (Trial 2), and read with emotional prosody + facial expressions (Trial 3, audio + video). If 100% accuracy was achieved on a trial, the next trial was not presented. We used a Kruskal-Wallace test and paired samples t -tests for analyses and corrected for multiple comparisons. Accuracy differed significantly between groups on Trial 1, H (2) = 26.68, p < .001. Controls achieved higher accuracy than LH ( p < .01) and RH participants ( p < .01). LH and RH participants did not differ, p = .51. LH participants achieved significant gains in accuracy from Trial 1 to 2 ( t (32) = 4.16, p = .001) and from Trial 1 to 3 ( t (32) = 5.49, p < .001), but not from Trial 2 to 3 ( t (32) = 1.79, p = .08). RH participants did not achieve significant gains in accuracy from Trial 1 to 2 ( t (23) = 1.59, p = .13), Trial 2 to 3 ( t (23) = 0, p = 1.0), or Trial 1 to 3 ( t (23) = 1.21, p = .24). To conclude, emotional prosody and facial expressions significantly improved discourse comprehension for LH but not for RH stroke survivors. Different/additional strategies to improve discourse comprehension after RH stroke are needed.

(Micro)saccade-related potentials during face recognition: A study combining EEG, eye-tracking, and deconvolution modeling.

Under natural viewing conditions, complex stimuli such as human faces are typically looked at several times in succession, implying that their recognition may unfold across multiple eye fixations. Although electrophysiological (EEG) experiments on face recognition typically prohibit eye movements, participants still execute frequent (micro)saccades on the face, each of which generates its own visuocortical response. This finding raises the question of whether the fixation-related potentials (FRPs) evoked by these tiny gaze shifts also contain psychologically valuable information about face processing. Here, we investigated this question by corecording EEG and eye movements in an experiment with emotional faces (happy, angry, neutral). Deconvolution modeling was used to separate the stimulus ERPs to face onset from the FRPs generated by subsequent microsaccades-induced refixations on the face. As expected, stimulus ERPs exhibited typical emotion effects, with a larger early posterior negativity (EPN) for happy/angry compared with neutral faces. Eye tracking confirmed that participants made small saccades in 98% of the trials, which were often aimed at the left eye of the stimulus face. However, while each saccade produced a strong response over visual areas, this response was unaffected by the face's emotional expression, both for the first and for subsequent (micro)saccades. This finding suggests that the face's affective content is rapidly evaluated after stimulus onset, leading to only a short-lived sensory enhancement by arousing stimuli that does not repeat itself during immediate refixations. Methodologically, our work demonstrates how eye tracking and deconvolution modeling can be used to extract several brain responses from each EEG trial, providing insights into neural processing at different latencies after stimulus onset.

An ERP Study of Face Processing in Schizophrenia, Bipolar Disorder, and Socially Isolated Individuals from the Community.

People with schizophrenia (SCZ) and bipolar disorder (BD) have impairments in processing social information, including faces. The neural correlates of face processing are widely studied with the N170 ERP component. However, it is unclear whether N170 deficits reflect neural abnormalities associated with these clinical conditions or differences in social environments. The goal of this study was to determine whether N170 deficits would still be present in SCZ and BD when compared with socially isolated community members. Participants included 66 people with SCZ, 37 with BD, and 125 community members (76 "Community-Isolated"; 49 "Community-Connected"). Electroencephalography was recorded during a face processing task in which participants identified the gender of a face, the emotion of a face (angry, happy, neutral), or the number of stories in a building. We examined group differences in the N170 face effect (greater amplitudes for faces vs buildings) and the N170 emotion effect (greater amplitudes for emotional vs neutral expressions). Groups significantly differed in levels of social isolation (Community-Isolated > SCZ > BD = Community-Connected). SCZ participants had significantly reduced N170 amplitudes to faces compared with both community groups, which did not differ from each other. The BD group was intermediate and did not differ from any group. There were no significant group differences in the processing of specific emotional facial expressions. The N170 is abnormal in SCZ even when compared to socially isolated community members. Hence, the N170 seems to reflect a social processing impairment in SCZ that is separate from level of social isolation.

The role of the differential outcomes procedure and schizotypy in the recognition of dynamic facial expressions of emotions

Emotional facial expression recognition is a key ability for adequate social functioning. The current study aims to test if the differential outcomes procedure (DOP) may improve the recognition of dynamic facial expressions of emotions and to further explore whether schizotypal personality traits may have any effect on performance. 183 undergraduate students completed a task where a face morphed from a neutral expression to one of the six basic emotions at full intensity over 10 s. Participants had to press spacebar as soon as they identified the emotion and choose which had appeared. In the first block, participants received no outcomes. In the second block, a group received specific outcomes associated to each emotion (DOP group), while another group received non-differential outcomes after correctly responding (NOP group). Employing generalized linear models (GLMs) and Bayesian inference we estimated different parameters to answer our research goals. Schizotypal personality traits did not seem to affect dynamic emotional facial expression recognition. Participants of the DOP group were less likely to respond incorrectly to faces showing Fear and Surprise at fewer intensity levels. This may suggest that the DOP could lead to better identification of the main features that differentiate each facial expression of emotion.

Developing conversational Virtual Humans for social emotion elicitation based on large language models

Emotions play a critical role in numerous processes, including, but not limited to, social interactions. Consequently, the ability to evoke and recognize emotions is a challenging task with widespread implications, notably in the field of mental health assessment systems. However, up until now, emotional elicitation methods have not utilized simulated open social conversations. Our study introduces a comprehensive Virtual Human (VH), equipped with a realistic avatar and conversational abilities based on a Large Language Model. This architecture integrates psychological constructs – such as personality, mood, and attitudes – with emotional facial expressions, lip synchronization, and voice synthesis. All these features are embedded into a modular, cognitively-inspired framework, specifically designed for voice-based semi-guided emotional conversations in real time. The validation process involved an experiment with 64 participants interacting with six distinct VHs, each designed to provoke a different basic emotion. The system took an average of 4.44 s to generate the VH’s response. Participants assessed the naturalness and realism of the conversation, scoring averages of 4.61 and 4.44 out of 7, respectively. The VHs successfully generated the intended emotional valence in the users, while arousal was not evoked, though it could be recognized in the VHs. Our findings underscore the feasibility of employing VHs within affective computing to elicit emotions in socially and ecologically valid contexts. This development holds significant potential for application in sectors such as health, education, and marketing, among others.

Perceptual integration of bodily and facial emotion cues in chimpanzees and humans.

For highly visual species like primates, facial and bodily emotion expressions play a crucial role in emotion perception. However, most research focuses on facial expressions, while the perception of bodily cues is still poorly understood. Using a novel comparative priming eye-tracking design, we examined whether our close primate relatives, the chimpanzees (Pan troglodytes), and humans infer emotions from bodily cues through subsequent perceptual integration with facial expressions. In experiment 1, we primed chimpanzees with videos of bodily movements of unfamiliar conspecifics engaged in social activities of opposite valence (play and fear) against neutral control scenes to examine attentional bias toward succeeding congruent or incongruent facial expressions. In experiment 2, we assessed the same attentional bias in humans yet using stimuli showing unfamiliar humans. In experiment 3, humans watched the chimpanzee stimuli of experiment 1, to examine cross-species emotion perception. Chimpanzees exhibited a persistent fear-related attention bias but did not associate bodily with congruent facial cues. In contrast, humans prioritized conspecifics' congruent facial expressions (matching bodily scenes) over incongruent ones (mismatching). Nevertheless, humans exhibited no congruency effect when viewing chimpanzee stimuli, suggesting difficulty in cross-species emotion perception. These results highlight differences in emotion perception, with humans being greatly affected by fearful and playful bodily cues and chimpanzees being strongly drawn toward fearful expressions, regardless of the preceding bodily priming cue. These data advance our understanding of the evolution of emotion signaling and the presence of distinct perceptual patterns in hominids.

Facial emotion recognition deficits are associated with hypomimia and related brain correlates in Parkinson's disease.

Hypomimia is a frequent manifestation in Parkinson's disease (PD) that can affect interpersonal relationships and quality of life. Recent studies have suggested that hypomimia is not only related to motor dysfunction but also to impairment in emotional processing networks. Therefore, we hypothesized that the severity of hypomimia could be associated with performance on a task aimed at assessing facial emotion recognition. In this study, we explored the association between hypomimia, recognition of facial expressions of basic emotions using the Ekman 60 Faces Test (EF), and brain correlates of both hypomimia and performance on the EF. A total of 94 subjects underwent clinical assessments (neurological and neuropsychological examinations), and 56 of them participated in the neuroimaging study. We found significant correlation between hypomimia, EF Disgust (r = -0.242, p = 0.022) and EF Happiness (r = -0.264, p = 0.012); an independent reduction in Cortical Thickness (Cth) in the postcentral gyrus, insula, middle and superior temporal gyri, supramarginal gyrus, banks of the superior temporal sulcus, bilateral fusiform gyri, entorhinal cortex, parahippocampal gyrus, inferior and superior parietal cortex, and right cuneus and precuneus; and multiple correlations between negative emotions such as EF Disgust or EF Anger and a reduced Cth in fronto-temporo-parietal regions. In conclusion, these results suggest that the association between hypomimia and emotion recognition deficits in individuals with PD might be mediated by shared circuits, supporting the concept that hypomimia is not only the result of the dysfunction of motor circuits, but also of higher cognitive functions.

The effect of negative emotion processing on spatial navigation: an experimental study using virtual reality.

Finding one's way in unfamiliar environments is an essential ability. When navigating, people are overwhelmed with an enormous amount of information. However, some information might be more relevant than others. Despite the mounting knowledge about the mechanisms underlying orientational skills, and the notable effects of facial emotions on human behavior, little is known about emotions' effects on spatial navigation. Hereby, this study aimed to explore how exposure to others' negative emotional facial expressions affects wayfinding performances. Moreover, gender differences that characterize both processes were considered. Fifty-five participants (31 females) entered twice in three realistic virtual reality environments: the first time, to encode a route to find an object and then to recall the learned path to reach the same object again. In between the two explorations of the virtual environment, participants were asked to undergo a gender categorization task during which they were exposed to sixty faces showing either neutral, fearful, or angry expressions. Results showed a significant interaction between emotions, time, and gender. In particular, the exposition to fearful faces, but not angry and neutral ones, decreased males' wayfinding performances (i.e., travel times and distance travelled), while females' performances were unaffected. Possible explanations for such gender and emotional dissimilarities are discussed.

Recognizing facial expressions of emotion amid noise: A dynamic advantage.

Humans communicate internal states through complex facial movements shaped by biological and evolutionary constraints. Although real-life social interactions are flooded with dynamic signals, current knowledge on facial expression recognition mainly arises from studies using static face images. This experimental bias might stem from previous studies consistently reporting that young adults minimally benefit from the richer dynamic over static information, whereas children, the elderly, and clinical populations very strongly do (Richoz, Jack, Garrod, Schyns, & Caldara, 2015, Richoz, Jack, Garrod, Schyns, & Caldara, 2018b). These observations point to a near-optimal facial expression decoding system in young adults, almost insensitive to the advantage of dynamic over static cues. Surprisingly, no study has yet tested the idea that such evidence might be rooted in a ceiling effect. To this aim, we asked 70 healthy young adults to perform static and dynamic facial expression recognition of the six basic expressions while parametrically and randomly varying the low-level normalized phase and contrast signal (0%-100%) of the faces. As predicted, when 100% face signals were presented, static and dynamic expressions were recognized with equal efficiency with the exception of those with the most informative dynamics (i.e., happiness and surprise). However, when less signal was available, dynamic expressions were all better recognized than their static counterpart (peaking at ∼20%). Our data show that facial movements increase our ability to efficiently identify emotional states of others under the suboptimal visual conditions that can occur in everyday life. Dynamic signals are more effective and sensitive than static ones for decoding all facial expressions of emotion for all human observers.

Stress and emotion recognition predict the relationship between a history of maltreatment and sensitive parenting behaviors: A moderated-moderation.

Our study proposes to examine how stress and emotion recognition interact with a history of maltreatment to influence sensitive parenting behaviors. A sample of 58 mothers and their children aged between 2 and 5 years old were recruited. Parents' history of maltreatment was measured using the Child Trauma Questionnaire. An emotion recognition task was performed. Mothers identified the dominant emotion in morphed facial emotion expressions in children. Mothers and children interacted for 15 minutes. Salivary cortisol levels of mothers were collected before and after the interaction. Maternal sensitive behaviors were coded during the interaction using the Coding Interactive Behavior scheme. Results indicate that the severity of childhood maltreatment is related to less sensitive behaviors for mothers with average to good abilities in emotion recognition and lower to average increases in cortisol levels following an interaction with their children. For mothers with higher cortisol levels, there is no association between a history of maltreatment and sensitive behaviors, indicating that higher stress reactivity could act as a protective factor. Our study highlights the complex interaction between individual characteristics and environmental factors when it comes to parenting. These results argue for targeted interventions that address personal trauma.

Altered attentional processing of facial expression features in severe alcohol use disorder: An eye-tracking study.

Social cognition impairments, and notably emotional facial expression (EFE) recognition difficulties, as well as their functional and clinical correlates, are increasingly documented in severe alcohol use disorder (SAUD). However, insights into their underlying mechanisms are lacking. Here, we tested if SAUD was associated with alterations in the attentional processing of EFEs. In a preregistered study, 40 patients with SAUD and 40 healthy controls (HCs) had to identify the emotional expression conveyed by faces while having their gaze recorded by an eye-tracker. We assessed indices of initial (first fixation locations) and later (number of fixations and dwell-time) attention with reference to regions of interest corresponding to the eyes, mouth, and nose, which carry key information for EFE recognition. We centrally found that patients had less first fixations to key facial features in general, as well as less fixations and dwell time to the eyes specifically, relative to the rest of the face, compared to controls. These effects were invariant across emotional expressions. Additional exploratory analyses revealed that patients with SAUD had a less structured viewing pattern than controls. These results offer novel, direct, evidence that patients with SAUD's socioaffective difficulties already emerge at the facial attentional processing stage, along with precisions regarding the nature and generalizability of the effects. Potential implications for the mechanistic conceptualization and treatment of social cognition difficulties in SAUD are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Automatic Assessment Method and Device for Depression Symptom Severity Based on Emotional Facial Expression and Pupil-wave

Automatic Assessment Method and Device for Depression Symptom Severity Based on Emotional Facial Expression and Pupil-wave

Stepping into emotions: investigating the effect of angry and fearful faces on forward stepping and quiet stance.

Facial expressions conveying an emotion may affect social interactions, such as approach- or avoidance-related behaviors. A specific facial feature is the gaze direction. An emotional facial expression such as anger will elicit distinct behavioral tendencies, depending on whether the angry gaze is directed toward the onlooker, or in a different direction. We tested whether facial expressions of anger and fear, combined with direct or averted gaze, elicit approach- or avoidance tendencies, using a go/no-go variant of the whole-body stepping task. Healthy adults stood on a force plate, recording the center of pressure (COP). Participants were presented with angry or fearful faces; either with direct or averted gaze. Participants had to identify the emotion, and "depending on instructions- either make a single step forward, or remain in a quiet stance. From the COP of the forward steps, we derived parameters such as reaction time and step size. From the quiet standing trials we derived parameters of postural sway, indicative of postural "freeze." We used analysis of variance to analyze the outcomes. First, we found that steps were initiated faster with angry faces than with fearful faces, in line with existing literature. Second, we did not observe a significant effect of gaze direction. Forward steps with direct and averted gaze had similar COP characteristics. Finally, we had expected to find freeze (postural immobility) with fearful faces, but this was also not observed. We discuss various explanations for the finding, and implications for research into the motoric grounding of social interactions.

Emotion Comprehension and Socio-cognitive Skills in Children with High Functioning Autism Spectrum Disorders.

This study aimed to compare socio-cognitive skills and emotion comprehension between children with Autism Spectrum Disorder (ASD) and children with neurotypical development. This quantitative, cross-sectional, controlled study involved 19 children in each group, matched by age (6-12 years) and sex. The assessments examined cognitive aspects (Intelligence Quotient was assessed using the Vocabulary and Matrix Reasoning subtests; working memory using the digit span and letter-number sequencing subtests; attention using the Continuous Performance Test - Identical Pairs; and executive functions using the Trail Making Test), social functions (Children's Social Skills, Behavior Problems, and Academic Competence Inventory), and emotion comprehension (language was assessed using the Strange Stories Test; emotional facial expressions using the digital emotion comprehension test; emotional/affective prosody using the Profiling Elements of Prosody in Speech-Communication - Brazilian Portuguese adapted version). The group with ASD exhibited better performance in executive functions (p=0.02). However, they lagged the control group in social skills (p=0.04), behavior problems (p=0.03), and emotion comprehension (language, facial expressions, and prosody) (all p<0.05). The findings indicate that children with ASD have diminished performance in social skills and emotion comprehension compared to children with neurotypical development. Therefore, the development of technologies and/or therapeutic interventions that address these deficits among children with ASD is recommended.

Supplemental Material for Role of Contingency in Reward–Emotion Interactions During the Categorization of Emotional Facial Expressions

Supplemental Material for Role of Contingency in Reward–Emotion Interactions During the Categorization of Emotional Facial Expressions

Does emotional valence affect cognitive performance and neurophysiological response during decision making? A preliminary study.

This study investigated the impact of the emotional valence of external situations (EVES) on cognitive performance and electrophysiological (EEG) responses during decision-making. 26 healthy adults underwent a modified version of the Trier social stress test, performing five interview-style discourses. Each discourse entailed preparing a speech under increasingly stressful conditions. Participants were also exposed to gradually increasing EVES (i.e., an examining committee displaying progressively more negative-connoted emotional facial expressions). In addition, after each speech, participants completed an arithmetic task to test how emotional manipulation affected cognitive performance. Behavioral data (preparation times) and EEG data (frequency bands) were collected to assess stress regulation, stress resilience, and cognitive performance. The results indicate that EVES significantly influenced stress regulation and resilience, as reflected in the behavioral data. Neurophysiological findings showed increased parietal lobe activity (P4) in the theta and delta bands with rising emotional valence, plateauing from the preparation of the second discourse onward. This suggests enhanced emotional processing and attentional demands. However, gamma band activity decreased in P4 during the preparations for the two discourses following the first, indicating a shift of cognitive resources from higher cognitive functions to emotional processing. This highlights the cognitive cost of maintaining performance and stress regulation under emotionally charged conditions. Such findings suggest that emotional valence modulates cognitive performance and that specific neural mechanisms are involved in managing stress responses. The findings underscore the complex relationship between emotion, cognition, and neural mechanisms, offering valuable insights for stress regulation and resilience, and enhancing performance under pressure.

Rational and Continuous Measurement of the Emotional Decision Making in Visual Recognition of Facial Emotional Expressions with M.A.R.I.E.: First Half

Rational and Continuous Measurement of the Emotional Decision Making in Visual Recognition of Facial Emotional Expressions with M.A.R.I.E.: First Half

The effects of online facial muscle training with resonance vocalization on mental health in postpartum women: A single-arm pilot study.

Mental health problems among expectant and nursing mothers also affect their infants, partners, and families. While physical activity is a potential method for preventing postpartum depression (PPD), it is difficult for postpartum women to find the time for physical exercise. A recent study reported that improving communication between expectant couples can be used as a preventive intervention for PPD, and a systematic review and meta-analysis recently reported decreased facial emotional expressivity in individuals with different non-psychotic disorders. Therefore, we focused on facial muscle training and its potential as prevention for PPD. We evaluated the effectiveness of online facial muscle training with resonance vocalization using real-time video conferencing programs on the PPD of postpartum women at 2-3 months. We recruited 20 postpartum women and used a single-arm, prospective, pre-post design. All subjects participated in 30 min of online facial muscle training with resonance vocalization once a week for 4 weeks. The first and final sessions were performed using a real-time remote chat application, and the second and third sessions were performed on demand. Scores on the Edinburgh Postnatal Depression Scale (EPDS) as an indicator of PPD were used as the primary outcome. Secondary outcomes included the appearance ratio of a happy facial expression, analyzed using FaceReader™; mood, which was measured using a visual analog scale; and stress level, which was measured using a smartwatch. The training had a significant effect on EPDS, appearance ratio of a happy facial expression, and mood; however, it did not affect physical stress. In the future, intervention studies with a higher evidence level, such as a crossover randomized controlled trial, are required.

Risk, Trust, and Emotion in Online Pharmacy Medication Purchases: Multimethod Approach Incorporating Customer Self-Reports, Facial Expressions, and Neural Activation.

Online pharmacies are used less than other e-commerce sites in Germany. Shopping behavior does not correspond to consumption behavior, as online purchases are predominantly made for over-the-counter (OTC) medications. The objective of this study was to understand the purchasing experiences of online pharmacy customers in terms of critical factors for online pharmacy adoption. This study examined the perceived risk, perceived trust, and emotions related to purchasing medications online and, consequently, the purchase intention toward online pharmacies. In a within-subjects design (N=37 participants), 2 German online pharmacies with different perceptions of risk and trust were investigated for their main business, namely OTC and prescription drugs. The results of a preliminary study led to 1 online pharmacy with high and 1 with significantly low self-reported risk by the prestudy sample. Emotions were measured with a multimethod approach during and after the purchase situation as follows: (1) neural evaluation processes using functional near-infrared spectroscopy, (2) the automated direct motor response during the use of the online pharmacy via facial expression analysis (FaceReader), and (3) subjective evaluations through self-reports. Following the shopping experiences at both pharmacies for both product types, risk, trust, and purchase intention toward the pharmacies were assessed using self-assessments. The 2 online pharmacies were rated differently in terms of risk, trust, emotions, and purchase intention. The high-risk pharmacy was also perceived as having lower trust and vice versa. Significantly stronger negative emotional expressions on customers' faces and different neural activations in the ventromedial prefrontal cortex and dorsomedial prefrontal cortex were measured when purchasing prescription drugs from the high-risk pharmacy than from the low-risk pharmacy, combined with OTC medications. In line with this, customers' self-ratings indicated higher negative emotions for the high-risk pharmacy and lower negative emotions for the low-risk pharmacy. Moreover, the ratings showed lower purchase intention for the high-risk pharmacy. Using multimethod measurements, we showed that the preceding neural activation and subsequent verbal evaluation of online pharmacies are reflected in the customers' immediate emotional facial expressions. High-risk online pharmacies and prescription drugs lead to stronger negative emotional facial expressions and trigger neural evaluation processes that imply perceived loss. Low-risk online pharmacies and OTC medications lead to weaker negative emotional facial expressions and trigger neural evaluation processes that signify certainty and perceived reward. The results may provide an explanation for why OTC medications are purchased online more frequently than prescription medications.