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Attempting to conceal one’s true emotion often leads to a split second display of the emotion and is known as a Microexpression. Micro Expression Training Tools (METT) have been developed by Paul Ekman and studies have shown that METT improves emotion recognition in schizophrenia patients. Schizophrenia patients seem to suffer from poor social functioning as they suffer deficits in facial affect recognition. Therefore, METT has been shown to help schizophrenia patients overcome their social functioning problem.

Emotions
Emotions are aroused by environmental stimuli and are part of our automatic body system. Emotions are complicated and involve different bodily systems such as expression, muscular tone, voice and autonomic nervous system activity.

Biological Mechanisms of Emotions
A study was conducted using functional imaging to identify the specific brain areas activated during emotion regulation. While it is a well-known knowledge that emotions activate the amygdala and orbitofrontal cortex, not everyone realizes that different emotions activates different specific brain areas at a different level.

A study by Damasio et al. focuses on the four primary human emotions; sadness, happiness, anger, and fear. Their study highlighted that the following brain structures were involved with expression of those four emotions: cingulate cortex, insular cortex, hypothalamus, secondary somatosensory and nuclei in brainstem tegmentum. They further describe that depending on the emotion, these structures are activated at different levels. During the expression of sadness, the insula, the ventral and medial frontal cortices are involved. In happiness, there is an increase in activity levels in the posterior cingulate and the right secondary somatosensory cortex. In contrast, these same structures are involved in the expression of sadness but in decreased levels of activity instead of an increase.

Activity in the right insula was perceived for fear while activity in the right anterior cingulate was perceived for happiness and anger. In addition, activation was observed in the posterior cingulate for sadness and anger. In the hypothalamus, feeling happy or angry resulted in activation, a positive spike was detected for sadness, and a negative dip for fear. In the orbitofrontal region, sadness displayed an active peak while negativities were displayed for happiness, anger and fear. In the anterior pontine nuclei, it was observed that there is an increased activity when there is sadness and anger, on the contrary, activity level decreases for the same brain areas when there is happiness and fear.

Micro Expression
Microexpressions appear only when one tries to hide his or her own true emotion. The attempt of hiding ones’ true emotion results in an emotional display that is quick and fragmented which is approximately 1/25th of a second. Emotional display which is an external signal, helps to provide information about internal changes in the body system, and is known as micro expression. A few studies have shown that each basic emotions contain a characteristic expression that is universal across cultures. Such basic emotions include anger, contempt, disgust, fear, happiness, sadness and surprise.

Micro Expression Training Tool
Dr. Paul Ekman who is an expert in the area of micro expression has been researching the different aspects of micro expression. Dr. Ekman devised a training tool known as Micro Expression Training Tool (METT) which is available for clinical usage. METT has been used to assist and train clinical patients to improve their capability in recognizing emotions. METT has been divided into five different sections; the pre-test to see how participants fare before the training, a training section, practice examples with feedback to reinforce training materials, review section and a post- test to evaluate if there is an improvement in the participant’s score after the training. As mentioned earlier, emotions are aroused by our environmental stimuli, and when one tries to hide his or her own true emotions, micro expression appears for a fraction of a second. Therefore, the presence of micro expression would indicate the presence of an emotional trigger. METT has been successfully used to train clinical populations who suffer from deficits in emotion recognition. The training enabled them to recognize emotions more accurately.

Schizophrenia
Schizophrenia is a type of mental illness characterized by psychosis, social withdrawal, apathy and cognitive impairment.

Three Broad Types of Symptoms
Schizophrenia patients generally describe three broad types of symptoms: psychotic symptoms, negative symptoms and cognitive impairment.

Psychotic Symptoms
Psychotic symptoms include hallucinations and delusions where schizophrenia patients experience loss of contact with reality. Hallucinations can be in various modals which include, auditory, which is one of the most common symptoms in schizophrenia patients, visual, olfactory, gustatory and tactile.

Negative Symptoms
Negative symptoms pinpoints emotional and behavioural deficits where schizophrenia patients suffer the inability to initiate or follow through a plan. Also, schizophrenia patients have difficulty expressing emotions which leads to monotonous voice tone during conversations.

Cognitive Impairments
Schizophrenia patients face cognitive impairment where they experience difficulties in attention, concentration, learning, memory and executive functions such as abstract thinking and problem solving. Impaired role functioning is one of the diagnosis for schizophrenia patients who face difficulties in their daily life. For example, inability to work, attend school, incapable of forming close relationships and the inability to take care of oneself. Such impairments result in the need for assistance with meeting basic necessities, such as housing, medical care, food and clothing.

Brain Lesions
In the study conducted by Mueser & McGurk (2004), their results seem to indicate an enlargement of the ventricular system, specifically the lateral and third ventricles, in some of the schizophrenia patients compared to control participants. Brain areas including the frontal lobe, amygdala, hippocampus, parahippocampus, thalamus, medial temporal lobe, cingulate gyrus as well as superior temporal gyrus appear to have decreased activity levels in schizophrenia patients compared to control participants. Some of these brain areas like the cingulate gyrus, amygdala and thalamus are also the same brain areas that regulate emotion. Thus this overlap in brain areas might explain why schizophrenia patients have the inability to express emotions and tend to engage in conversations with a monotonous voice tone.

Application in Schizophrenia Population
Studies have shown that schizophrenia patients have trouble with expressing emotions and interacting with people. A study conducted by Russell et al. (2006), incorporated METT into helping schizophrenia patients with improving their emotion recognition performance level.

The study conducted compared control participants with schizophrenia patients. Both groups underwent an emotion matching assessment before micro expression training. Results from the assessment reflected that schizophrenia patients fared poorly at the emotion matching assessment compared to the control participants. The reason suggested for the poor results was due to schizophrenia patients failing to focus on the feature areas of the face (eyes, nose, mouth, etc.) that is central to the processing of emotional faces. Therefore, micro expression training was brought in to help schizophrenia patients to focus their attention on the essential features of the face during the processing of emotional faces, which in turn should help to improve their performance in the emotion matching assessment.

After micro expression training, control participants and schizophrenia patients were requested to go through emotion matching assessment again. Results showed that there was an improvement in the emotion matching assessment for both groups of participants. However, schizophrenia patients still had lower scores compared to control participants even after micro expression training. Nonetheless, while Schizophrenia patients still did not fare as well as control participants even after micro expression training, METT did manage to help schizophrenia patients improve their emotion recognition performance level from pre to post training. This in turn would hopefully lead to better future social interactions.