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A Randomized Controlled Trial of Emotion Recognition Training After Traumatic Brain Injury

Neumann, Dawn PhD; Babbage, Duncan R. PhD; Zupan, Barbra PhD; Willer, Barry PhD

Journal of Head Trauma Rehabilitation: May/June 2015 - Volume 30 - Issue 3 - p E12–E23
doi: 10.1097/HTR.0000000000000054
Original Articles

Objective: To examine the effectiveness of 2 affect recognition interventions (Faces and Stories) in people with a traumatic brain injury.

Setting: Postacute rehabilitation facilities.

Participants: A total of 203 participants with moderate to severe traumatic brain injury were screened; 71 were eligible and randomized to the Faces (n = 24), Stories (n = 23), and Control interventions (n = 24). Participants were an average of 39.8 years of age and 10.3 years postinjury; 74% of participants were male.

Design: Randomized controlled trial with immediate, 3-month, and 6-month follow-up posttests. Interventions were 9 hours of computer-based training with a therapist.

Measures: Diagnostic Assessment of Nonverbal Accuracy 2-Adult Faces; Emotional Inference From Stories Test; Empathy (Interpersonal Reactivity Index); and Irritability and Aggression (Neuropsychiatric Inventory).

Results: The Faces Intervention did significantly better than the Control Intervention on the Diagnostic Assessment of Nonverbal Accuracy 2-Adult Faces (P = .031) posttreatment; no time effect or group interaction was observed. No other significant differences were noted for the Faces Intervention. No significant differences were observed between the Stories and the Control Interventions; however, a significant time effect was found for the Emotional Inference From Stories Test.

Conclusion: The Faces Intervention effectively improved facial affect recognition in participants with chronic post–traumatic brain injury, and changes were maintained for 6 months. Future work should focus on generalizing this skill to functional behaviors.

Supplemental Digital Content is Available in the Text.

Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, and Rehabilitation Hospital of Indiana Indianapolis (Dr Neumann); Auckland University of Technology, Centre for Person Centred Research, Auckland, New Zealand (Dr Babbage); Department of Applied Linguistics, Brock University, St. Catharines, Ontario, Canada (Dr Zupan); and School of Medicine, Department of Psychiatry, The State University of New York, Buffalo, New York (Dr Willer).

Corresponding Author: Dawn Neumann, PhD, Rehabilitation Hospital of Indiana, 4141 Shore Dr, Indianapolis, IN 46254 (

This study is supported by the National Institute on Disability and Rehabilitation Research (grant no. H133G080043).

The authors are indebted to R. C. Gur and colleagues for permission to use their pictures of facial affect in their training program. The authors are also indebted to NIDRR not just for the financial support but also for the willingness to support a multinational research project.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

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