Keep smiling! Facial reactions to emotional stimuli and their relationship to emotional contagion in patients with schizophrenia

Introduction Emotional contagion is a common phenomenon in verbal and nonverbal communication between individuals. Perception and mimicry of facial movements play an important role in this process. Several studies have demonstrated impaired facial expression recognition in patients with schizophrenia and differences in their facial behavior compared to healthy subjects, but so far, the relationship between facial mimicry and emotional contagion has not been studied in this group. Methods Seventeen schizophrenic patients and an equal number of matched healthy controls were presented with digital versions of happy, sad and neutral faces from the "Pictures of facial affect" (Ekman and Friesen, Consulting Psychologists Press, Palo Alto, 1976) and were asked to pull their lip corners up or down (like in smiling or showing a sad face) according to the direction of two arrows that were presented simultaneously. In healthy subjects, congruous movements (i.e. pulling the lip corners up when seeing a happy face or pulling them down when seeing a sad face) are facilitated and dissonant movements are inhibited; these tendencies were considered as indicators of emotional contagion. Results In schizophrenic patients, these tendencies were significantly diminished. The patients were more apt to display a smile as a reaction to a sad face. We found a positive correlation between these effects and the PANSS-Scores for General Psychopathology. Discussion Patients' tendencies towards positive reactions even when a negative stimulus was presented could function as a protective mechanism against overwhelming emotional experiences.