In our longitudinal study, we examined self-reported or explicit basic emotions, i.e., happiness, sadness, anxiety, and anger, in depressed patients during acute illness and inpatient treatment. For exploratory purposes, we also assessed implicit emotions. We analyzed how changes in emotional clarity relate to changes in emotions and depressive symptoms. A sample of depressed inpatients (n = 52) was examined at admission and on average after seven weeks of multimodal psychiatric treatment. A healthy control group (n = 52) was tested at the same time interval. Basic emotions were measured via the Differential Emotions Scale and a discrete-emotions variant of the Implicit Positive and Negative Affect Test. Emotional clarity was measured with the WEFG scales. Patients reported lower explicit happiness and heightened explicit sadness, anxiety, and anger compared to healthy controls, regardless of time of measurement. Across groups and time points, implicit happiness was greater than implicit sadness, anxiety, and anger, with no group differences. Patients’ emotional clarity improved and correlated with improvements in depressive symptoms, explicit happiness, sadness, and implicit anger. In summary, depressed patients experience heightened anxiety and anger, suggesting broader alterations of negative emotions beyond sadness. Increased emotional clarity during treatment was found to be correlated with changes in explicit and implicit affectivity.

Individuals differ in their susceptibility to emotional contagion, i.e., the automatic tendency to mirror and synchronize another person's expressions and movements, resulting in shared emotional experiences. The objective of this research was to investigate how susceptibility to emotional contagion connects to automatic facial emotion processing and emotional competences. An affective priming task using happy, angry, neutral, and blank faces was administered to a sample of 104 women with a mean age of 24.72 years (SD = 3.63). They completed self-report measures assessing susceptibility to positive and negative emotional contagion, alexithymia, trait emotional intelligence, affectivity, and depression. Although prime valence-congruent evaluative shifts were found in our sample, there were no correlations of susceptibility to positive and negative emotional contagion with affective priming effects. Susceptibility to positive emotion contagion was negatively correlated with alexithymia and positively with emotional intelligence. However, susceptibility to positive emotion contagion predicted only emotional intelligence (but not alexithymia), when controlling for relevant affect variables. Our findings indicate that emotional contagion susceptibility could be less strongly linked to automatic emotion perception than previously suggested. Moreover, the trait-like tendency to resonate with other people's positive emotions seems to be linked to enhanced capacities in perceiving, interpreting, and regulating emotions.

Social anxiety involves persistent fears of social situations and a heightened sensitivity to signs of disapproval. Eye-tracking studies involving socially anxious individuals without clinical diagnoses have yielded heterogeneous results regarding alterations of attentional processes. Cognitive models of anxiety propose that early, automatic processes play a crucial role in attentional orientation. To date, no eye-tracking research has explored the relationship between social anxiety and the automatic processing of facial stimuli preceded by masked emotional expressions using eye-tracking technology. To address this research gap, the present study examined gaze orientation toward pairs of happy faces as a function of prime emotion and social anxiety in 105 healthy women. Happy faces were primed with angry, disgusted, happy, or neutral expressions (prime presentation duration: 50 ms). Subjective non-awareness of emotional primes was assessed by interview. The participants had the task to make dichotomous authenticity choices concerning happy facial expressions. Socially anxious tendencies were not correlated with authenticity judgments or initial attention allocation toward happy faces as a function of prime emotion. However, dwell time on happy faces preceded by very brief displays of anger and disgust was negatively correlated with socially anxious tendencies. Heightened social fears in women seem associated with avoidance tendencies with regard to happy faces that briefly show a threatening expression. These results align with the hypothesis that individuals with high social anxiety exhibit avoidance of threatening stimuli at later processing stages and suggest that these avoidance tendencies may occur even when the threatening information was perceived automatically.

Socially anxious individuals are characterized by higher social fears and a sensitivity to signals of rejection. Eye-tracking studies in socially anxious participants without clinical diagnoses provided mixed findings on altered attentional processes. Investigations of gaze behavior in response to socially threatening scenes are scarce. By using eye-tracking technology in a free-viewing task, the present study examined in 108 healthy women the relationship between socially anxious tendencies and gaze orientation to anger and disgust faces and social scenes paired with neutral stimuli. The Liebowitz Social Anxiety Scale (LSAS) was used to assess social anxiety. Picture pairs were presented for 8000 ms to examine early (probability of first fixation) and late (dwell time) parameters of attention. To induce experiences of failure, participants were confronted with a social stressor. Social anxiety was not related to an initial attention orientation bias toward threatening stimuli, relative to neutral stimuli. However, dwell time bias for anger and disgust faces was negatively correlated with social anxiety. In non-patients, social fears and resulting avoiding behavior seem to go along with turning one’s attention away from negative facial expressions and more toward neutral stimuli. This attention pattern was not observed for socially threatening scenes. For faces, our results support the assumption of avoidance of threatening stimuli at later processing stages in high social anxiety. Alternatively, socially anxious individuals may show a relative attentional preference for neutral faces when they are shown simultaneously with threatening faces.

A recent study investigated the relationship between childhood trauma and attention to emotions as a function of type and severity of maltreatment in a sample of women. It was found that high levels of physical and emotional abuse severity were associated with a diminished attentional preference for happy faces. Given that men exhibit distinct patterns of childhood maltreatment and often show lower accuracy and attention toward facial emotions compared to women, investigating these relationships specifically in male populations is warranted. In the present study, we examined the relationship between childhood trauma and attention to emotions in a sample of men. Gaze behavior of 98 men with a history of childhood trauma was analyzed in a free-viewing task. Pairs of faces with an emotional (happy, surprised, angry, disgusted, fearful, and sad) and a neutral face were shown for 5 s. An attentional bias score was calculated by subtracting the total fixation duration on the neutral face from that on the emotional face. To assess childhood maltreatment experiences, the Childhood Trauma Questionnaire was employed. Linear mixed models were used to investigate research questions. The attentional bias scores exhibited high reliability. For all emotion categories, participants looked longer at the emotional compared to the neutral face. The highest attentional preference was found for happy faces. Results indicated neither a significant main effect of childhood maltreatment type, nor a significant interaction effect between childhood maltreatment type and emotion category. Similarly, no main effect or interaction involving overall childhood maltreatment severity was found. The present findings reveal no significant relationship between childhood experiences of maltreatment (including emotional, sexual, and physical abuse, as well as emotional neglect) and visual attention to facial emotions in men. Our data do not support the hypothesis that early life trauma may lead to alterations in attentional processing of emotional facial expressions in men.

BackgroundLong-term cognitive-affective impairments could be a significant outcome of childhood maltreatment. According to trait models of emotional intelligence, experiential abilities (emotion perception and thought facilitation through emotion) are distinguished from strategic abilities (understanding and managing emotion). In a previous study including only women with adverse childhood experiences, childhood emotional neglect was found to be linked to a diminished capacity to understand own feelings in adulthood. In the current study, relationships between childhood maltreatment experiences and trait emotional intelligence in adulthood were investigated in a sample of men.Materials and methodsThe sample comprised 97 young men maltreated during childhood. The Childhood Trauma Questionnaire (CTQ) was administered to identify a history of childhood trauma. The Self-Rated Emotional Intelligence Scale (SREIS) was used to assess trait emotional intelligence. Tests measuring verbal intelligence, cognitive flexibility, trait anxiety, and depressive symptoms were also administered.ResultsEmotional neglect showed a negative correlation with the SREIS subscale Managing emotion (self). No other CTQ scale was correlated with the SREIS. Depressive symptoms predicted poor emotion management. Regression analysis revealed that emotional neglect was a predictor of managing one’s emotions independent of verbal intelligence, cognitive flexibility, trait anxiety, and depressive symptoms.DiscussionIn men, experiences of emotional neglect during childhood but not of other maltreatment types seem to be associated with a diminished ability to manage one’s emotions in adulthood. The present findings support the idea of a strategic emotional intelligence vulnerability following emotional neglect.

Affective egocentricity, the tendency to project one’s own affect onto others, appears reduced in those with alexithymia, a condition often linked to autism. This study investigated the relationship between self-reported affectivity (implicit and explicit) and emotion perception (accuracy, perceived intensity) as well as facial muscle responses (corrugator supercilii, zygomaticus major) in autism. Autistic adults (N = 40) and a non-autistic comparison group (N = 40) watched facial expressions whilst recorded (fEMG) and judged the stimuli afterwards. For explicit affect, non-autistic participants showed affective egocentricity, with positive state affect linked to lower accuracy in recognizing angry expressions. In contrast, autistic participants showed an altered pattern, where positive state affect was associated with improved recognition of angry and fearful faces. For implicit affect, autistic participants showed an affect-incongruent link between negative affect and lower perceived intensity of fearful faces. When controlling for alexithymia, explicit state affect differences became more pronounced, but non-significant for implicit affect. These findings offer new insights into how affect shapes social perception in autism differently and highlight the need to better understand the mechanisms underlying these differences and their potential strengths.

Borderline personality disorder (BPD) is associated with alterations in emotion processing. To date, no study has tested automatic emotion perception under conditions of unawareness of emotion stimuli. We administered a priming paradigm based on facial expressions and measured judgmental and gaze behavior during an evaluation task. A total of 31 patients with BPD and 31 non-patients (NPs) viewed a briefly shown emotional (angry, fearful, sad, or happy) or neutral face followed by a neutral facial expression (target). Areas of interest (AOI) were the eyes and the mouth. All participants included in our analysis were subjectively unaware of the emotional primes. Concerning evaluative ratings, no prime effects were observed. For early dwell time, a significant interaction between prime category and AOI was found. Both BPD patients and NPs dwelled longer on the eyes after the presentation of angry and fearful primes than of happy primes and dwelled longer on the mouth after the presentation of happy primes than of sad and neutral primes. Patients rated target faces more negatively. BPD patients, when compared to NPs, seem not to show alterations in automatic attention orienting due to covert facial emotions. Regardless of primes, individuals with BPD seem to be characterized by an increased negative interpretation of neutral facial expressions.

Trait anger is defined as a personality dimension of anger proneness. Previous research based on multimodal stimuli suggests that trait anger could be linked to poor emotion decoding. The present investigation examined the relationship between trait anger and emotion decoding ability for men and women. An emotion recognition task with images of emotional faces expressing anger, disgust, fear, sadness, surprise, or happiness was administered to 249 young adults (125 women). Participants completed the State–Trait Anger Expression Inventory (STAXI-2) along with other self-report instruments. Unbiased hit rate was calculated to assess emotion recognition accuracy. Women reported more trait anger than men. In men, but not in women, trait anger was related to negative affect variables. There were no sex differences in decoding facial emotions. For men, trait anger was negatively correlated with overall emotion recognition performance and specifically with the recognition of fear and disgust—even when controlling for relevant person variables. For women, trait anger was not related to facial emotion recognition. Compared to men with low trait anger, men with high trait anger appear to be worse at recognizing facial expressions of fear and disgust, which are negative emotions indicating being threatened or rejection.

Background:Research on the long-term consequences of childhood maltreatment underscores its contribution to impairments in cognitive-affective functions. According to trait models, emotional intelligence is subdivided into experiential abilities (emotion perception and thought facilitation through emotion) and strategic abilities (understanding and managing emotion). In the present study, we examined the relationship of emotional and other forms of childhood maltreatment with overall trait emotional intelligence and its specific facets in women with adverse childhood experiences. Materials and Methods:Our sample consisted of ninety-seven young women with experiences of childhood maltreatment as assessed with the Childhood Trauma Questionnaire (CTQ). Trait emotional intelligence was measured using the Self-Rated Emotional Intelligence Scale (SREIS). Participants' verbal intelligence, cognitive flexibility, trait anxiety, and depressive symptoms were also assessed. Results:Emotional neglect was negatively correlated with the SREIS subscale Understanding emotions. Regression analysis indicated that emotional neglect was a significant predictor of understanding emotion independent of women's verbal intelligence, cognitive flexibility, trait anxiety, and depressive symptoms. Neither emotional abuse nor other CTQ subscales showed correlations with any of the SREIS scores. Discussion:Experiences of emotional neglect during childhood but not of other types of maltreatment seem to go along with a decreased ability to understand and verbalize emotional states in adulthood. Thus, early emotional neglect could have an impact on strategic emotional abilities. Emotional neglect may have a greater effect on the development and expression of emotional intelligence than emotional abuse.

Little eye-tracking research has been conducted so far on the association of subtypes of childhood maltreatment and habitual emotion regulation with attention to emotions. To address this issue, gaze behavior of one hundred women with experiences of childhood maltreatment was examined in a free-viewing task in which pairs of faces consisting of an emotional (happy, surprised, angry, disgusted, fearful, and sad) and a neutral face were displayed. Participants’ childhood maltreatment experiences, emotion regulation strategies (reappraisal and suppression), anxiety, depression, stress perception, level of alexithymia, and intelligence were assessed. Fixation durations were used to assess attentional bias. A mixed linear model with post-hoc pairwise comparisons was used to investigate research questions. Results indicated that, at high levels of maltreatment severity, attentional preference for positive over other emotional faces was found to be diminished for physical and emotional abuse but not for emotional neglect. At a severe level of emotional abuse, a bias away from disgusted faces was observed. Suppression was linked to reduced and reappraisal was related to heightened attention allocation to facial emotions. Our data indicates that attention to social emotional information in adulthood could depend on the type and severity of childhood trauma and habitual emotion regulation strategy.

Attention orientation toward positive stimuli may have mood-protective or mood-enhancing effects. Eye-tracking is an increasingly administered method to assess biased attention allocation and maintenance. In the present paper, we point to an underestimated but reliable method of eye-tracking research for measuring positive attentional bias and its temporal dynamics: the free-viewing paradigm. To date, few free-viewing eye-tracking studies have specifically examined positive attentional biases in healthy individuals. Against this background, we summarize findings from clinical and subclinical eye-tracking research using free viewing in healthy control groups. We discuss the observed time courses of positive attentional biases during experimental trials, which vary depending on type and number of presented stimuli, and make recommendations on which experimental conditions appear to be favorable for capturing dynamic time courses of positive attentional biases. We identify various individual difference factors that may influence the magnitude of positive attentional biases and should be considered in future studies. Time course analyses of eye-tracking data offer the opportunity to learn more about the time of onset and extent of increase in attention to positive information during free viewing and their relationships to individual difference variables. Directions for future research on positive attentional biases are discussed.

BackgroundAlexithymia is a risk factor for emotional disorders and is characterized by differences in automatic and controlled emotion processing. The multi-stimulus free-viewing task has been used to detect increased negative and reduced positive attentional biases in depression and anxiety. In the present eye-tracking study, we examined whether lexical emotional priming directs attention toward emotion-congruent facial expressions and whether alexithymia is related to impairments in lexical priming and spontaneous attention deployment during multiple face perception.Materials and methodsA free-viewing task with happy, fearful, angry, and neutral faces shown simultaneously was administered to 32 alexithymic and 46 non-alexithymic individuals along with measures of negative affect and intelligence. Face presentation was preceded by masked emotion words. Indices of initial orienting and maintenance of attention were analyzed as a function of prime or target category and study group.ResultsTime to first fixation was not affected by prime category or study group. Analysis of fixation duration yielded a three-way interaction. Alexithymic individuals exhibited no prime or target category effect, whereas non-alexithymic individuals showed a main effect of target condition, fixating happy faces longer than neutral and angry faces and fearful faces longer than angry faces.DiscussionOur results show evidence of attentional biases for positive and fearful social information in non-alexithymic individuals, but not in alexithymic individuals. The lack of spontaneous attentional preference for these social stimuli in alexithymia might contribute to a vulnerability for developing emotional disorders. Our data also suggest that briefly presented emotion words may not facilitate gaze orientation toward emotion-congruent stimuli.

Alexithymia, a multifaceted personality construct, is known to be related to difficulties in the decoding of emotional facial expressions, especially in case of suboptimal stimuli. The present study investigated whether and which facets of alexithymia are related to impairments in the recognition of emotions in faces with face masks. Accuracy and speed of emotion recognition were examined in a block of faces with and a block of faces without face masks in a sample of 102 healthy individuals. The order of blocks varied between participants. Emotions were recognized better and faster in unmasked than in masked faces. Recognition performance was worst and slowest for participants starting the task with masked faces. In the whole sample, there were no correlations of alexithymia facets with accuracy and speed of emotion recognition for masked and unmasked faces. In participants starting the task with masked faces, the facet externally oriented thinking was positively correlated with reaction latencies of correct responses for masked faces. Our findings indicate that an externally oriented thinking style could be linked to a less efficient identification of emotions from faces wearing masks when task difficulty is high and support the utility of a facet approach in alexithymia research.

The present longitudinal investigation had two major goals. First, we intended to clarify whether depressed patients are characterized by impairments of emotional awareness for the self and the other during acute illness and whether these impairments diminish in the course of an inpatient psychiatric treatment program. Previous research based on the performance measure Levels of Emotional Awareness Scale (LEAS) provided inconsistent findings concerning emotional self-awareness in clinical depression. Second, we investigated whether cognitive and affective empathic abilities change from acute illness to recovery in depressed patients. Fifty-eight depressed patients were tested on admission and after 6–8 weeks of inpatient psychiatric treatment. A sample of fifty-three healthy individuals were also examined twice at an interval of 6–8 weeks. The LEAS and the Interpersonal Reactivity Index (IRI) were administered to assess emotional awareness and empathic abilities. Written texts were digitalized and then analyzed using the electronic scoring program geLEAS, the German electronic Levels of Emotional Awareness Scale. Depressed patients reported more depressive symptoms than healthy controls and less severe depressive symptomatology at time 2 compared to time 1. Independent of time, depressed individuals tended to show lower geLEAS self scores and had lower geLEAS other scores than healthy individuals. Depressed patients showed higher personal distress scores than healthy individuals at both measurement times. No group differences were observed for the cognitive empathy scales of the IRI (perspective taking and fantasy) and empathic concern, but empathic concern decreased significantly in depressed patients from time 1 to time 2. Empathic abilities as assessed by the IRI were not significantly correlated with emotional awareness for others, neither in the whole sample, nor in the patient and control subsample. Depressed patients seem to be characterized by impairments in emotional awareness of others during acute illness and recovery, but they also tend to show deficits in emotional self-awareness compared to healthy individuals. Self-reported cognitive empathic abilities seem to be at normal levels in depressed patients, but their heightened self-focused affective empathy may represent a vulnerability factor for depressive disorders.

BACKGROUND:Attentional processes are important for regulating emotional states and coping with stressful events. Orientation of attention acts as filter for subsequent information processing. So far, only few eye-tracking studies have examined attentional processes during emotion perception in borderline personality disorder (BPD). In these studies, gaze behaviour was analysed during simultaneous or delayed evaluation of single stimuli. The objective of the present eye-tracking study was to investigate early and late attention allocation towards emotional facial expressions in patients with BPD and non-patients (NPs) based on a free-viewing paradigm, which allows to examine processes of self-generated attention deployment. METHODS:In a multiple-stimulus free-viewing task with facial expressions, i.e. happy, angry, sad, and neutral faces, presented simultaneously early and late attentional allocation was analysed in 43 patients with BPD and 43 age- and sex-matched NPs. We assessed study participants' trait anxiety, depressive symptoms, level of alexithymia, traumatic childhood experiences, and borderline symptoms. Entry time was used to measure initial gaze orientation, whereas dwell time was calculated as an index of late attention allocation. RESULTS:As could be expected, patients with BPD reported more anxiety, depressive symptoms, experiences of childhood maltreatment, and showed higher levels of alexithymia than NPs. Patients differed from NPs in dwell time on happy facial expressions but not in dwell time on angry, sad, and neutral expressions. Contrary to our hypothesis, patients did not differ from NPs concerning entry times on angry facial expressions. CONCLUSIONS:According to our results, patients with BPD show a reduced attentional preference for happy facial expression during free viewing compared to NPs. A decreased positive attentional bias at a late processing stage could be part of emotion regulation impairments and add to the vulnerability for negative affects in BPD, which represent core symptoms of the disorder. In contrast to previous eye-tracking research in BPD examining attention during evaluative processing, our dwell time data could be more indicative of self-generated, endogenously controlled attentional processes in emotion perception. The present data do not support an early vigilance for threatening social information in BPD.

Alexithymia is a clinically relevant personality construct characterized by difficulties identifying and communicating one’s emotions and externally oriented thinking. Alexithymia has been found to be related to poor emotion decoding and diminished attention to the eyes. The present eye tracking study investigated whether high levels of alexithymia are related to impairments in recognizing emotions in masked faces and reduced attentional preference for the eyes. An emotion recognition task with happy, fearful, disgusted, and neutral faces with face masks was administered to high-alexithymic and non-alexithymic individuals. Hit rates, latencies of correct responses, and fixation duration on eyes and face mask were analyzed as a function of group and sex. Alexithymia had no effects on accuracy and speed of emotion recognition. However, alexithymic men showed less attentional preference for the eyes relative to the mask than non-alexithymic men, which was due to their increased attention to face masks. No fixation duration differences were observed between alexithymic and non-alexithymic women. Our data indicate that high levels of alexithymia might not have adverse effects on the efficiency of emotion recognition from faces wearing masks. Future research on gaze behavior during facial emotion recognition in high alexithymia should consider sex as a moderating variable.

Biased emotion processing has been suggested to underlie the etiology and maintenance of depression. Neuroimaging studies have shown mood-congruent alterations in amygdala activity in patients with acute depression, even during early, automatic stages of emotion processing. However, due to a lack of prospective studies over periods longer than 8 weeks, it is unclear whether these neurofunctional abnormalities represent a persistent correlate of depression even in remission. In this prospective case-control study, we aimed to examine brain functional correlates of automatic emotion processing in the long-term course of depression. In a naturalistic design, n = 57 patients with acute major depressive disorder (MDD) and n = 37 healthy controls (HC) were assessed with functional magnetic resonance imaging (fMRI) at baseline and after 2 years. Patients were divided into two subgroups according to their course of illness during the study period (n = 37 relapse, n = 20 no-relapse). During fMRI, participants underwent an affective priming task that assessed emotion processing of subliminally presented sad and happy compared to neutral face stimuli. A group × time × condition (3 × 2 × 2) ANOVA was performed for the amygdala as region-of-interest (ROI). At baseline, there was a significant group × condition interaction, resulting from amygdala hyperactivity to sad primes in patients with MDD compared to HC, whereas no difference between groups emerged for happy primes. In both patient subgroups, amygdala hyperactivity to sad primes persisted after 2 years, regardless of relapse or remission at follow-up. The results suggest that amygdala hyperactivity during automatic processing of negative stimuli persists during remission and represents a trait rather than a state marker of depression. Enduring neurofunctional abnormalities may reflect a consequence of or a vulnerability to depression.

Background Eye contact is a fundamental part of social interaction. In clinical studies, it has been observed that patients suffering from depression make less eye contact during interviews than healthy individuals, which could be a factor contributing to their social functioning impairments. Similarly, results from mood induction studies with healthy persons indicate that attention to the eyes diminishes as a function of sad mood. The present screen-based eye-tracking study examined whether depressive symptoms in healthy individuals are associated with reduced visual attention to other persons’ direct gaze during free viewing. Methods Gaze behavior of 44 individuals with depressive symptoms and 49 individuals with no depressive symptoms was analyzed in a free viewing task. Grouping was based on the Beck Depression Inventory using the cut-off proposed by Hautzinger et al. (2006). Participants saw pairs of faces with direct gaze showing emotional or neutral expressions. One-half of the face pairs was shown without face masks, whereas the other half was presented with face masks. Participants’ dwell times and first fixation durations were analyzed. Results In case of unmasked facial expressions, participants with depressive symptoms looked shorter at the eyes compared to individuals without symptoms across all expression conditions. No group difference in first fixation duration on the eyes of masked and unmasked faces was observed. Individuals with depressive symptoms dwelled longer on the mouth region of unmasked faces. For masked faces, no significant group differences in dwell time on the eyes were found. Moreover, when specifically examining dwell time on the eyes of faces with an emotional expression there were also no significant differences between groups. Overall, participants gazed significantly longer at the eyes in masked compared to unmasked faces. Conclusions For faces without mask, our results suggest that depressiveness in healthy individuals goes along with less visual attention to other persons’ eyes but not with less visual attention to others’ faces. When factors come into play that generally amplify the attention directed to the eyes such as face masks or emotions then no relationship between depressiveness and visual attention to the eyes can be established.

BackgroundIndividuals with anxiety disorders (ADs) often display hypervigilance to threat information, although this response may be less pronounced following psychotherapy. This study aims to investigate the unconscious recognition performance of facial expressions in patients with panic disorder (PD) post-treatment, shedding light on alterations in their emotional processing biases.MethodsPatients with PD (n=34) after (exposure-based) cognitive behavior therapy and healthy controls (n=43) performed a subliminal affective recognition task. Emotional facial expressions (fearful, happy, or mirrored) were displayed for 33 ms and backwardly masked by a neutral face. Participants completed a forced choice task to discriminate the briefly presented facial stimulus and an uncovered condition where only the neutral mask was shown. We conducted a secondary analysis to compare groups based on their four possible response types under the four stimulus conditions and examined the correlation of the false alarm rate for fear responses to non-fearful (happy, mirrored, and uncovered) stimuli with clinical anxiety symptoms.ResultsThe patient group showed a unique selection pattern in response to happy expressions, with significantly more correct “happy” responses compared to controls. Additionally, lower severity of anxiety symptoms after psychotherapy was associated with a decreased false fear response rate with non-threat presentations.ConclusionThese data suggest that patients with PD exhibited a “happy-face recognition advantage” after psychotherapy. Less symptoms after treatment were related to a reduced fear bias. Thus, a differential facial emotion detection task could be a suitable tool to monitor response patterns and biases in individuals with ADs in the context of psychotherapy.