Validation of a Spanish short version of the EMOTICOM battery (VEA-EMTICOM).
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Introduction: Most scales used in the assessment of psychiatric disorders focus on the clinical status of the patient. However, it is important to quantitatively measure specific dimensions, such as cognitive, affective or social functioning, and to record their evolution in the clinical or research setting. The EMOTICOM battery includes four domains of affective cognition; processing of emotions; motivation; impulsivity; and social cognition. Here we present psychometric data from an abbreviated Spanish version (VEA-EMOTICOM). Methodology: The sample included two hundred healthy volunteers (31.68 years ± 8.38; 111 men). Forty-two subjects were re-evaluated, to determine test-retest reliability. The VEA-EMOTICOM comprises 9 tasks programmed on a laptop computer to be completed in one hour. The battery was administered in a random sequence and rest periods were allowed. Results: Small floor effects were observed for 3 outcomes and moderate for 1 outcome, as well as small ceiling effects for 3 outcomes and moderate for 1 outcome. Two tasks showed excellent test-retest reliability; four showed good reliability; seven showed moderate reliability; and two showed poor test-retest reliability. The results of most of the tasks were not correlated with age or gender. An underlying four-factor structure could not be confirmed. Conclusions: The VEA-EMOTICOM seems to be a practical and adequate battery to evaluate affective cognition in Spanish-speaking population
Key words: EMOTICOM, neuropsychological tests, affective cognition, psychometrics.
Psychiatric disorders are a complex mixture of affective, cognitive and behavioral symptoms. Therefore, most of the scales used in their assessment include multiple items and subscales in an attempt to cover all these domains comprehensively. Still, their main focus remains on the clinical status of the patient. However, it is essential to quantitatively measure specific dimensions, such as cognitive, affective or social functioning, and to record their change or evolution in the clinical or research setting.
On the other hand, although the Cambridge Neuropsychological Test Automated Battery (C.A.N.T.A.B.) (www.cambridgecognition. com), and MATRICS Consensus Cognitive Battery (M.C.C.B.) (www.matricsinc.org), are just two examples of widely used, well constructed and validated batteries that account for progress in this area, they do not include a comprehensive assessment of affective cognitive functions.
Affective cognition, or “warm” cognition, as opposed to non-emotive or “cold” cognition, refers to aspects of cognitive function where stimuli have affective salience(1). Affective cognition can be considered an interface, in which emotional and cognitive processes are integrated to generate behavior(2). Emotional disorders present in people with mental illness include many such manifestations. For example, there are biases in the emotional processing of people with depression(3), anxiety(4), schizophrenia(5), eating disorders(6) and addictions(7); motivational and positive reinforcement deficits in schizophrenia8 and affective disorders(9); impulsivity, in the case of addictions(10), eating disorders(11) and personality disorders(12); and failures in social cognition in autism(13), major depressive disorder(14), bipolar depression(15) and schizophrenia.(16)
In addition to being manifestations of psychiatric disorders, the emotional aspects described above may be risk factors for the subsequent development of a pathology, key moderators of patients’ recovery during their therapeutic processes, and at the same time, significant predictors of quality of life and psychosocial functioning in both psychiatric and medical conditions.
Research shows that affective responses are more behaviorally related than cognitive beliefs and thus may independently predict treatment adherence(17) or health risk behaviors(18,19). In addition, emotions and emotion regulation may also affect the prognosis of various medical conditions such as pain(20), inflammation(21), hypertension(22) and cancer.(23)
Currently, the emotional aspects of psychiatric disorders are assessed by global scales of psychopathological symptoms or individual tests, which only consider specific or partial aspects. However, the EMOTICOM(24) battery, which assesses a wide range of processes relevant to affective cognition, was recently validated in English, its original language.The EMOTICOM battery was designed to include four affective domains; emotion processing, understood as the ability to process and respond to affective stimuli, including emotional faces; motivation, or the ability to learn, strive, and make incentive- driven decisions; impulsivity, or the tendency to premature or risky responses; and social cognition, defined as the ability to process information about situations involving interpersonal interactions. After testing new tasks and adapting existing ones, sixteen were selected for inclusion in the final battery. The results proved reliable, independent of age and educational level, but the authors suggest caution in generalizing their data to other settings. The EMOTICOM battery was subsequently validated in a Danish population(25) and used in studies on neurodegeneration(26), characterization of depressive symptoms(27) and paranoid ideation in the general population.(28)
Here we evaluated an abbreviated Spanish version of EMOTICOM (VEA-EMOTICOM) in a sample of healthy Chilean volunteers. Nine tasks were selected from the original full version, with at least one task chosen from each of the four domains. In addition, attention was paid to the factor loadings reported by the authors to eliminate tasks that appear redundant, allowing for a 60-minute version. Below, we report the main results for each task and the psychometric properties of this abbreviated version.
MATERIALS AND METHODS
The sample consisted of two hundred healthy volunteers (31.68 years ± 8.38; 111 men). Forty- two subjects were re-evaluated within 5-10 days to determine test-retest reliability. This sample size provides sufficient power to detect a test-retest reliability of > 0.35 (p = 0.05, 80 % power).
Participants were recruited by personal contact from the investigators and public notices in the local community. The following inclusion criteria were considered: 18-50 years of age; at least eight years of education; no self-report of previous or current psychiatric disorders, including depression, anxiety, eating disorders, and drug/alcohol dependence; no neurological disorders; no traumatic history with loss of consciousness; no current use of medications known to affect mood or cognition; no first- degree relative with a psychiatric disorder; and fluency in Spanish. The absence of psychiatric pathology was confirmed using the Mini- International Neuropsychiatric Interview (MINI).(29)
Participants completed the Spanish version of the Brief Symptom Inventory (B.S.I.)(30), meeting the criteria for adult non-patients in the nine symptom dimensions; somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism.The protocol was reviewed and authorized by the Ethics Committee of the University of Valparaiso, Chile. Participants provided written informed consent after the procedures and purposes of the study were explained to them. All participants received monetary compensation for their participation, plus a variable sum depending on their performance in the tests.
Participants attended a 3.5-h appointment at the Department of Psychiatry, University of Valparaiso, Chile. The abbreviated Spanish version of the EMOTICOM battery comprised nine tasks programmed on a laptop computer and completed in a quiet room for one h. The test was administered in a randomized sequence, and rest periods were allowed. The test was administered in a randomized sequence, and rest periods were allowed.
Abbreviated Spanish version of the EMOTICOM
According to its original authors, the battery seeks to evaluate four cognitive-affective dimensions:
1. Emotion processing:
Emotion recognition: The task requires subjects to identify emotions represented in static full faces.
Emotion detection: Participants are shown faces that increase or decrease in the emotional intensity of the expression they represent and are instructed to respond when they detect or no longer detect, the presence of the emotion.
Emotional memory: participants are asked to rate a series of scenes as positive, negative, or neutral, which are then paired with new ones.
Participants are asked to indicate which image they saw previously.
2. Motivation and reward
Reinforcement learning task: Participants are shown two colored circles and asked to bet on one, depending on which is more likely to win or not lose money. They receive feedback, and their total score is constantly reported so that they can learn by sampling the circles which of the two is the better choice.
Cambridge Gambling Task adapted. In each test, the participant is presented with a roulette wheel; painted in different proportions, so the outcome of the bets varies from very certain to very uncertain. Participants must bet on the outcome they expect.
Discounting task: the participant is presented with ten conditions; five levels of time delay (0, 30, 90, 180, 365 days) and five levels of probability (100, 90, 75, 50,
50, 25%). Then, participants must decide whether they prefer a standard fixed monetary amount with a particular delay or probability compared to an alternative amount immediately available.
4. Social cognition
Moral emotion: In the moral emotion task, the participant views cartoons depicting deliberate or accidental harm. Participants are asked to imagine how they would feel in the situation as either the perpetrator or the victim, choosing from the following emotions; guilt, shame, anger, and feeling “bad”.
Social information preference. Participants are shown a scene with three faces (feelings), three thoughts and three objects from the scene hidden from view. They can only select four of nine information items and then must choose from three possible interpretations of the situation (negative, positive, or neutral)
Prisoner’s Dilemma: evaluated with simulated games against a virtual opponent in which they must choose between a cooperative or competitive strategy to maximize a previous monetary gain or minimize a monetary loss.
A list of the outcomes chosen for each task and the administration time is provided in Table 1.
Statistical analysis: Task outcomes and descriptive statistics: the primary outcomes for each EMOTICOM task were selected following the recommendations of the original authors. Mean, standard deviation, median, and range are reported for all primary outcomes. Floor and ceiling effects were determined as the percentage of participants achieving minimum scores (floor effect) or maximum scores (ceiling effects) for a given task outcome. Floor or ceiling effects greater than 10% were considered moderate, whereas effects greater than 30% were considered severe/problematic.
Correlation analysis: A two-tailed Pearson correlation was used to correlate task performance with age and years of education as a complimentary exploratory analysis. Gender differences were examined with independent samples t-tests.
Reliability analysis: Intraclass correlation coefficients (I.C.C.s) and their 95% confidence intervals (95% C.I.s) were calculated based on the re-evaluation data of 42 participants to assess test-retest reliability using a two-way mixed-effect model of absolute agreement. I.C.C. values below 0.40 were considered poor, between 0.40 and 0.59 fair, between 0.60 and 0.74 as good, and above 0.75 as excellent.
Factor analysis: to verify the grouping of the tasks into four domains, the representative scores for each of the nine tasks were standardized using z-scores and entered into a factor structure to determine the underlying latent variable structure.
Task outcomes and descriptive statistics: There are a variety of possible outcomes to be obtained for each task. Descriptive statistics for the primary outcomes chosen for each task are shown in Table 2. Only small floor effects (<10%) were observed for three outcomes and moderate floor effects (? 10%) for one outcome, in addition to small ceiling effects for three outcomes and moderate ceiling effect for one outcome.
Test-retest reliability: intraclass correlation coefficient scores varied across task outcomes: 2 task outcomes exhibited excellent test-retest reliability (ICC ? 0.75); 4 outcomes good reliability (0.60 ? ICC <0.75); 7 outcomes moderate reliability (0.40 ? ICC <0.60); and 2 outcomes exhibited poor test-retest reliability (ICC <0.40). (Table 3).
Correlations with demographic and descriptive factors: Results on most tasks were not correlated with age, with the exceptions of more choice thoughts on the S.I.P.T., greater loss adjustment on reinforcement learning, less stealing behavior on the Prisoner’s Dilemma, and greater risk adjustment on the Cambridge Gambling Task for older participants. The only observable differences by gender were that males chose more thoughts on the social information preference test and showed more risk adjustment on the Cambridge Gambling Task. (Table 4).
Factor analysis An exploratory factor analysis was used, taking the scores of the standardized variables to a comparison scale. Considering four factors, and using maximum likelihood and varimax rotation, an explained variability of 33.1% was obtained, which can be regarded as insufficient. On the other hand, the sedimentation graph, considering a cut-off point, the eigenvalue equal to 1, suggests using six factors. The overall K.M.O. index is 0.5179.
Correlations with demographic and descriptive factors Most of the results of the VAS- EMOTICOM tasks were not correlated with demographic characteristics, suggesting that the performance of these tasks does not depend on the age or sex of the participants. Notable exceptions were the proportions of chosen thoughts in the Social Information Preference Task and in the risk of winning adjustment in the Adapted Cambridge Gambling Task that correlated with both factors.Test-retest reliability: Most of the tasks showed moderate to excellent test-retest reliability, supporting the internal validity of the battery and the representativeness and stability of the measures. However, two of the results, affective bias in the emotional memory and affective bias with increasing intensity in the emotion detection task, showed poor test-retest reliability. We found these results intriguing, mainly because the emotion recognition task, which measures accuracy in emotion recognition, showed high reliability. It could be argued that we actually detected changes in participants’ emotional states that led to variations in their responsiveness to different emotions.
Floor and ceiling effects: Most of the outcomes chosen for the tasks exhibited small or no floor or ceiling effects, ensuring adequate variability in the data collected. However, 15% of the participants met the criteria for the floor effect in the Prisoner’s Dilemma. Given that this task aims to identify aggressive versus cooperative strategies rather than assess performance, this should not be a limitation.
Factor analysis: We could not find evidence to support a four-factor structure of the battery, representing different emotional domains. This was also observed in the validation study of the EMOTICOM battery.
The translation and subsequent validation of a short Spanish version of the EMOTICOM In our native Chilean population allow us to provide new standardized data to support the use of this tool worldwide, allowing comparisons between different settings, thus facilitating collaborative collaboration efforts. Likewise, professionals in our region will benefit from information and tools to advance knowledge in this area of mental health.
We also expect that the translation of a short version of the EMOTICOM battery will be helpful in non- psychiatric settings since the affective components of general pathologies are crucial variables in the treatment and recovery of patients and, as such, should be measured explicitly as outcomes of interventions.
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