Validation of a Spanish short version of the EMOTICOM battery (VEA-EMTICOM).

Álvaro Cavieres , Patricio Limarí , Natalia Zambrano , Rebecca Elliott, Rocío Maldonado , Amy Bland

ABSTRACT

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.

INTRODUCTION

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

Participants
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.

DESIGN

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
battery (VEA-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.

3. Impulsivity
•         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.

 

RESULTS

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.

 

CONCLUSIONS

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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(2023). Validation of a Spanish short version of the EMOTICOM battery (VEA-EMTICOM)..Journal of Neuroeuropsychiatry, 57(4).
Recovered from https://www.journalofneuropsychiatry.cl/articulo.php?id= 105
2023. « Validation of a Spanish short version of the EMOTICOM battery (VEA-EMTICOM).» Journal of Neuroeuropsychiatry, 57(4). https://www.journalofneuropsychiatry.cl/articulo.php?id= 105
(2023). « Validation of a Spanish short version of the EMOTICOM battery (VEA-EMTICOM). ». Journal of Neuroeuropsychiatry, 57(4). Available in: https://www.journalofneuropsychiatry.cl/articulo.php?id= 105 ( Accessed: 6diciembre2023 )
Journal Of Neuropsichiatry of Chile [Internet]. [cited 2023-12-06]; Available from: https://www.journalofneuropsychiatry.cl/articulo.php?id=105

 

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