Seeing enemies? A systematic review and treatment proposal for anger bias in the perception of facial expressions among anger-prone and aggressive populations

Background: It is well known that individuals with antisocial pathologies can be a challenge to manage in clinical settings and those available psychological interventions have to date not shown much promise. Objective: The objective of this paper was to clarify whether populations with externalizing and potential aggressive behavior are characterized by attentional bias towards perceiving others as angry and hostile, when processing facial expressions in neuropsychological paradigms. Based on this review the second objective was to recommend potential treatment for antisocial pathology. Method: A PRISMA guided systematic search of electronic databases and a subsequent manual search identified 15 studies/ 20 experiments (N = 2125), involving samples of children, adolescents and adults, and recruited from the community as well as clinical and forensic settings. Results: The reviewed literature reveals that anger and hostile bias in the processing of facial expressions could indeed be another distinctive cognitive dysfunction in anger-prone and aggressive populations, in addition to recognition impairment in decoding negative facial expressions. Conclusion: Based on the results of the review specific treatment recommendations for potential attentional bias and recognition impairments both based on the Attentional Bias Modification (ABM) are outlined. It is suggested, that a simple modification of ABM could convert the method into a candidate treatment of recognition impairments; Attentional Recognition Impairment Modification (ARIM). Applying this treatment, ARIM, supraminally and subliminally presented stimuli could target more automatic processes mediating fear and anxiety and lead them to focus on the neglected ocular or facial expressions. The neuropsychological treatment recommendations may display important implications in treatment management.

Keywords: emotional bias, facial expressions, anger, aggression, antisocial pathology, attentional bias modification, recognition impairment