Emotional Neurophysiological Response In Intimate

Emotional Neurophysiological Response in Intimate Partner Violence Against Women. A Pilot Study Juan Manuel López López Biomedical Engineering Program Escuela Colombiana de Ingeniería Julio Garavito Bogotá, Colombia [email protected]

María Paula Acero Triviño Biomedical Engineering Program Escuela Colombiana de Ingeniería Julio Garavito Bogotá, Colombia [email protected]

Alejandra Rizo-Arévalo Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Diana Carolina Cárdenas-Poveda Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Mayerli Andrea Prado-Rivera Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Eliana Mejía-Soto Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Alexandra González-Álvarez Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Jonathan Ferney Lamprea Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Jose Luis Velasquez Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Deissy Lorena Flórez-Duarte Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Katherine Cruz Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

María Fernanda Higuera Psychology Program Corporación Universitaria Minuto de Dios Bogotá, Colombia [email protected]

Juan Felipe Molina Biomedical Engineering Program Escuela Colombiana de Ingeniería Julio Garavito Bogotá, Colombia [email protected] Abstract— Studies have shown that trauma in battered women might affect neural responses during emotional processing tasks. Being intimate partner violence (IPV) a major problem in Colombia nowadays, this research seeks to contribute the understanding, in a broad way, of the biological effect of violence against women. This paper describes a pilot study conducted to analyze emotional neurophysiological response in women who had experienced IPV. Participants assessed different pictures from the International Affective Pictures System (IAPS) through the Self-Assessment Manikin (SAM) technique. EEG data were recorded and analyzed in the frequency domain to observe interhemispheric asymmetries in the alpha and beta bands. The SAM results show differences in the arousal dimension between the two groups of women, suggesting a different interpretation in those with history of IPV. For the valence dimension the results were not conclusive. EEG signals show evidence of asymmetries, varying according to the valence dimension, especially in the frontal area, correlated with the SAM results and IAPS normative values.

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Keywords— Emotions, neurophysiology, violence against women, IAPS, intimate violence partner

I.

INTRODUCTION

According to the World Health Organization (WHO), violence against women is a matter of public health and a violation of human rights. Globally, it has been identified that 38% of homicides to women were committed by their partners; in America, rates of sexual and physical violence against women by their partners have been increasing, and it is considered one of the most common violence in the continent. [1]. In Colombia violence against women is understood as any action or omission that causes death, physical, sexual, psychological, economic or patrimonial damage or suffering to a person because of their status as women (Law 1257, 2008, art.2) [2]. In addition, Intimate Partner Violence (IPV) against women currently constitutes a main problem in Colombia. Reports of legal medicine from 2015 [3] showed that a

woman is a victim of violence by her partner every 10 minutes. This means that 140 women report situations of violence every day. In Bogotá, it has been found that violence is one of the main causes of premature deaths with physical and psychological sequelae for women. For instance, in 2016, 10,734 cases of violence against women were reported in this city, and 109 women were murdered by their current or former partners [4]. Although not all women who have experienced situations of violence have these consequences at a physical and psychological level, it can be considered a latent risk. It has been found that one of the IPV effects is the maintenance of cycles of violence that undermine decisionmaking capacity and autonomy of women. These cycles are maintained by social stereotypes about gender, from which patterns of action and relationship between men and women are determined. To that extent, gender myths and stereotypes shape the way in which women perceive themselves, sometimes leading to interpret acts of violence as acts of love. Violence is justified based on the roles assigned to men, in relation to power, lack of control, and impulsivity. Women, on the other hand, are blamed for allowing the continuity of violence. According to the above, IPV against women is perpetuated and transmitted from generation to generation [5]. As a consequence of the above, it is possible that emotional responses in women experienced IPV changed, taking into account that emotional processing and their neurobiological related responses are highly sensitive to environmental factors such as repeated stressors. When people constantly experience situations subjectively interpreted as stressing, depression and posttraumatic stress disorder (PTSD) symptoms could emerge, with wellcharacterized brain functional and structural changes (for a recent review see [6]), and literature has shown that emotional responses differ from people with and without these diagnoses. For instance, adolescents with Major Depressive Disorder (MDD) showed different activation patterns in medial, temporal and prefrontal regions during encoding and retrieval of an incidental memory task for valenced words compared to healthy control participants [7]. Japanese people with PTSD diagnosis showed more physiological activation, measured by their heart rate, during both anticipatory period and emotional memory assessment compared to healthy women control [8], and British adults with PTSD exhibited a poorer performance on an emotional working memory task in comparison with participants without PTSD [9]. Epidemiologic studies have shown a higher likelihood of women developing PTSD after experience traumatic events compared to men [10], [11], and being IPV the major predictor for PTSD in women [12]. According to this, IPV might be understood as a traumatic event, and suitable evidence of psychobiological consequences in abused women should be urgently determined to improve wholesome psychological interventions. For the case of

emotional consequences, some reports have shown that emotional control [13], emotional intelligence [14], hormonal biomarkers related to emotional response (i.e. cortisol release) [15], and emotional-related brain activity patterns in amygdala, insular and cingulate cortex [16] are altered in women with IPV experiences. Nevertheless, many aspects related to neurophysiology of emotion relevant to women with history of IPV remains unclear, thus this study aims to investigate the emotional neurophysiological response of women who have experienced IPV and those who have not (WIPV). Specifically, we focused on the CNS response, via the EEG activity, to examine cortical activation pattern and interhemispheric asymmetries, since previous reports have shown right-left prefrontal asymmetry correlations with differences in emotional processing [17]- [19] The results presented here correspond to a pilot study. This research seeks to contribute the understanding, in a broad way, of the biological effect of violence against women. The question about the effects of violence on women, not only allows us to explore more deeply a phenomenon that has become visible in recent years in Colombia, but also facilitates women to empower themselves about their bodies and their rights. II.

MATERIALS AND METHODS

A. Participants Participants were six healthy female adults, ranged in age from 18 to 55 years old, recruited through the Basic and Clinical Neuroscience Student Group of Corporación Universitaria Minuto de Dios. Inclusion criteria were: no history of psychiatric or neurological disorder and adequate visual and auditory processing to resolve the tasks. They were classified into two groups: women with reported IPV (n=3) and women without reported IPV (n=3). B. Materials Sociodemographic and health data questionnaire. Consist on a set of questions on general health aspects from the participants. International Affective Pictures System (IAPS). Validated in Colombian population by Gantiva et al [20], consists on a set of 238 emotionally evocative color pictures including valence (pleasant-unpleasant), arousal (activated-relaxed) and dominance (dominated-dominant) dimensions, rated by men and women. Nine pictures were selected: 3 appetitive, 3 neutral and 3 aversive, chosen from their low, medium and high scores in each dimension. The Self-Assessment Manikin (SAM) [21] were used to acquire ratings of valence, arousal and dominance for pictures in the IAPS. Each dimension was represented by five graphic figures. g.Nautilus 32 g.LadyBird. Is a wireless biosignal acquisition electroencephalographic (EEG) signal system. It has 32 active sensors, with a resolution of 24 bits and a sampling frequency of 250 Hz or 500 Hz. Additionally, it has digital inputs for synchronization signals and connection to other systems. Through a MATLAB interface, the following

electrodes were registered, in a single-ended (referential montage) configuration, for the participants: AF3, AF4, C3, Cz, C4, P3, PZ, P4 and A2 (for reference). C. Procedure Upon arrival to the lab, the participant agreed and completed informed consent and the sociodemographic and health data questionnaire. EEG equipment were placed and impedance on the selected channels were tested. SAM scales were explained to the participant and when all questions were answered, a test image was presented to familiarize the participant with the SAM. After this, the selected IAPS pictures were shown. Each picture was presented for 15 seconds and then, the participant has to fill the SAM. During the test, EEG signals were recorded at a sampling frequency of 205 Hz. Each time the image changed, a digital pulse was sent to the EEG device, to identify the signals corresponding to each picture. Each EEG record lasted 8 minutes approximately. In fig. 1, the procedure is shown. D. Ethical Considerations This study follows the research requirements specified in the Colombian Mental Health Act 1616 of 2013 which guarantees mental health rights through promotion and prevention with comprehensive care, and Ethics and Bioethics in Psychology, Act 23 of 1982 on copyright and intellectual property, Act 1090-060906 of 2006 and Act 1392 of 2010, approved by the Ethics Committee of Corporación Universitaria Minuto de Dios. Likewise, the study complies with the ethical and safety recommendations for research on violence against women carried out by the World Program on Scientific Evidence for Health Policies of the World Health Organization (WHO).

Finally, neurophysiological and psychometric results of the study were presented to the groups of women in order to facilitate the process of recognition of their emotional expression. E. Data analysis Data from the SAM were analyzed per subject, obtaining the qualitative assessment for the images in each dimension (see table I). Then the mean and standard deviation were obtained per group. IAPS data were analyzed per group according to the normative values made by Gantiva et al [20] (see table II). TABLE I. DESCRIPTIVE ASSESSMENT FOR THE IMAGES IN EACH DIMENSION

Dimension

Descriptive Assessment Values 1

5

9

Valence

Highly unpleasant

Neutral

Highly pleasant

Arousal

Relaxed

Moderate activated

Activated

Dominance

Dominated or Low control

Moderate control

Dominant or highly control

EEG data were analyzed in the frequency domain to observe interhemispheric asymmetries in the alpha and beta bands, as suggested by Davidson et al [23] and Petrantonakis et al [24]. EEG signals were analyzed from second 16 to second 20 after the presentation of each picture (see fig. 2), following that emotions, under laboratory conditions, are installed in the participant after an exposure of at least 10 seconds (in our case, the presentation lasted 15 seconds) and lasts approximately 0.5 to 4 seconds after the presentation of the stimulus [25].

Fig. 2. Example of a segment extraction for analysis. The picture onsets are acquired thought digital inputs of the system. After 16 seconds of the picture presentation, a 4-seconds segment is extracted. Fig. 1. Flow diagram of the experiment.

The 4 seconds segments of EEG data were inspected to verify if they were contaminated with motion artifacts, from an amplitude threshold, fixed at 250 mV peak to peak. No segments were rejected. In addition, no digital filters were used, given that the processing took place in the frequency domain. From a Power Spectrum Density (PSD), obtained by the Welch method (half second windows, 50% overlap), the ratio of alpha band (8 to 12 Hz) and beta band (12 to 30 Hz) power were computed, for each channel, according to 𝛼 𝛽

=

∑𝑖∈𝛼 𝑃𝑥𝑥𝑖 ∑𝑗∈𝑏𝑒𝑡𝑎 𝑃𝑥𝑥𝑗

(1)

Where 𝑃𝑥𝑥 is the obtained power from the Welch method. Fig. 3 shows the procedure. Fig. 4 shows the ratios of participant 2, for the AF3 and AF4 channels. It can be observed that for most of the pictures with positive valence (according to the SAM valence of the participant), a greater alpha/beta ratio is located at right hemisphere and vice versa Right hemisphere ratios were subtracted from the left hemisphere ratios to observe the interhemispheric asymmetries. For instance, to analyze frontal lobe activity, alpha/beta ratio from AF4 were subtracted to AF3. Midline located channels (Cz and Pz) were not used for this analysis.

Fig. 4. Alpha/beta ratio for participant 2 (Group WIPV). In the x axis is the number of the image and in the parenthesis is the SAM valence assessment of the participant and the IAPS category: N for neutral, A for aversive and P for appetitive. Greater alpha/beta ratio is observed for appetitive pictures in the right hemisphere.

Two types of activity profiles, or signals, were created to compare the electrophysiological responses with them. The first profile reflects the SAM valence of the participant. The second profile uses the normative values of valence of the pictures, therefore, this profile is common to all participants. A linear correlation coefficient was used to test if the interhemispheric activity was correlated with the SAM valence responses and IAPS normative valence. Fig. 5 (a) shows both, the asymmetries and the SAM valence response for participant 5 and fig. 5 (b) shows the asymmetries and the IAPS normative values for the same participant. III.

Fig. 3. Power spectrum density of EEG, explaining the procedure for extracting the alpha/beta ratio. A summation over all the alpha and beta coefficients is made.

RESULTS

According to the IAPS results (see table II), on average women WIPV assessed the aversive pictures as highly unpleasant for valence dimension, which were under Colombian normative data. The neutral and appetitive pictures were within neutral and highly pleasant values for this dimension. Compared with the normative values for Colombian population, the appetitive pictures were evaluated in a similar way and neutral above them. For arousal dimension, there was a greater activation for the aversive pictures, in contrast to the neutral and appetitive ones, which were considered relaxing; these results were consistent to normative values. In the dominance dimension, the participants assessed appetitive and neutral pictures as dominated or low control. Compared with the normative values, this result was one unit above. Finally, the participants rated the aversive pictures as moderate control, similar to normative values.

On the other hand, participants in the IPV group judged the aversive pictures between highly unpleasant and neutral for valence dimension. The neutral pictures were assessed as within the expected, and the appetitive ones as highly pleasant. Compared to the normative values, these results were above average, especially for the appetitive pictures which were rated in the highest point of the scale (i.e. 9 points). For arousal dimension, appetitive images were evaluated as activated, while the neutral ones elicited a moderate activation. Two aspects were above average by more than two units compared with the normative values. The aversive pictures remained ranked within the relaxed and moderate activation range, and they were two units under the normative values. Finally, for dominance dimension, participants perceived the aversive and neutral pictures as a moderate control, but compared with the normative values, the former category was similar and the latter was one unit under the mean. The appetitive pictures were considered dominant or highly control by the participants and were one unit under normative data.

(a)

Interhemispheric asymmetries of EEG activity, for the ratio alpha/beta in all channels were observed. However, variations in accordance to the emotional valence dimension, were found especially in the frontal region: when experiencing a positive emotion, alpha/beta ratio was greater in the left frontal area (AF3) in comparison to the right frontal area (AF4) and vice versa for a negative emotion.

(b) Fig. 5. Profile of SAM and IAPS values for valence of participant 5 (Group: IPV). (a). SAM profile and interhemispheric asymmetry. Correlation: R = 0.68518, p = 0.0017. (b) IAPS value and interhemispheric asymmetry. Correlation: R = -0.68456 p = 0.0017. TABLE II. IMAGES DESCRIPTION FOR CATEGORY AND GROUP RESULTS IN THREE DIMENSIONS OF THE IAPS Picture category

Neutral

Aversive

Appetitive

International #

Picture description

Presentation order

Normative values by Gantiva et al [20] V A D

WIPV

IPV

V

A

D

V

A

D

Mean by category

5,19

3,69

6,27

7,11

3,67

7,67

6,78

5,00

5,89

7026

Picnic table

1

2235

Charcuterie

5

2025

Woman

8

SD by category

0,22

0,03

0,34

0,96

0,33

0,67

0,77

0,00

0,77

9471

Burnt building

2

Mean by category

2,71

5,26

4,51

1,44

5,89

4,44

3,56

3,44

4,00

2695

Refugees

6

9413

Gallows man

7

SD by category

0,21

0,74

0,29

0,38

0,84

0,38

0,84

1,02

0,58

2158

Children

3

Mean by category

7,71

5,74

6,37

7,11

4,44

7,33

9,00

9,00

7,22

5199

Garden

4

5829

Sunset

9

SD by category

0,52

0,34

0,41

0,69

0,84

0,33

0,00

0,00

1,54

Valence (V); Arousal (A); Dominance (D); Standard Deviation (SD); Mean (M); Intimate Partner Violence (IPV); Without reported Intimate Partner Violence (WIPV)

Interhemispheric asymmetries were compared to the SAM results for each participant through a linear correlation test. These asymmetries were also compared to IAPS normative values. Figure 6. shows an example of the results for one participant in the IPV group and another one from the group WIPV. No group average values were calculated to be compared due to the reduced sample size of groups. Significant correlation (p < 0.05) between the profile of SAM valence values and the interhemispheric asymmetries were found in four of the participants for the parietal and frontal areas, according to a linear correlation test. When the asymmetries were compared to the profile of normative values of the IAPS, the linear correlation test showed that for five of the participants, there are significant correlation between the variables. Table III summarizes these results. Large inter-subject differences were observed regarding the power in the beta and alpha bands and the interhemispheric signals.

Fig. 6. IAPS normative values and interhemispheric asymmetries for valence of participant 1 (Group: IPV) and participant 2 (Groups: WIPV). Correlation for participant 1: R = -0.034249 p = 0.89268 and for participant 2: R = 0.63566 p = 0.0045794.

TABLE III. RESULTS OF LINEAR CORRELATION FOR THE SAM AND IAPS NORMATIVE VALUES WITH INTERHEMISPHERIC ASYMMETRIES P

Group

AF3-AF4 SAM R

1

IPV

2

AF3-AF4 IAPS

P

R

C3 - C4 SAM

p

R

C3-C4 IAPS

p

R

p

P3-P4 SAM R

p

P3-P4 IAPS R

P

0,50

0,03

-0,03

0,893

0,11

0,66

0,04

0,885

0,60

*0,009

0,62

*0,006

WIPV

-0,37

0,13

-0,64

*0,005

-0,16

0,52

-0,11

0,660

-0,32

0,190

-0,37

0,133

3

IPV

-0,19

0,44

-0,20

0,437

-0,18

0,46

-0,18

0,482

0,23

0,300

0,25

0,314

4

WIPV

-0,63

*0,005

-0,18

0,487

0,02

0,94

0,14

0,592

-0,42

0,080

-0,54

0,021

5

IPV

-0,69

*0,001

-0,68

*0,002

-0,78

*0,0001

-0,58

0,011

0,01

0,970

-0,16

0,533

6

WIPV

0,38

0,12

0,70

*0,001

0,08

0,75

0,22

0,385

0,65

*0,003

0,67

*0,003

Significance level, p < 0.05

IV.

CONCLUSIONS

Emotional processing might be affected by highly stressful situations; thus, it is possible to hypothesize that women with IPV could have different emotional processing and responses [14], assuming that women undergoing violence by their partners, in many cases, are interpreting it as a traumatic event, and considering evidence of IPV and PTSD correlations [12]. In this pilot study, arousal dimension judgments show a different tendency between the two groups of women, suggesting a different interpretation in those with IPV history, for whom aversive images were rated between the relaxed and moderate activated range, while the WIPV group assessed it as highly activating similar to IAPS normative values. For the valence dimension, the IPV group rate as more pleasant the appetitive images compared with the

WIPV group and the normative data. No differences were found in the dominance dimension. The IAPS results suggest that women with IPV may be perceiving violence in a different way; this can justify the normalization of violence and the process of legitimizing it, which causes women to accept abusive behavior patterns without being aware of it, maintaining the cycles of violence and perpetuating it in their family relationships [26] [27]. The naturalization of violence has to do with social and cultural factors, in which the frequency of exposure to violence and the perception of women in front of it, do not allow the recognition of different possibilities of action [28]. Although the sample from this study was small and therefore no statistical comparisons were made, these results suggest that women who have experienced violence

situations, who in many cases live in contexts where negative emotions such as anger [29] and domination actions by their partners are present, can have an impact on the level of recognition of violence as a negative event. This might imply a change in the perception of situations that can put their lives at risk and even modify the way they perceive themselves, their abilities and their choices [30]. Hard environmental challenges could boost coping strategies in some people whereas might lead to overwhelming results in others. Coping depends on subjective interpretation of any given demanding situation and the perceived resources to face it [31]. On the other hand, EEG activity of most of the participants exhibited the behavior explained by Davidson et al. [23], showing an interhemispheric difference or asymmetry in the ratio alpha/beta, especially in the frontal lobe. The measurements of similarity showed a high relationship with the profiles corresponding to SAM valence and IAPS normative values of valence for the pictures used. A significant correlation was observed with IAPS normative values but not with the SAM in some of the subjects, which may indicate that the electrophysiological response of the participants is not always related to the subjective assessment of the pictures, or that the SAM test is not correctly filled by the participants perhaps because of a weak understanding of the assessment method. A statistical analysis of the EEG responses for the IPV and WIPV groups was not possible due to the small size of the sample. Even so, most of the significant correlations found per subject were moderate, some direct and others inverse, with large inter-subject differences and without a clear group tendency. On account of the above and considering that the IAPS is proposed from the bio-informational model of emotions proposed by Lang [32], [33], in which the valence dimension organize the emotion structure, we suggest for future studies some methodological arrangement in the procedure based in previous IAPS protocols, in order to reduced inter-subject variability and increase data reliability. For instance, Gantiva et al. [34] presented 21 images twice, for 6 seconds, in four counterbalanced orders of 42 images each one. In each block, the images were presented in random order and the interval between trials varied randomly between 10 to 14 seconds. This example is adequate, considering that the authors obtained a significant correlation between the SAM responses and a physiological measure such as electromyography of the orbicularis oculi of the eye. Moreover, for the final phase of the present study, the participants recognized, according to the presentation of the neurophysiological and psychometric results, that violence may have an effect on their way of responding to images with emotional content. They report that these results allow them to know more about themselves and generate a broader perspective on violence, and on the possible impacts of it on their bodies, emotions and perceptions.

Finally, it is essential to take up the recommendations presented by different sectors and woman who lived this experiences to prevent violence against women. This involves carrying out more complex investigations that present risk factors and effects on the nervous system functioning, which impact on women's health, as well as strategies to raise awareness about the problem in order to carry out more comprehensive approaches [4], [35]. With that purpose, a second stage of this project is currently taking place, including a learning process on violence against women and attention network, an analysis of other physiological variables, along with the EEG: blood pressure, heart rate and eye movements and fixation during the tests. In addition, other psychometric tests will take place to include emotional memory processes and emotion identification. V. ACKNOWLEDGMENT We appreciate the participation of women in this research, from whom we learned and who allowed us to work as a team from different disciplines. We are also grateful to the students of Processing of Images and Signals PROMISE Student Group of the Biomedical Program of the Escuela Colombiana de Ingeniería Julio Garavito and the students of the Basic and Clinical Neuroscience and Tejiendo Saberes Student Group of the Psychology Program of Corporación Universitaria Minuto de Dios. VI. REFERENCES [1] [2]

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