This study examined the effects of psychodrama and cognitive behavioral therapy (CBT)-based virtual reality (VR)-supported psychoeducation on facial emotion recognition skills in earthquake survivors using an artificial intelligence-based Facial Emotion Recognition System. It was conducted using a pre-test-post-test randomized quasi-experimental design. The sample consisted of 32 adult earthquake survivors affected by the February 6, 2023, Kahramanmaraş-centered earthquakes who were residing at the Temporary Accommodation Center. Participants were randomly assigned to two groups: a psychodrama group (n=16) and a VR-supported psychoeducation group (n=16). The first experimental group received 13 psychodrama sessions, held once a week, while the second group received CBT-based psychoeducation consisting of 10 sessions held once a week, with VR content incorporated at the end of each session. A Personal Information Form, a Semi-Structured Interview Form, and the Facial Emotion Recognition System were used as data collection tools. Findings based on the Facial Emotion Recognition System revealed that VR-supported psychoeducation produced more pronounced changes in immediate emotional responses, increasing levels of happiness and neutral affect while reducing expressions of fear, sadness, and anger. In conclusion, the results from the Facial Emotion Recognition System indicate that VR-supported psychoeducation had significant positive effects on participants' immediate emotional responses, reducing negative emotions while increasing happiness and neutral affect. In contrast, the psychodrama intervention did not produce a significant change in the measured immediate emotional responses. These findings can contribute to the planning and development of post-disaster mental health services.
Post-traumatic stress disorder (PTSD) and depression are among the most common psychiatric conditions observed in individuals who experience major traumatic events such as earthquakes. Post-earthquake traumatic reactions and the recovery process result from the complex interaction of biological, personal, cultural, and environmental factors, and the overall treatment goal is to restore an individual's daily functioning. The importance of early and systematic psychological interventions to prevent symptoms from becoming chronic is increasingly recognized. Indeed, according to the findings of a systematic review and meta-analysis conducted on victims of the Kahramanmaraş earthquakes, trauma-focused cognitive-behavioral therapy, psychoeducation, and virtual reality-based programs have yielded significant improvements in PTSD and depression, with large effect sizes . Trauma profoundly affects not only mental health but also an individual's social-cognitive functioning. In particular, the ability to recognize emotions from facial expressions is central to these processes. Trauma can alter how individuals interpret emotional and social cues, weakening their capacity to successfully maintain social relationships. Individuals diagnosed with PTSD are affected by three main symptom clusters: avoidance/numbing, increased emotional arousal, and intrusive memories. The emotional distress at the core of this condition negatively impacts the ability to recognize emotions in facial expressions. Research shows that veterans diagnosed with PTSD experience difficulties recognizing facial expressions across all basic emotion types compared to controls without the diagnosis. Moreover, this impairment exhibits intergenerational transmission, negatively affecting the emotion recognition skills of these individuals' children. In light of these findings, systematic assessment and support of emotion recognition skills during the post-traumatic period should be integral components of psychosocial intervention programs. It is well established that verbal approaches alone are insufficient to alleviate trauma symptoms. The effects of trauma are often experienced as difficult or impossible to put into words; psychodrama's action-based interventions offer trauma survivors nonverbal and symbolic channels of expression. The psychodramatic experience can transform the internalized and physical traces of trauma by creating a space in which individuals can safely access the traumatic neural network and restructure it while resolving the fight-or-flight-or-freezing response. Research shows that trauma-focused psychodrama models result in measurable reductions in PTSD symptoms; the vast majority of participants reported a strong sense of emotional safety and connection, increased hope, improved capacity to express emotions, and progress in managing trauma-related symptoms. Technological advancements are paving the way for new forms of intervention that complement traditional psychotherapeutic approaches to mental health. Virtual reality (VR) technology is an emerging and increasingly prominent tool in this field. VR can provide multisensory stimuli tailored to the patient's individual trauma and create a highly interactive virtual environment with high ecological validity that reenacts the traumatic event for therapeutic purposes through computer-generated visual, auditory, olfactory, and tactile experiences. Systematic reviews and meta-analyses have shown that virtual reality exposure therapy (VRET) yields significantly better results for PTSD symptoms than control groups and demonstrates efficacy equivalent to other trauma-focused psychotherapies. In contrast, integrating VR with psychoeducation gives individuals the opportunity to experience both psychoeducational content and emotion regulation skills in a safe, structured environment. Studies conducted in this context indicate that SG-supported interventions can increase post-traumatic growth, reduce trauma symptoms, and strengthen the pursuit of social support and problem-focused coping skills among individuals who have experienced trauma. However, no randomized quasi-experimental study has directly examined the relationship between psychodrama, virtual reality-supported psychoeducation, and emotion recognition skills among earthquake survivors. To address this gap, the planned study aims to investigate the effect of psychodrama and virtual reality-supported psychoeducation on facial emotion recognition skills among earthquake survivors living in a container city in a province that experienced a severe earthquake, using a pre-test-post-test randomized quasi-experimental design and an artificial intelligence-based Facial Emotion Recognition System. The findings of this study are expected to make significant contributions to the development of intervention programs in disaster psychology and to the wider adoption of technology-supported psychosocial interventions in the future.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
32
The psychodrama intervention for the first experimental group was conducted by a faculty member from the Department of Psychiatry holding a psychodrama certification and a psychologist holding a co-therapist certification. The program consisted of 13 sessions held once a week, each lasting 90-120 minutes.
The second experimental group received a CBT-based, SG-supported psychoeducation program delivered by a faculty member from the Department of Guidance and Psychological Counseling, along with two faculty members from the Department of Psychiatric Nursing who were experienced in leading CBT-based psychoeducation groups. The program consisted of 10 sessions held once a week, each lasting for 60 minutes. The first session was dedicated to introductions and establishing group rules, and the final session was reserved for closing and farewells; thus, SG content was used only during sessions 2 through 9.
Inonu University Faculty of Nursing
Malatya, Battalgazi, Turkey (Türkiye)
Emotion Recognition Scores for the Psychoeducation and Psychodrama Groups
A micro-expression is a facial expression that is easily distinguishable and identifiable as a means of communication in social psychology. Facial expressions play an important role in human interaction by providing information about emotions and conveying intentions and goals. In this study, a system comprising six basic human expressions (happy, angry, sad, fearful, surprised, and neutral) was used to classify facial expressions at the macro level. Studies conducted using facial emotion recognition systems demonstrate that facial expression recognition achieves high accuracy using the FER2013 dataset (Shukla et al., 2021; Irhebhude et al., 2023; Yang et al., 2021; Riyantoko et al., 2021; Liu et al., 2021; Echoukairi, 2023). Prior to the start of this study, the researcher tested the Emotion Recognition System in a pilot study involving 20 earthquake survivors whose homes had sustained moderate or severe damage. Approximately 10-minute interviews were conducted with the participant
Time frame: 5 months
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