As we come to a close on our month dedicated to TBI, we will be discussing novel measures of assessing emotion perception following a TBI, The Complex Audio Visual Emotion Assessment Task (CAVEAT), developed by Rosenberg, McDonald, Rosernberg, & Westbrook (2017). Rosenberg et al. (2017), explain the importance of their research as “the effects of TBI on psychosocial functioning have been shown to pose an even greater barrier to adjustment and rehabilitation than the effects on physical and cognitive functioning” (Rosenberg et al., 2017). While there are many factors that lead to reduced psychosocial functioning, Rosenberg et al. (2017) chose to focus on alexithymia. Alexithymia is the difficulty describing or recognizing emotions, which can ultimately lead to interpersonal difficulties, social isolation and depression (Schwartz, 2015).

The CAVEAT has two unique features compared to other emotional recognition tasks: the number of emotions included, and the use of complex audio video cues participants can assign emotions to (as opposed to traditional still photographs) (Rosenberg et al., 2017). In particular, the CAVEAT was designed to test participants on 22 different emotions, half were positive and the remaining negative (Rosenberg et al., 2017). Since the 1970s, psychology as a field has recognized the basic emotions as fear, anger, sadness, disgust, happiness, and surprise, four of which are negative, one of which is positive, and the last is arguably neutral (Cherry, 2020; Ekman & Friesen, 1976). The CAVEAT’s 22 emotions are: amused, caring, confident, enjoyment, excited, flirtatious, happy, interested, positively surprised, proud, relieved, angry, annoyed, baffled, contempt, disinterested, disgusted, fearful, negatively surprised, sad, shy, and suspicious (Rosenberg et al., 2017). These emotions were then acted in video vignettes designed to “[incorporate] dynamic, multi-modal cues and [represent] genuine (not posed) displays of emotion” (Rosenberg et al., 2017). Scripts were then enacted by professional “method” actors, who intentionally induced the emotional in themselves before filming (Rosenberg et al., 2017). The scenes included two actors, one of which was the target actor for the emotion, the other actor remaining neutral (Rosenberg et al., 2017).

Participants were asked, first to choose whether the emotion displayed was positive or negative, then choose the emotion depicted from the list of 11 possible emotions. Results on this measure were compared between a group of participants with TBI and a group of participants without TBI or any other mental health illnesses. Two studies were conducted, the first study compared both the TBI and non-TBI group in terms of accuracy on both the CAVEAT and other emotional recognition tasks. While the second study, was to compare the CAVEAT results to results recognizing the six universal emotions (Rosenberg et al., 2017). Aside from the occurrence of a TBI, participants were chosen for a similarity in age, gender, education level, and occupation (Rosenberg et al., 2017). These two studies were proposed to find the significance between performance differences in TBI, and TBI participants and results correlate with other standard measures of emotional recognition (Rosenberg et al., 2017). 

For the first half of the study, the other emotional recognition tasks were The Awareness of Social Inference Test (TASIT),The Emotion Evaluation Test (EET), The Reading the Minds in the Eyes Test (RMET), twenty-item Toronto Alexithymia Scale-I (TAS-20), and Balanced Emotional Empathy Scale (BEES). The TASIT and EET are two separate parts included in one test, that use video prompts to test participants on recognizing the six universal emotions (McDonald, Flanagan, Rollins, Kinch, 2003; Rosenberg et al., 2017). This is similar to the CAVEAT, except that the CAVEAT tests participants on twenty two emotions instead of the universal six (Rosenberg et al., 2017). Meanwhile, the RMET uses 36 still photographs of eye-regions and has participants choose one of four emotions (Rosenberg et. al, 2017). Like the CAVEAT, there is a wider range of emotions to choose from, though the selection process varies (Rosenberg et al., 2017). The BEES, varies from the previous two measures in that it is a self-reporting test. Participants rank themselves as agreeing or disagreeing with various statements that then serve as a score for how “responsive to the emotional expressions and [experiences] of others” the participant is (Rosenberg et al., 2017). Similarly, the TAS-20 is a self-reporting questionnaire assessing features of alexithymia (difficulty describing and identifying feelings) (Rosenberg et al., 2017; Bagby, Parker & Taylor, 1994).

Overall, the participants with TBI performed worse on emotional recognition tasks and had higher rates of alexithymia (Rosenberg et al., 2017). It is necessary to prove this deficit in order to assert both the need for and accuracy of the CAVEAT (Rosenberg et al., 2017). Participant performance on the CAVEAT was positively correlated with accurate answers on other emotional recognition tasks, as well as negatively correlated with severity of alexithymia (Rosenberg et al., 2017). 

An adapted study by Palermo and Coltheart (2004), noted the CAVEAT performance was also proven to correlate with performance on recognition of the six universal emotions. This was done with a modified version of the CAVEAT that asked participants to choose one of the six universal emotions (Rosenberg et al., 2017).

While these initial results are promising, Rosenberg et al. (2017), suggest further testing regarding response time, construct validity (does emotional recognition vary enough from other quantifiable deficiencies to warrant its own tests), and how performance correlates to real-life function. Cited drawbacks of the test include its length and complexity (Rosenberg et al., 2017). Though the test is designed to be more complex, said complexity also makes the test harder and more resource costly to implement (Rosenberg et al., 2017). However, the test’s largest pro is that it provides an accurate measure of emotional recognition across a more detailed range of target emotions (Rosenberg et al., 2017). This range is important, because it brings simulated measures closer to assessing real life function (as real life emotional expression is often more complex than the universal six) (Rosenberg et al., 2017). These profiles of function can then be used to better train the patient on emotional recognition and thus increase quality of life (Rosenberg et al., 2017).

If you or someone you know have experienced a TBI and need help, you can contact HBSF’s Patient Advocacy program at or look into care, prognosis, and federal resources available for TBI here. You can read this month’s other posts on TBI here (our introduction), here (on professional risks of TBI), and here (on the treatment of neuroinflammation).

Though TBIs are a chronic condition, TBI awareness month happens every March, lead by the Brain Injury Association of America. More about de-stigmatizing TBI, empowering people with TBI and their caregivers, and promoting support systems can be found through their #ChangeYourMind on various social media. 

Written by Senia Hardwick


Bagby, R. M., Parker, J. D. A. & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23-32.

Cherry, K. (2020, January 13). The 6 types of basic emotions and their effect on human behavior. Verywell Mind. Retrieved from

Ekman, P., & Friesen, W. V. (1976). Pictures of facial affect. Consulting psychologists Press.

McDonald, S., Flanagan, S., Rollins, J., & Kinch, J. (2003). TASIT: A new clinical tool for assessing social perception after traumatic brain injury. The Journal of Head Trauma Rehabilitation, 18(3), 219–238.

Palermo, R., & Coltheart, M. (2004). Photographs of facial expression: Accuracy, response times, and ratings of intensity. Behavior Research Methods, Instruments, & Computers, 36(4), 634–638.

Rosenberg, H., McDonald, S., Rosenberg, J., & Westbrook, R. F. (2019). Measuring emotion perception following traumatic brain injury: The complex audio visual emotion assessment task(Caveat). Neuropsychological Rehabilitation, 29(2), 232–250. Retrieved from

Schwartz, A. N. (2015). The loneliness of alexithymia [Dr. Schwartz’s Weblog]. Retrieved from