Perspective Chapter: Emotional Intelligence from a Neuropsychological Perspective

Abstract

Social cognition enables the processing of information necessary to evolve within a social group. Neuropsychology explores models linking brain networks to social information processing. Social cognition is closely tied to the concept of Emotional Intelligence (EI), defined as the mental ability involved in accurately perceiving, understanding, using, and regulating one’s own emotions and those of others. EI could explain the variability of socially guided behavior. Therefore, EI seems to be an interesting concept for neuropsychologists. EI abilities are summarized, showing the neuroanatomical correlates, the tools enabling their assessment, and the functional impact in everyday life. Perceiving emotions in others, alexithymia, empathy, emotional memory, decision-making, theory of mind, and mind regulation are neuropsychological processes than can be explained through the lens of the concept of Emotional Intelligence. Creating standardized tools to assess perception, identification, emotional regulation skills, establishing emotional intelligence profiles, and comparing them to rational intelligence should contribute to enhancing our comprehension of social interactions and their associated dysfunctions.

1. Introduction

The complexity of human social interactions defines our nature as individuals. A wide range of information processing mechanisms allow humans to process information related to social interactions. Social cognition concerns the various psychological processes that enable individuals to take advantage of being part of a social group [1]. In the field of neuropsychology, attempts have been made to develop explanatory models of social information processing and to draw parallels with the involved brain networks.

The “social brain” [2] comprises specific brain circuits that facilitate the processing of social information, including (1) the amygdala network, which evaluates the emotional value of stimuli; (2) the mentalization network, that supports the ability to think about the mental states of oneself and others; (3) the empathy network, which detects and responds to others’ distress; and (4) the mirror network, enabling observation and execution of actions [3].

Emotional Intelligence (EI) is closely intertwined with social cognition. It refers to an individual’s capacity to perceive, comprehend, utilize, and regulate their own emotions, as well as the emotions of others. By having a higher EI, individuals may better understand and manage social interactions. Different models of EI have been developed, focusing on either trait-based approaches or specific-ability approaches. The Mayer & Salovey model represents one of the specific-ability models and presents an adequate concept’s validity (e.g., [5]). This model considers overall EI as a combination of abilities from four branches: perceiving emotions, using emotions to facilitate thinking, understanding emotions, and managing emotions [4, 5, 6].

The aim of this chapter is to establish the connection between these EI abilities and specific processes in neuropsychology and social cognition by presenting the corresponding brain structures, assessment tools, and the functional impact and associated pathologies related to each branch.

2. Perceiving emotion

According to Mayer and Salovey model, perceiving emotion is the first branch of EI. Perceiving emotion has two main functions: (a) the identification function of emotional content; (b) the expression function [6]. These functions encompass a set of skills of problem-solving that allow carrying out an emotionally intelligent reasoning [6]. This set of skills includes the recognition of emotion in other people from facial, postural and voice expressions [6]. It also includes the recognition of one’s own emotion from feelings, though and physical manifestations, as well as the recognition of emotional content from non-living material (e.g., music, arts) [6]. Finally, perceiving emotion involves expressing accurately and appropriately one’s emotions [6]. For instance, in the context of EI, perceiving emotion enables individuals to determine if a friend is afraid. Individuals utilize the skills encompassed within this component to observe that the friend’s eyebrows are raised, jaw is dropped open and lips are stretched horizontally backward, upper eyelids are raised, lower eyelids are raised, mouth is stretched, and voice has a higher pitch and more strained tone [7].

2.1 The neural correlates

2.1.1 Single neural system accounts for perceiving different emotions

Limbic system is often defined as the affective brain. This group of brain structures is a main supporter of emotional reactions [8]. However, limbic structures alone cannot fully explain emotional processes [10]. They are linked with other main structures necessary for perceiving emotions (e.g., frontal lobe, see Ref. [8]).

In addition, the right brain hemisphere theory [9] postulates that the right hemisphere would play a dominant role in perceiving emotion. Such a statement is essentially based on lesion studies. However, this dominance of the right hemisphere is not supported by meta-analysis [10].

Although single neural system accounts of emotion perception have been appealing, they are challenged by results of meta-analysis.

2.1.2 Specific and distinct neural accounts for perceiving different emotions

An alternative view is to conceptualize emotion perception from discrete brain structures specific to each emotion in addition to a generic brain system common for several emotions. Some neural structures seem to be specialized in the perception of specific emotions.

Amygdala is a key brain structure involved in perceiving emotion. It supports both the expression and identification of fear [9, 10, 11, 12, 13]. The amygdala seems to allow priority processing of external information associated with an emotional connotation. This region plays a role in fear circuits through two mechanisms. Firstly, it detects threats at an unconscious level and controls behavioral and physiological responses. Secondly, it influences the emergence of a conscious feeling of fear through cognitive systems [14].

Perceiving disgust emotion would be underpinned by the insula and the basal ganglia. Particularly, basal ganglia are involved in the recognition of disgust signals (e.g., facial expression), and both the experience and expression (e.g., facial and vocal expression) of disgust [10, 12]. Insula also supports recognizing and experiencing feelings of disgust [10, 15]. Mainly, experiencing disgust would be underpinned by the anterior insular region while recognizing disgust would be supported by the ventral anterior insula [16]. Perceiving facial expression of surprise recruits the medial temporal lobe, especially the right parahippocampal gyrus [15]. Murphy et al. [10] suggested that supracallosal anterior cingulate cortex (ACC) supports happiness and sadness perception, while Phan et al. [12] proposed that these emotions are respectively underpinned by basal ganglia and cingulate cortex.

The specificity account also proposes that brain regions can play a generic role in perceiving emotion. Meta-analyses proposed a generic role of the frontal cortex (e.g., medial prefrontal cortex, ACC) in the recognition and experience of emotions [10, 12]. The amygdala allows priority processing of external information with an emotional connotation. The embodied and enactive theory of emotion [9, 17] proposed a somatosensory account of emotion recognition. Facial feedback helps to feel and decode emotion. Faced with an emotional cue, people subtly imitate the associated emotion with a facial expression [17, 18]. These muscle contractions are used as afferent information by the brain to recognize the emotion [18].

2.1.3 Beyond faces: neural correlates of vocal emotion and emotional touch

Beyond face, emotion perception can involve voice, touch, and posture. Perceiving emotion from voice involves areas localized in temporal regions (especially in the right hemisphere), in the medial prefrontal cortex, and posterior superior temporal sulcus (STS) [19]. Insula would support vocal disgust perception. Vocal fear and anger are underpinned by amygdala [19]. Concerning emotional touch, research is restricted to the perceived pleasure. It has been shown that right posterior insula is involved in experiencing pleasure during touch [19].

2.2 Neuropsychological assessment

2.2.1 Assessment of emotion perception in other people

2.2.1.1 Perceiving emotion from facial expressions

Most of neuropsychological tests assessing the perception of others’ emotions are based on the perception of emotion from facial expression. There are many tests and batteries that assess this capacity.

A well-known test used in neuropsychology is the Ekman’s Facial Emotion Recognition task [[20], see also [21]]. It has been adapted to be included in the Mini Social Cognition and Emotion Assessment (SEA) [22]. In this battery, the Ekman’s test is a forced-choice naming task. Thirty-five facial expressions are presented on a screen. Subjects have 12 seconds to indicate, for each face, which emotion is expressed among neutral, joy, anger, surprise, disgust, fear, and sadness. The Faces Test [23] is another princeps test. It is also a naming task of twenty emotional facial expressions with a binary forced-choice. A revised version of this test is included in the Bordeaux Social Cognition Assessment Protocol [24, 25]. Both tests share a common limit. They assess the perception of others’ emotions only through naming task.

Neuropsychologists can use the Florida Affective Battery [[26], see also Ref. [27]]. It includes a set of five subtests to assess the perception and recognition of emotion (happiness, sadness, anger, fear, and neutral) from facial expressions. The subtest one is a facial identity discrimination test. It is a non-emotional task employed to make sure that patients do not suffer from visual and/or neuro-visual impairments. The subtest two is a facial affect discrimination task. Patients indicate if two faces express the same emotion. The subtest three is a naming task in which patients have to label emotion from a facial expression. Conversely, the subtest four is a selection task. Among five emotion facial expressions, patients have to indicate which one expresses the target emotion. Finally, the matching task (subtest five) requires matching a target face with a face that expresses the same emotion. The latter is presented among four distractors.

Likewise, the Comprehensive Affect Test System proposes several tasks to assess emotion perception from facial expression: a non-emotional facial identity discrimination task, facial emotion discrimination task, facial emotion naming task, facial emotion matching task, facial emotion selection task [28]. The strength of these tests lies in their inclusion of a diverse range of tasks that go beyond mere emotion naming task, enabling a more comprehensive assessment of emotion perception. However, both tests show two common main limits: the limited quality of psychometric properties and the nature of the stimuli. All the tests presented thus far employ caricatured stimuli. The intensity of facial emotion is high and presented during a relatively long time. In social interactions, the expression is often shorter and subtler than the emotions displayed in the test.

The Test of Facial Emotion Recognition, TREF [29], is a facial emotion naming task of fifty-four photos. There are nine photos for each of the six assessed emotions (anger, disgust, joy, fear, sadness, contempt). Each of nine photos corresponds to a different level of expression intensity from 20 to 100%. The lower the percentage, the more subtle the facial emotion expression. This test is included in the standardized battery ClaCoS [30]. It has the advantage of manipulating the emotional intensity of stimuli and employing color images.

Tests discussed thus far have a common limit. They use static facial expression. In social interaction, facial expressions are not static; instead, people can perceive the dynamics of emotional facial expressions. Furthermore, although patients have a limited time to answer in these tests, the duration of facial emotion expression is usually shorter in daily interactions. The Emotest [31] has been created to assess the recognition of facial expression from dynamic facial expressions. It is a computer task including twenty-four dynamical stimuli.

2.2.1.2 Perceiving emotions from other modalities

We have reviewed several tests assessing emotion visual recognition from facial expression with a consistent improvement of tools. These tools can be useful in clinical practice. However, their evaluation is restricted to the visual perception of emotions through facial expressions, while in certain cases, there are dissociations in the ability to perceive emotions based on the nature of the stimulus. Furthermore, in clinical neuropsychology, several pathologies are associated with visual and/or neuro-visual impairments. For this patient in those cases, these tests cannot be administered. Therefore, neuropsychologists must: (a) be attentive to not overgeneralize the impairment of emotion recognition; (b) use and develop new tools for assessing emotion recognition in other modalities.

The Emotion Recognition Index [32] assesses emotion recognition with a six forced-choices emotion naming task. It includes a subtest with facial stimuli and a subtest with vocal stimuli. Both express either sadness, fear, anger, happiness, or “neutrality”.

The Florida Affective Battery [26] includes in addition to the set of five subtests to assess recognition of emotion from facial expression, the Florida Affective Battery includes a set of 3 prosodic subtests: nonemotional prosody discrimination, emotional prosody discrimination, name the emotional prosody and conflicting emotional prosody; a set of 2 cross-modal subtests: match emotional prosody to an emotional face, match emotional face to the emotional prosody.

Likewise, the Comprehensive Affect Test System [14] has subtests that assess emotion recognition based on prosody and multimodality. They include: (a) a non-emotional prosody discrimination task; (b) an emotional prosody discrimination task; (c) an emotional prosody naming task with neutral content; (d) a matching task in which patients select a facial expression among distractors associated with a target emotion prosody, and (e) interference tasks in which participant must either name emotion from prosody while ignoring semantic content or name emotion from semantic content while ignoring prosody.

The stimuli of the Florida Affective Battery and the Comprehensive Affect Test System are statics. It would be interesting to develop subtests that combine the crossmodal tasks of these tests with the Emotest. The Multimodal Emotion Recognition test [33] provides such a tool by incorporating static and dynamic visual face stimuli, auditory stimuli, as well as crossmodal stimuli. Emotion expressions vary according to five emotions and two level of arousal intensity. Thus, this test includes ten facial expressions: anxiety, panic fear, happiness, elation, cold anger, hot anger, sadness, despair, disgust, and contempt. Each emotion is presented in three videos in four modalities: video only (dynamic facial expression), audio only (vocal expression), audio with video (dynamic facial and vocal expression), and photos from films (frozen facial expression).

In the same vein, the Geneva Emotion Recognition Test [[34, 35]; see also Ref. [36] for a short version] is a forty forced-choices emotion naming task from crossmodal stimuli. Emotions are expressed through dynamic face expressions, voices, and body gestures.

2.2.2 Assessing perception of one’s own emotion

2.2.2.1 Expressing one’s emotion

For the assessment of emotion expression, neuropsychologist can use several self-report tools (see Ref. [37] for a review of tools). The test of Self-Conscious Affect is the most widely used and well-validated tool to assess guilt and shame expression [38, 39, 40]. Subjects read scenarios and then indicate how they would react on a five-point scale of fifty items.

The Toronto Alexithymia Scale-20 (TAS-20) is a worldwide scale used to assess alexithymia [41, 42]. One factor of this scale corresponds to the difficulty to describe emotions to others (e.g., “It is difficult for me to find the right words for my feelings”).

The Ambivalence Over the Expression of Emotion Questionnaire includes 28 items that assess the difficulty in emotion expression with a five-point Likert scale (e.g., “It is hard to find the right words to indicate to others what I am really feeling”) [43].

Expressing emotion can also be captured in the self-report tool that assesses coping strategies. The Emotional Approach Coping scale [44] includes a subscale that assesses the ability to express emotion outward (e.g., “I allow myself to express my emotion”).

The emotion-focus strategies items of the COPE Inventory include an assessment of emotional expression [45].

Such scales can provide relevant information regarding the patient’s abilities to express emotions. While useful, self-report scales have intrinsic limitations that can be related to construct and or reliability/measurement issues, and to the reliance on participants’ introspection. To provide informative self-report on their emotional expression abilities, it presupposes that patients are capable of recognizing their own emotions.

2.2.2.2 Recognition of one’s own emotion

The Levels of Emotional Awareness Scale, LEAS [46], is a widely used tool to assess people’s ability to recognize their emotional experience [47]. Subjects have to describe their anticipated feelings and those of another subject in response to twenty scenarios. Each item is scored according to the level of emotional awareness. For each scenario, a score is attributed for self and other feelings, respectively. Translations in eight languages including German, French, Italian Dutch, Portuguese, Japanese, Danish, and Spanish are available. This scale seems to be very interesting and relevant for clinical practice. However, it requires that subjects are able to express their emotions.

The Toronto Alexithymia Scale-20, exposed above, includes also a factor and a set of items that assess feeling identification (e.g., “I am often confused about what emotion I am feeling”) [41, 42].

Researchers have developed a Bodily Maps of Emotions [48] that assesses emotion expression through body sensations perception. In this task, participants have to color bodily regions of empty body silhouettes in which they feel an increase or a decrease in activation in response to emotional stimuli. This task is not yet validated for clinical use, but it could become an interesting tool directly targeting the physical experience of emotions and bypassing linguistic abstraction.

2.3 Functional impact

Finely perceiving emotion is critical to social skills. For example, an impairment in the recognition of facial emotion is associated with disability, quality of life reduction, and disturbance in social relationship [49]. Thus, perceiving emotion is essential in daily functioning. For example, it has been shown that a better capacity to perceive emotion protects quality of life in bipolar type I disorder [50], is associated with social adjustment for school-aged girls [51], a better work functioning and independent living in schizophrenia [52], a better adaptive functioning in adults with autism spectrum disorder [53], and a better quality of life in psychological and social aspects in multiple sclerosis [54]. Conversely, difficulties in perceiving emotion are associated with a higher likelihood to be unemployed or unable to work in bipolar disorder [55], a reduced psychological quality of life and a lower social participation following stroke [56], a communication, community functioning, social problem-solving, social skills and occupational dysfunction in schizophrenia [57, 58], and lower socializing abilities in autism spectrum disorders [59].

3. Using emotions to facilitate thought

Regarding the Ability Model of emotional intelligence, the second branch of abilities involves using emotions to enhance one’s thinking [6]. These capacities include both generating emotions to facilitate thought and tailoring thinking to emotion. Thus, this branch would allow us to (1) select problems based on how one’s ongoing emotional state might facilitate cognition; (2) leverage mood swings to generate different cognitive perspectives; (3) prioritize thinking by directing attention according to present feelings; (4) generate emotions as a means to relate to experiences of another person; and (5) generate emotions as an aid to judgment and memory [6]. Using our emotions to facilitate thinking would allow us to put our emotions at the service of our cognitive functioning by allowing us, in particular, to guide our attention toward the most relevant environmental cues [60]. Individuals with a good ability to use their emotions to optimize their thinking understand that certain emotions are relevant to carrying out an activity or achieving a goal [60].

Part of emotional facilitation lies in knowing how to include emotional in, and how to exclude emotions from, thought. Some studies show that people with higher EI might have less interferences from emotional words in a Stroop emotional test (e.g., see [61]).

These abilities seem to involve the coordination between cold processing (as reasoning or memory) and emotions. Indeed, several neuropsychological studies have shown that emotional events are better memorized than neutral ones. Also, studies regarding decision-making have shown that emotional intelligence would make decision-making processes more efficient by reducing cognitive biases [62].

Emotions, as well as physical sensations, are the information processing heuristics that have an evolving function. In his presentation of Phineas Gage, Damasio already highlighted the impact of emotions on driving decision-making [63].

Some authors link this second branch of abilities to the concept of affective empathy [64]. It would be a catalyst through which another person’s emotions can influence and mobilize social behavior [64]. Affective empathy refers to the capacity to share the emotional state of another person, becoming a major source of motivation for individuals to perform prosocial behaviors intended to benefit the other [65].

Empathy involves the generation of an emotional response from the observer to a situation that affects other individuals. Several authors differentiate two types of empathy: cognitive empathy, which refers to the person’s ability to interpret and understand the experiences and feelings of others; and affective empathy, which involves the emotional reactivity of the person in the face of the emotion of others.

If cognitive empathy solicits neurocognitive abilities of mentalization, affective empathy solicits different capacities and is associated with its own neural networks. A process still different from affective empathy is emotional contagion, which leads to the observer not only being aware of the emotional state of the other person, but also feeling the same emotion [64].

3.1 The neural correlates

3.1.1 Affective empathy and emotional contagion

These various processes seem to have different, but connected neural subtracts. The ability to prioritize emotional information from oneself and others depending on contextual demand appears to be dependent on the temporoparietal junction (TPJ) [64]. The ability to sense another person’s emotional states depends on the ventro-lateral region of the Pre-Frontal Cortext (vlPFC) and the insula (involved in bodily feelings related to emotions) [64]. This empathy network, therefore, would allow face detection and response to others’ distress [3].

3.1.2 Emotional memory

The memorization of events with positive or negative emotional valence plays a key role in decision-making processes [64]. The cerebral circuits, which support the processes of memorizing information containing an emotional valence, are well known, the Papez circuit associated with the amygdala. This circuit includes the perirhinal cortex and the hippocampus. The hippocampus is a key region in the encoding and retrieval of episodic information. The perirhinal cortex seems to play a role in the recognition of stored items. As for the amygdala, it allows the amplification of the consolidation and the retrieval of information with an emotional valence. The amygdala and nucleus accumbens are involved in associative learning [66].

3.1.3 Mirror network

The mirror neuron system (MNS) is a group of specialized neurons located in the parietal and prefrontal areas that “mirror” the actions and behavior of others [3, 67].

Brain imaging studies have shown that when humans observe actions, specific areas of the brain are activated. These areas include the inferior frontal gyrus (IFG), the precentral gyrus, the inferior parietal lobe (IPL), as well as the visual areas [68].

The MNS is somatotopically organized and fires while observing meaningless movements [68]. The IFG, the IPL, and the superior temporal sulcus (STS) regions participate in giving meaning to the movements [69].

The mirror neurons transform visual observation into knowledge. [64] Studies on humans during action observation have shown activation of the IFG, the IPL, and a region within the STS.

3.1.4 Decision-making

Being able to adjust and improve our behavior in response to changes in emotional significance is crucial for success in tasks that involve reversal learning and decision-making [70]. Damasio [63] described several cases of patient with frontal lesion which led to major difficulties in decision-making (disastrous professional and personal choices, difficulties in adjusting appropriately in activities of daily living, in adapting their social behavior, or in reacting appropriately to various professional or personal situations), whereas other cognitive functions were preserved. Those lead to the proof that (a) decision-making involves cognitive intelligence, but also emotional processing; (b) those skills are at least supported by frontal areas.

In order to make good decision, critical clues must be selected. Amygdala acts as an amplifier that will bias downstream cortical targets’ activity in order to prioritize the processing of salient stimuli [64]. The orbitofrontal cortex, the amygdala, and the ventral striatum are involved in the emotional marking of stimuli [71].

The medial prefrontal cortex, including the orbitofrontal cortex, receives multimodal sensory information and provides the main outputs from the cortical structures to the visceromotor structures of the hypothalamus and the brainstem [72]; the medial prefrontal cortex involved in the processing of pleasure [73], gratifying results [74] and in the formation of hedonic associations [75].

The ventromedial prefrontal cortex (vmPFC) involved in the association between a situation and a specific internal state would make it possible to create somatic markers which will either encourage or conversely constrain decision-making processes according to the harmful consequences and by seeking beneficial solutions [63].

3.2 Neuropsychological assessment of empathy

The assessment of empathy in neuropsychology has usually been done with questionnaires. To our knowledge, no standardized behavioral test of empathy has been developed. The Interpersonal Reactivity Index (IRI) [76] self-questionnaire is the most widely used in research. It is composed of 28 items and differentiates between cognitive and emotional or affective empathy. Four sub-dimensions make up the questionnaire: perspective-taking, imagination, empathic concern, personal distress. Perspective taking and imagination make up cognitive empathy, and empathic concern and personal distress affect affective empathy.

The Empathy Quotient (EQ) of Baron-Cohen and Wheelwright [77] is a 60-item self-questionnaire (there is also a shorter, 40-item version) designed to measure empathy in adults.

The Basic Empathy Scale in Adults (BES – A) [78] is also a self-administered questionnaire comprising 20 items. Like IRI, this scale differentiates cognitive and affective dimension.

The Questionnaire of Cognitive and Affective Empathy (QCAE) [79] is a tool for self-assessing the cognitive and emotional components of empathy. It is more used in patients with psychiatric disorders in particular with schizophrenia.

3.3 Functional impact

3.3.1 Academic achievement

Brasseur and Gregoire [80] observed in unskilled students as well as in high potential students that high scores in certain areas of emotional intelligence related to the ability to use emotions to improve reasoning (empathy score, interpersonal skills, adaptability, and assertiveness) were positively correlated with academic achievement as well as social skill.

3.3.2 Social relationship

Lopes and colleagues’ study [81] observed that higher score at on the second branch of the model significantly predicted participants’ self-perceptions of social competences. Another study shows a better ability to estimate one’s skills in reacting to events in their friends’ lives [82]. Also, the higher the EI, the better the perception by others of one’s own social competence (i.e., social commitment and the degree of being a team player) [82]. Lopes et al. [83] showed that higher EI score predicts better capacities in social interaction.

3.3.3 Occupational

Day and Carroll [84] reported that participants with high EI had more citizenship behavior at the group level (e.g., showing concerns for the organization). The Affect Infusion Model [85]explains how affects can be used to influence cognitive processes. It proposed that the more complex the task, the more affects influence cognitive processes involved in that task [60, 85] . Thus, affective experience cannot be ignored in the workplace because according to this model affective state has a direct influence on decisions made at work [60]. For example, workers involved in complex tasks use their affective states to make decision based on heuristic or substantive reasoning [60].

3.3.4 Psychological and physical well-being

EI is related to greater life satisfaction, self-esteem, and lower ratings for depression. In contrast, EI seems to be negatively correlated with some negative physical health behaviors even though this correlation was not systematically found or was small [5].

4. Understanding emotions

After perceiving an emotion, the individual utilizes emotion-related information not only to make inferences about the social situation and the interlocutor but to also to make inferences about the interlocutors’ representation of the observer [86].

Understanding the emotions and thoughts of others is essential for social interaction. This cognitive ability is referred to as “theory of mind” (ToM) or mentalizing [87]. It plays a fundamental role in the development of interaction skills.

4.1 The neural correlates

Neuropsychologists differentiate two aspects of theory of mind. One is the cognitive ToM, and the other is the affective ToM [88]. Cognitive theory of mind refers to the ascription of mental states to the self and others [64]. However, the ability to distinguish and recognize both our own emotions and those of others, as well as being aware of the causes and trajectories in emotions, requires the utilization of the affective theory of mind. These two aspects of social cognition are associated with different brain circuits [64].

4.1.1 Cognitive and emotional theory of mind systems

A circuit connecting the regions of the superior temporal cortex and prefrontal cortex appears to be involved in the attribution of mental states.

Indeed, cognitive ToM appears to be systemically correlated in neuroimaging studies with the neural activity recorded in the TPJ, the middle temporal gyrus, the precuneus, and the lateral and medial prefrontal cortices and lesions in any of these regions cause alterations in cognitive ToM (see [89] for a summary of available data). The dlPFC is associated with the cognitive but apparently not with non-affective aspects of the ToM [90].

The activation of the TPJ is diminished during an intention attribution task and in false belief detection tasks [91].

The vmPFC appears to treat emotional inferences. Lesions in the vmPFC cause impairments in the ability to infer thoughts and behaviors of others influenced by emotions. The lesions to the left hemisphere of this region are linked to difficulties in identifying social faux pas [64].

4.1.2 First- and second-order beliefs

The study of the theory of mind makes the difference between the ability to represent first-order mental states (my inferences about others’ mental states) that appear early in development and the ability to identify second-order mental states (my representation about others’ inferences about my mental states) [92]. This second representation is of later development (5–6 years) [93].

Increased brain activity was observed in ToM of first-order task in a complex network of the social brain: the medial prefrontal cortex (mPFC), TPJ, STS, and precuneus when subjects represented the beliefs of others [94].

Second-order representation appears to similarly activate the PFC and the STS, but also the posterior cingulate cortex and the PFC. In functional activation correlation studies, a greater correlation was observed between PFC/CCA activation and the hippocampus. And the task of prediction of second-order mental states also seems to couple the activity of caudate and insula [94].

4.1.3 Implicit and explicit treatment

Automatic inferences versus explicit information processing can also be differentiated. The explicit processing is more flexible in the ability to process information, is resource intensive, appears later in the development (around 4 years), and is related to the TPJ, precuneus, temporal poles, and STS network [95]. Automatic processing consumes fewer cognitive and energy resources, develops earlier (18 months), and is less flexible [95, 96, 97, 98]. Similar regions seem to be concerned in automatic ToM with the addition of the prefrontal cortex [99].

4.2 Neuropsychological assessment

Among the neuropsychological tests that allow for the assessment of inferences about cognitive and emotional states in others, the most relevant one is the Reading the Mind in the Eyes Test - RMET [77]. It measures affective theory of mind in participants who are presented with different actors’ gazes and who have to choose among four response options that correspond to complex mental states.

The Attribution of Intentions task [100, 101] in the form of a comic strip evaluates the ability to understand physical causal inferences with human characters and inferences about the characters’ intentions.

The Theory of Mind-15 (TOM-15) test [102] assesses the individual’s ability to detect a cognitive false belief. It is presented in the form of a comic strip and includes both first-order and second-order false belief tasks.

The Faux Pas task [103] assesses the ability to recognize social awkwardness based on the presentation of multiple fictional and socially ambiguous stories.

The Mask test from the ClaCoS battery [30] is a test to evaluate the ability of theory of the mind by means of a film, where it is a question of attributing an emotional or cognitive mental state to the characters. This test allows differentiating of the types of response error: lack of ToM, default of ToM (a low inference is produced), and hyperToM mistake. These different types of error allow neuropsychologists to guide the type of cognitive rehabilitation proposed later.

4.3 Functional impact

Difficulties in understanding and interpreting the thoughts and feelings of others can be associated to psychopathological conditions. This is seen in several conditions, including schizophrenia, borderline personality disorder, post-traumatic stress disorder, depression, and eating disorders but also with psychosocial conditions as childhood adversity [[104] for a review]. Dysfunctional ToM has been proposed as a transdiagnostic clinical marker [105]. Good performance in ToM capabilities is related to a better social functioning (e.g., less loneliness, less social rejection, and being rated as socially skilled by teachers [106, 107, 108]) and also to prosocial behavior, peer popularity, and reciprocal friendship [109, 110, 111].

5. Regulating emotions

Although neuropsychology has traditionally made a distinction between the generation of emotions and the management of their impairments from reports on patients with brain lesions who demonstrated dissociation in these abilities [112], the concept of emotional regulation has been weakly addressed in neuropsychology [113].

Emotional regulation is a multifactorial concept that incorporates several psychosocial skills. One of the most widespread conceptual models on emotional regulation is Gross’s Process Model of Emotion Regulation [114]. This model suggests that emotional regulation is supported by a series of behavioral strategies that depend on neuropsychological functions (situation selection, situation modification, attentional deployment, cognitive change, and response modulation).

5.1 Situation selection

Situation selection is the competence that allows one to guide their actions in order to avoid or ensure future consequences. More concretely, it enables the prediction of trajectories of emotional experiences in the future [115]. It is supported by two neuropsychological functions, the capacity to generate an array of hypothetical future scenarios and the ability to decide among them based on their potential emotional impact [116].

These abilities rely on autobiographical memory and the capacity to make inferences about the future consequences of actions. Bilateral activation of the hippocampi appears to be important in utilizing episodic memory for these competencies [117], while the vmPFC appears to enable the generation and selection of multiple scenarios [118, 119].

Subjects having alterations in these areas present difficulties in decision-making and in using memory to generate scenarios [112].

If we imagine the example of a person with a subway phobia, a strategy of situation selection to manage emotions would be the choice of a less uncomfortable transport.

5.2 Situation modification

Situation modification involves rapidly and flexibly devising alternative actions that could potentially alter the course of a situation [116]. This psychosocial competence requires good problem-solving skills and depends on the dlPFC [112].

Problem-solving requires task setting skills and the ability to change the action plan depending on internal or external constraints. These executive processes appear to be associated with the left lateral PFC cortex. However, the monitoring of the action plan and the detection of errors seem lateralized to the right hemisphere [120]. Behavioral perseverations are the behavioral correlation of difficulties in having flexible executive control [121].

Following the example of a person with difficulties traveling in subway, if there is a breakdown, the strategy of being able to quickly change the means of transport would be a modified situation strategy.

5.3 Attentional deployment

Similar to how the situation selection skill enables the choice of situations that lead to an improvement in emotional experience, attentional deployment facilitates the shift of attentional focus toward more positive thoughts or stimuli [112].

This skill requires the use of networks of attentional control (sustained attention, inhibitory control in working memory, and detachment of attentional focus from negative stimuli). The fronto-parietal attentional control network appears to be the underlying anatomical substrate [112].

This network is functional early in development and is correlated with the regulation of negative emotions [122].

For our traveler stuck in the metro, this skill would change the attentional focus of catastrophic and negative automatic thoughts that would otherwise increase the experience of a grueling journey.

5.4 Cognitive change

Cognitive change is the strategy of using verbal thinking to change one’s emotions. This strategy is the basis of the cognitive or Socratic restructuring, a psychotherapeutic method from the Cognitive Behavioral Therapy (CBT) approach. Cognitive reappraisal involves recognizing the negative pattern the person thoughts have fallen into, and changing that pattern to one that is more effective.

Cognitive change is also a multifactorial skill requiring several neuropsychological components: working memory, inhibition, verbal fluency, and set shifting. Buhle and colleagues reported [123] that the implementation of this strategy consistently modulated the amygdala bilaterally and activated cognitive control regions (dmPFC, dlPFC, vlPFC, and posterior parietal lobe).

For the person stuck in the metro, the cognitive change skill can generate such altered thoughts in the face of automatic thoughts. For example, in the face of thoughts “I am always the one who finds difficulties in the subway” or “if I have a medical problem, I will not be able to get out of here”; the ability to change cognitively and generate thoughts like “I take the subway every day and most of the time it runs without problems” or “there is no reason for me to have a medical problem, and there is an alarm that will allow the doors to open and rescue to arrive quickly.”

5.5 Response modulation

Response modulation consists of either amplifying or suppressing the behavioral reactions generated by emotions [114, 124]. These answers are at the level of the facial muscles, gestures, and postures [116].

Neuroimaging studies show the activation of regions associated with interoception, emotional awareness, and cognitive inhibition.

Previous research on emotional response suppression has reported a correlation between this style of behavior evaluated with a self-assessment questionnaire and resting activation of the vmPFC [125].

Other authors [126] have found broader activation of the left lateral prefrontal cortex, the medial prefrontal cortex and the medial orbitofrontal cortex during an emotional suppression task compared to an emotional attending task. In the former, participants had to try to suppress their emotional responses to stimuli. In the latter, participants had to be aware of their emotional responses to stimuli without regulating them.

In addition to the differences at the functional level, at the structural level, the use of emotional regulation strategies is associated with greater volume of gray matter in the dorsal anterior cingulate/paracingulate cortex, the amygdala [127], the medial prefrontal cortex [127, 128] and the anterior insula [129] (which is involved in interoceptive treatment and emotional awareness).

To our knowledge, no research has studied the neural correlates of the emotional amplification response.

Cognitive inhibition is the basis for suppressing response and cognitive inhibition difficulties are presented in the form of behavioral impulsivity, that is, inability to control a behavioral reaction once it is elicited [130].

If we continue with the example of the person feeling unpleasant sensations in the subway, the response of emotional modulation could remove the facial and postural signs of anxiety.

5.6 Regulating emotion assessment

The evaluation of these behavioral strategies has not been performed within the framework of neuropsychology. However, process psychotherapeutic approaches (CBT) increasingly incorporate questionnaires to assess emotional regulation. The Multidimensional Experiential Avoidance Questionnaire MEAQ [131] assesses Experiential Avoidance, which is defined as the tendency to avoid negative internal experiences.

The Mini-Cambridge Exeter Repetitive Thought Scale [132] allows identifying of repetitive automatic thoughts and differentiating between constructive and non-constructive thoughts.

5.7 Functional impact

Difficulties in regulating emotions are a transdiagnostic symptom common to several disorders (e.g., substance use disorders [133], eating disorders [134], bipolar disorder [135]). Notably, ADHD is conceptualized as a difficulty in modulating cognitive and emotional functioning [136].

Personality disorders also present difficulties in emotional regulation at the core of their expression [137]. Lopes et al. [83] showed that high emotional regulation capacities predicted: (a) reciprocal friendship nomination (i.e., the fact that the student X nominates the student Y as their friend, who in turn nominated the student X as their friend); (b) self and peer-perception of interpersonal sensitivity and prosocial tendencies; (c) and the proportion of positive peer nomination (i.e., the nomination of a student for positive criteria) versus negative peer nominations.

6. Conclusions

The neuropsychological assessment of processes related to emotional intelligence and social cognition allows for the identification of difficulties in typical social interactions in a significant number of neurological, psychiatric, and neurodevelopmental conditions. In the case of adult individuals, these cognitive difficulties are often compensated for by executive strategies.

The development of assessment tools for emotion perception, emotion identification, and emotional regulation skills, along with the establishment of emotional intelligence profiles, has paved the way for the development of more systematic EI testing in neuropsychology practice.

At a time when hospital and private practitioners are often overwhelmed with diagnostic and support demands related to emotional difficulties, the conceptualization of emotional intelligence could prove to be an integrated, practical tool for neuropsychologists and psychotherapists.

The current theoretical confusion among terms such as intellectual giftedness, hypersensitivity, and emotional giftedness could be reduced thanks to the development of conceptual and psychometric tools within the sphere of emotional intelligence. All these above mentioned categories represent a form of intricacy between “cold” and “hot” cognition and the theoretical confusion mentioned could be partly due to the lack of a clear integration between “affective” and “cognitive” processes. In this state of affairs, several concepts have been developed separately. EI could serve as a set of criteria contributing to distinguishing between or to assimilating, the various categories.

Finally, the neuropsychological point of view interprets EI as a meta-concept that provides us with a connection between classical neurocognitive functions and social cognition, extending also the intellectual evaluation of the individual to better understand the success in social interactions.