RCT Emotion Recognition after TBI, 1
Stories Intervention
Supplemental Digital Content
I. Treatment Concepts
 The Stories Intervention aims to improve the following skills believed to be important for
emotion recognition:
Context-specific
(a)
General
emotion (b, c)
a. Attending to and understanding important contextual information indicative
of an emotion (as described in short stories).
b. Personal experiences with one’s own emotions in order to better recognize
emotion in others. In other words, making associations with one’s own
personal experience with their emotions.
c. Developing a stronger conceptual understanding of emotions.
II. Learning Strategies
 Repetition
 Vanishing Cues
 Increasing difficulty
 Feedback
III. Communicating the purpose and importance of the treatment to participants
Prior to beginning treatment activities, the therapist reviewed the following foundations of the
intervention with each participant:
1. Goal of treatment:
“The purpose of this treatment is to try to help you better recognize how people are feeling. When this
study is over, we hope that when you are talking or socializing with others, you will be better able to
figure out how they are feeling. For the next several weeks we are going to read a series of stories that
should help with your ability to make social inferences. Although the content of each story will vary,
the goals for all of the stories are to work on figuring out what the characters in the story feel,
think, and want. We will also talk about situations that have happened in your life that might be
similar to the situations in the stories. Although you may find that are you quite good at answering
the questions for the stories, you must complete each story. There are 14 altogether. For each story, you
will get a score out of 5. If you get less than 4, you will need to repeat that story by the end of the 9
treatment sessions.”
2. Importance of recognizing others’ emotions.
 Help you to interact with others better (behavior)
 Help you develop stronger emotional bonds with others.
 Gives you the skills to be more supportive towards others.
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 Help you to show you care about others’ feelings.
3. Importance of discussing and understanding their own emotions.
During the course of this treatment, there will be times we will ask you to refer to your own emotions
and to discuss some of your emotional experiences. It is expected that the more you are able to
understand your own emotions, the better you will be able to recognize others’ emotions. It’s important
to be in touch with your own emotions because:
 It may improve your emotional self-awareness and understanding of your own emotions
 It is believed to be important for helping you to better relate to others’ emotions
 It is believed to be important in helping you identify your emotional needs, and consequently
important for finding more motivation.
 It is believed to be important for judgment and decision-making if you consider how
consequences of your actions will make you feel better.
III.
Description of Stories intervention and treatment administration
 The Stories Intervention is a computer-based treatment program comprised of 14 short stories
that were developed by the study authors. Stories range from 928 to 1178 words and are at an
average reading grade level of 6.6 (Flesch-Kincaid Grade Level rating system). The short stories
were initially piloted with typically developing adults to ensure that the intended target emotion
could actually being correctly inferred from the context. The target emotion was correctly
identified between 80-100% of the time across all stories. For the Stories Intervention,
participants complete the stories sequentially. See Figure 1.
Figure 1.

Stories are presented in a simultaneous visually (written text displayed on the computer) and oral
(read aloud in neutral tone) format. The oral presentations of the story were pre-recorded. Stories
are sectioned out by paragraph, and only one paragraph appears on each screen so as to not
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overwhelm the participants. An icon indicating “Play” must be clicked to turn the audio on for the
oral presentation (See Figure 2).
Figure 2.

Vanishing Cues and increasing difficulty: Participants were trained to pay attention to relevant
contextual information that was highlighted through the use of colored words and bolded text
(See Figure 2). The use of colored words and text gradually faded during the course of treatment:
Stories 1-6 (easy difficulty) used both cues (see Figure 2); Stories 7-10 (medium difficulty) used
only colored text (see Figure 3); Stories 11-14 (difficult) provided no cues. (see Figure 4).
Therefore, cues gradually vanished as participants progressed through the intervention.
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Figure 3.
Figure 4.

At the end of each story, participants are presented with 5 questions that ask how the character(s)
were feeling at certain points during the story. To respond to the questions, participants select
from 4 emotions: Happy, Sad, Angry, and Fearful. Questions are presented one at a time and
participants cannot advance to the next question until they correctly answer the current question.
As shown in Figure 5, relevant story content appears in a window next to the question, allowing
participants to re-read that section of the story. This was done so participants would not have to
rely on their memory of the story. In addition, participants were also encouraged to identify
specific contextual information that was indicative of the characters’ emotions while re-reading
the story sections relevant to the question at hand.
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Figure 5.

Participants were always given feedback about their answers with a popup box (Figure 6). When
correct, the popup box would additionally ask participants to to explain what contextual
information they used to determine how the character was feeling. When participants answered
incorrectly, the popup box guided participants to review cues that included the relevant
contextual information from which to infer the emotion (Figure 7). The correct answer was
included alongside the relevant contextual information so participants could learn to associate
that context with the targeted emotion.
Figures 6 and 7.
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
Important contextual information included: Information about characters’ beliefs, expectations,
wants/ desires, and behaviors (what they did and said), as well as information as to whether or
not their beliefs, expectations, and wants/desires were supported or not.

Advanced Emotional Processing: After completing the story questions, participants were asked
to describe and discuss a personal event from their own lives that was similar to at least one of
the main concepts discussed in the story (i.e.. contextual dilemma or circumstances that evoked
their own emotional experience). This part of the training took approximately 15 minutes per
story.
(a) Describe the situation in more detail. What was the surrounding context?
(b) How did you feel? Please describe all emotions you felt.
o Label your emotions (e.g.. angry, sad, etc.)
o What physiological reactions were you experiencing? Use Table 1 below for
examples.
o Re-enact physiological and body sensations.
(c) Why do you think you felt the emotions you did? For example, I was angry because…,
but I was also sad because….. etc.
 Thoughts, beliefs, wants, and expectations (consistent/ inconsistent with what happened)?
 Probe for deeper emotions (beyond superficially expressed emotion) such as sad and fear
especially when discussing anger.
(d) What was your response to the situation?
o How did you behave?
o What emotion were you outwardly expressing via your actions?
(e) What do you think others’ perception of your emotion was at the time? Based on the
participants’ response, what does the participant think others thought that he or she (the
participant) was feeling?
(f) How did others in the situation respond to your behavior?
o Their behavior
o Other’s feelings (How do you think they were feeling based on behavior);Why do
you think others were feeling that way?
Happy
Sad
Angry
Muscles
are…
Relaxed
Heavy, as if a
weight is on
your chest.
Very tense.
Heart
rate…
Low and normal
May be slow (or
fast if anxious
too)
Speeds up.
Speeds up.
Feel like…
Floating in air or
on water, Tingly.
Lacking in
energy;
Tense and tight;
hot as if
temperature
rises; may want
to hit something
or yell and
scream.
Stomach has
butterflies;
Sweating and
shaking; Feel on
edge or jumpy.
tired; weighed
down
Fearful
Table 1. Examples of physiological responses and body states associated with emotions.
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IV.
Story Descriptions and Key Concepts
Below are brief descriptions about the stories and the concepts/context that participants needed to use to
infer what the character was feeling in response to each question. Each concept is labeled 1-5 and those
numbers directly correspond to the question asked. If participants had difficulty identifying a personal
experience that related to the story, the therapist could present these key concepts to them ask if they had
ever had a similar situation occur in their own life.
Story 1: You’re Fired! Miranda goes back to work after a stroke and confronts challenges due to some
of her newly acquired deficits.
Key Concepts:
1. Incorrect assumption about your behavior; Not provided with something you truly need to
accomplish a task
2. Having something happen that you wanted to happen; Getting out of a situation you dislike
3. Unsure about the future; Insecure about what might happen to you
4. Realizing you haven’t achieved a goal(s) you set for yourself
5. Worry/concern about a new situation, whether you will succeed and/or fit in
Story 2: Bahamas. A married couple leaves their kids with their grandparents while they go away on a
romantic vacation.
Key Concepts:
1. Second thoughts about a decision
2. Saying goodbye to a loved one you won’t see for some time
3. Enjoyable holiday/vacation; Time where you felt comfortable/relaxed/no pressure
4. Unsure of a new experience
5. Returning home/seeing loved ones after some time away
Story 3: Soldier Returns Home. An injured war veteran comes home and deals with challenges of reintegrating back into her family as a different person with new roles and abilities.
Key Concepts:
1. Anticipation of seeing someone you haven’t seen in awhile
2. Worry about what others might think
3. Having people do things for you because they think you aren’t able to do them on your
own/feeling ‘babied’
4. Feeling like you don’t fit in/feeling replaced
5. Getting back to the ‘norm’/regaining independence
Story 4: Back to School. An older mother realizes she’s not fulfilled with her job and considers going
back to school to pursue her dream of becoming a doctor.
Key Concepts:
1. Nice accomplishment/achievement strived long and hard for
2. Settling for less
3. Doubts of a decision; concern about how something will work out; planning
4. Talking with someone as sounding board to solve problems; expressing true feelings concerns/
stress in a productive manner
5. Having people not believe in you and/or not agree with your decision.
Story 5: Lake House: A family just bought a summer lake house, but the children are initially skeptical
of leaving familiar friends behind and having to fit in with new kids.
Key Concepts:
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1.
2.
3.
4.
5.
Able to obtain a goal
Being forced to do something you didn’t want to do
Feeling left out
Being accepted into a group
Knowing something you enjoy is coming to an end
Story 6: Model Car. A father struggles to balance the difference between doing something for his son
versus teaching him new skills that would allow him to learn to do the task independently.
Key Concepts:
1. Feeling like you can’t do anything right
2. Feeling betrayed/like you were lied to/misled
3. Relief about getting past a bad memory
4. Someone assuming you can’t do something on your own
5. Realizing you hurt someone else’s feelings
Story 7: Newlyweds. A newly married couple deals with conflict as they try to blend their lives and
realize their own goals and expectations of each other might not mesh as well as they thought.
Key Concepts:
1. Disagreement. Both persons think they are right
2. Happy because of something someone else did- came through.
3. Worried about having made a mistake/ bad decision
4. Knowing you have to do something you don’t want to do
5. Fear of future/ unknown/ fear of being alone
Story 8: Parents-To-Be. A couple finally gets pregnant after a long time of trying and thinking they
wouldn’t be able to have kids.
Key Concepts:
1. Unlikely you will get something you want
2. Getting something you’ve wanted that you didn’t think you would get
3. Someone doing something you didn’t want them to.
4. Uncertainty/ doubts
5. Fear of a bad outcome
Story 9: Independence Day. A man is blinded in an accident with firecrackers on 4th of July and
struggles with adapting to his new life.
Key Concepts:
1. Angry at outcome/fighting change/refuse to acknowledge disability or the need for assistance
2. Self-doubt; worried about future; lacking confidence
3. Loss of independence; unable to succeed, even after trying. Give up/helplessness
4. Fed up with taking the brunt of someone else’s frustrations/ angry with the way someone is
acting
5. Getting back to the ‘norm’; regaining independence
Story 10: To be a Friend. A young woman realizes that one of her long-time friends might actually be
selfish and not such a good friend after all.
Key Concepts:
1. Feeling frustrated and needing to vent frustrations
2. Feeling disappointed and let down by somebody who’s supposed to care for you.
3. Feeling betrayed
4. Concerned about future/ meeting new friends/ fearful of being alone
5. Relief and joy from discussing feelings/ being honest/ getting past a sensitive/upsetting situation.
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Story 11: Baby on Board. A couple who has chosen not to have kids gets pregnant.
Key Concepts:
1. Unexpected/unwanted outcome
2. Somebody being insensitive to your feelings
3. Feeling unwanted
4. Fear of unknown/pain
5. Giving up something you knew you had to, but didn’t necessarily want to
Story 12: Grandma. A young man’s grandma dies after his family puts her in a nursing home, an action
that caused strife between the grandson and his parents.
Key Concepts:
1. Fearful of telling someone bad news
2. Feeling you’ve made a difference/contributed/gave back
3. Disagreement with decision/ decision made without being consulted
4. Feeling missed out on something
5. Worried about someone’s reaction to a situation
Story 13: College Years. A young college man struggles with school. He’s not the academic type and
would rather just get out in the real world and start his own business.
Key Concepts:
1. Feeling trapped or forced to do something you don’t want to do.
2. Missing familiarity/comfort
3. Fear of trying and failing
4. Fear of trying and failing
5. Sense of accomplishment
Story 14: SFPD. A married cop dies on duty and never makes it home to his family, a family who never
fully accepted his dangerous job in the first place.
Key Concepts:
1. Annoyed that someone had selfish priorities
2. Fear of bad or unknown outcome
3. Being alone/ thought of losing someone you love
4. Regret
5. Happy about resolution/ justice
V.





Logistics of Treatment Administration
Training should be one-on-one in a quiet room.
A computer is needed for the software.
Provide breaks to the participant as needed.
Training should attempt to be administered 3 times a week for 3 weeks, with each session lasting one
hour. However, if there are transportation concerns, there is flexibility in how the 9 hours of treatment
can be administered (e.g., ……).
Participants may often finish more than one story in one session. In order for participants to move on to
the next story, they must achieve 80% accuracy (i.e., answer 4 of the 5 questions correctly). If they are
unable to answer the questions with 80% accuracy, they must repeat that story. Participants are only
exposed to each story a maximum of two times. If after the second reading of a story they are unable to
answer the questions at an accuracy level of 80%, they move on to the next story. If the participant is
below 80% accuracy for a story and there is a lot of time remaining in that session, the therapist can
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move on to the next story for that day. However, on the following training day, the therapist must start
with and repeat the story in which the 80% target was not reached in he previous session.