Botox may diminish the experience of emotion

DO you smile because you're happy, or are you happy because you are smiling? Darwin believed that facial expressions are indeed important for experiencing emotions. In The Expression of the Emotions in Man and Animals, he wrote that "the free expression by outward signs of an emotion intensifies it...[whereas]...the repression...of all outward signs softens our emotions." This idea was subsequently elaborated by the great psychologist William James, who suggested that "every representation of a movement awakens in some degree the actual movement which is its object." 

Botox, which is used by millions of people every year to reduce wrinkles and frown lines on the forehead, works by paralyzing the muscles involved in producing facial expressions. A study due to be published in the journal Psychological Science suggests that by doing so, it impairs the ability to process the emotional content of language, and may diminish the quality of emotional experiences.

David Havas of the University of Wisconsin-Madison and his colleagues have been investigating the relationship between emotion and language. In a study published in 2007, they covertly manipulated facial expressions by asking participants to hold a pen either in their teeth, to simulate smiling, or between their lips, to prevent them from smiling. This was found to affect the time taken to read sentences containing emotional content: reading times for sentences describing pleasant situations were shorter when the participants were smiling than when they were prevented from smiling, and this was reversed when they read sentences describing unpleasant situations. Thus, understanding of the  sentences was apparently enhanced when their emotional content matched the participants' facial expression, and impaired when it did not.

Other researchers have shown that reading words describing emotions can activate the muscles involved in producing the facial expressions associated with those emotions. For example, reading negative emotional words causes contraction of the corrugator supercilii, which pulls the eyebrows down towards the centre of the face to produce vertical frown lines at the top of the nose, whereas reading positive emotional words activates the zygomaticus, which raises the corners of the mouth to produce a smile. These findings provide evidence that involuntary facial expressions can evoke emotions, and suggest that the brain mechanisms involved in experiencing emotions are also used in understanding the emotional content of language.

Following on from this earlier work, Havas recruited 40 women for the new study, all of whom were seeking first-time botox injections as a cosmetic treatment for frown lines on the forehead. These participants were asked to read sentences describing happy, sad or emotionally neutral situations. Immediately afterwards, they were taken to the physician, who gave them a single injection of botox into the corrugator supercilii, or "frown" muscle. (Botox acts by inhibiting the release of the neurotransmitter acetylcholine from motor neurons, leading to temporary muscle paralysis 24-48 hours later. Typically, the procedure is repeated after 3-4 months; with time, the muscles may atrophy, or waste away, through disuse.) Two weeks after the injection, the participants returned to lab to read another set of similar sentences.

The reseachers found that botox slowed the reading of the sentences containing sad emotional content, which, as the earlier work showed, would normally cause the frown muscle to contract. The reading time for the happy and neutral sentence was the same in both sessions. The researchers assume that the increase in reading time means that paralysis of the frown muscles hindered the participants' understanding of the emotional content of the sad sentences. They also argue that their findings support the hypothesis that feedback from the muscles involved in producing facial expressions is critical in regulating emotional experiences.

The media have overstated the findings of this study, by reporting that botox can damage relationships and cause those that use it to lose friends. The results may suggest that botox can impair emotional reactivity, but this is by no means conclusive, and the news stories completely overlook the more profound implication of the results - that by paralyzing the muscles involved in producing facial expressions, botox may actually diminish the experience of emotion in those who use it. According to statistics compiled by the American Society for Plastic Surgeons, some 4.6 million people received botox injections in 2008 in the United States alone, making it by far the most popular cosmetic procedure. Given the widespread and unregulated use of botox, the findings suggest that further investigation of its possible effects on cognitive function is needed.


Havas, D., et al. (2010). Cosmetic use of botulinum toxin affects processing of emotional language. Psych. Sci. (in press). [PDF]

Niedenthal, P. M., et al. (2009). Embodiment of emotion concepts. J. Pers. Soc. Psych. 96: 1120-1136 [PDF]

Oberman, L. M., et al. (2007). Face to face: Blocking facial mimicry can selectively impair recognition of emotional expressions. Social Neurosci. 2: 167-178 [PDF].

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Very interesting, and very well written =)

The authors have a pretty provocative interpretation of the results. Did they attempt to measure emotional comprehension in some way other than duration of reading times? Seems to me that these protracted reading times could be caused by subconscious processing aimed at figuring out why a normal physiological process (frown muscle contraction) has not occurred. I mean, anytime the body is tweaked from homeostasis, compensatory mechanisms kick in, and this increased load on the brain may be interfering with reading.

Their interpretation also suggests that after receiving botox injections feelings of sadness should be diminished. Any evidence of this???

Let's try this from a different perspective.

Ever hear of Mobius Syndrome?

Seeking Emotional Clues Without Facial Cues. NY Times, April 5, 2010.

These individuals do not seem to be emotionally detached.

I suggest that slowed reading comprehension may be due to chronic over-treatment with very mild facial paralysis resulting in reduced visual scanning efficiency.

Ever tried to read by turning your head? Thats the case with Mobius Syndrome patients. Imagine the difficulty when interacting with strangers unfamiliar with the condition.

Family members and close associates of these patients learn to interpret tone of voice and body posture in lieu of facial expression cues to emotion content in conversation - but that compensation is learned by both patient through professional voice coaching and therapy, and family/friends in a lengthy cue familiarization process.

What would happen if your face were suddenly paralyzed, and you found that casual listeners were constantly misinterpreting your intentions from a lack of emotional cues. Might that not inhibit emotional responsiveness?

Botox might not directly alter emotional reactivity, but it might dampen inclination to learn to compensate for that loss, particularly when working in public with strangers who may not recognize the reason for the loss of facial expressiveness. Does anybody tell Botox users that they may need to relearn communication skills to make up for the loss of facial pattern reactivity that complicates verbal and nonverbal communication?

Botox treatment may impair intent to use facial emotional cues when there is no compensatory training and learning to modulate voice and body language.

Impaired emotional reactivity could be attributed to reluctance toward social interactions, where a lack of facial cues reduces listener comprehension and reaction.

Why speculate about this? Try it for yourself: immobilize your frown muscles with your fingers and hold that for a bit. Are you emotionally paralyzed? Is your experience of emotions diminished? Didn't think so...

@Passerby, Möbius Syndrome, while interesting, is not a very good comparison with the present study. The main reason is that individuals with Möbius Syndrome are born with an inability to express their emotions so they have to find other ways to do so. Furthermore, the lack of input from their facial muscles (if this is required for the experience of emotion as the above papers argue) may induce neural plasticity because no input from the facial muscles is present.

On the other hand, people who undergod botox are very much reliant on their facial expression to convey emotion, something that becomes a lot harder when these muscles are paralysed. A sudden lack of input from the face is not going to have the same effect as a congenital loss of facial muscle signals to the brain.

@R. Wayne, a few second sof partial immobility (as soon as you let go of the muscles, mobility starts to return and your manipulation starts to disappear) is not the same as a much more chronic change, especially if the botox is not a once-off.

Well, if finger immobilization is too transient for you, try this: get one of those Breathe-Rite strips used to prevent snoring--preferably a clear one. Stick one of them across your brow so that you immobilize your frown muscles. Leave the strip in place for as long as you like. Are you now emotionally paralyzed? Is your experience of emotions diminished?

If you feel any effect at all, chances are you'll find that you are just as capable of experiencing emotions as always, but now you've entered a more resourceful frame of mind. Disturbing or "sad" thoughts don't devolve into the usual unpleasant reactions that cling and reiterate. Instead, after a pause, they resolve. Such resolution could well require more processing time than habitual reaction; hence the slower reading time required for "sad" statements in Botox patients.

@passerby, if Botox merely reduced visual scanning efficiency, then you would get reduced reading speed with "happy" and "neutral" statements, as well as with "sad" ones. But only the reading of "sad" statements was slowed.

And yes, @passerby, there are both clinical and anecdotal observations to the effect that Botox improves mood and reduces depressed feelings. See this article in the Washington Post:

But the whole argument that this anti-depressant effect results from lack of facial muscle movement begins to fall apart when you find out that Botox still has the same kind of effect in lower, non-paralyzing doses; and that it has the same kind of effect when injected in the head or neck rather than the face.

Long time ago we did a simple experiment - smile, then check for an internal emotional response - frown, grit your teeth, clench your hands, then check for an emotional response. If sitting quietly or doing whatever we do to relax doesn't get us to calm down a bit, then why do we do it?

Neuroshift, materials and methods re last paragraph re placebo effect, please.
Relatively less research has been done concerning the RESPONSE to facial expressions, or, more to the point, facial FEATURES that may be interpreted as expressions. An adverse response to an unintended nonverbal communication by false expression creates adverse expectations in the person with the false "expression."
An example in the young is the downturned mouth, which implies a mood so different than one that is upturned in fortuitous happy way. Several television commentators owe their careers to fortunate lip shapes. Others will 'face' career delays as they consciously contrive to overcome distracting mouth dis-symmetry.
For those aging, facial furrows can communicate wrong impressions of mood, especially deep glabellar creases and sagging skin around the eyes. Add intolerance of bright light or uncorrectable visual problems leading to squint, and their problems multiply.
It is true that a sagging face reveals too much of one's emotions compared to youthful features as one in age for example may struggle to conceal almost constant pain of some sort (80 percent of it back pain) , pain which may be interpreted as anger by the youthful. However, even mild irritation can be "over-expressed."
Nevertheless, if it is true botox might affect one's mood directly, it may also affect one's mood by feedback, as one is greeted with expectations that one is feeling well, and not arriving with a goal of conflict or that a mild complaint isn't deep anger.
Boy, I love this site.

I think the fact hat someone felt they needed botox already says they have issues that need to be addressed from a mental health perspective.

They should look inside for a change that would make them happy(ier).

Adding external materials to their body such as botox, saline, silicon, etc., will not fix the existing problem.

The emotional sterility of "Our Lady of Perpetual Surprise" should hardly concern any American, it's her cognitive disassociation that results in inability to stop spending the US into bankruptcy that should concern & frighten all taxpaying citizens.

By Constitution First (not verified) on 21 Apr 2010 #permalink

Hmmm-Botox Nancy raises the emotions of many. Is it the botox that causes her to continually play with her lower plate?

Is that why Nanci Pelosi is so heartless and her face looks like a Zombi on STeroids

Here's the thing anyone dumb enough to use botox which to all accounts is a poison have it injected into them on a regular basis and does not expect it to leak into ones system and effect something ( in this case the head which would be eyes, ears, brain etc.)is just kidding themselves.. Pelosi, in particular is showing her natural personality, which just by getting the botox treatments shows a large ego and a vain streak.. It is the sign of one who is so wrapped up in ones self others DON'T matter.. There is no emotion left in her it's been frozen to DEATH..

By Independent (not verified) on 21 Apr 2010 #permalink

It ought not take a molecular and developmental neurobiologist to discover that when one makes oneself look like a clown, one's emotional expressiveness and responsiveness (both internal and external cues)will be distorted.

Of course, if someone asks a doctor to inject their face w/a toxin, it's a safe bet their emotional life is screwy from the get go.

Anyone that thinks injecting anything into themselves is already void of common sense, self respect and scientific critical thinking ... and is emotionally retarded.

I can attest that this is not true, though it is interesting. Do paralyzed people feel things less? Ridiculous. Probably more.

No wonder Obama never smiles.
No wonder the Liberals do not care about the average "Working Person": Botox has fried their brains.

Next can we come up with a shot that supresses Liberalism?

Emotion follows action. Keep repeating something, let's say smiling at and behaving loving toward someone and eventually the emotion will be genuine. Erase the actions and the emotions dissipate..

Well in the case of Nancey "Crazy Eyes" Polosi and with most politicians, this is kind of redundant. I mean these people are narcissistic sociopaths to begin with. Too bad we can't perform an extremely late term abortion for these people.

Interesting. Does this mean that botox could be theraputic for those who experience negative, crippling emotions? For example, depressed people?

Should a soldier shoot up some botox before engaging in a fight, to reduce the subsequent risk of PTSD?

Will holding a pen in one's lips cure a manic person?

By Dr. Acula (not verified) on 21 Apr 2010 #permalink

Too bad so sad... who cares? This is news?

Very interesting article. Indeed we are "fearfully and wonderfully made"!
(Psalm 139:14)

Fairly certain that if Pelosi used a large enough amount of botox, the rest of us would be happier.

A few good points. As an engineer, a system "learns" by feedback. Delete the feedback (in this case a visible response shared to/with others) and you have an 'open loop' control (the best example is trying to drink after a shot of Novocaine). Taken often enough, over a long enough period, and I can well believe that Botox could be a cause for social-disassociation and possible either psychotic or sociopathic behavior. But this doesn't forgive bad behavior, Nancy.

I dont know about emotion, but if Pelosi is any example then it certainly paralyzes intelligence and class.

Now I understand why Nancy Pelosi feels no shame.

Hilarious! You can see the last 10-15 commenters came directly from the link on the Drudge Report, where this article was placed below a pic of Nancy Pelosi -- even though there's no reference between her pic and this article. Enjoying your kool-aid, fellas?

The Lord will forgive her â- she knew not that her attempts to stay young would twist her into the cold-hearted, lying, dismal, soulless bitch which it has . . .

By Michael S. Byington (not verified) on 21 Apr 2010 #permalink

Pelosi has also proven that Botox lowers a person's IQ down to 60.

The most interesting thing to me, about this article, is not the article itself (although that was fascinating). It's the comments: in particular, the change in both tone and content when the Drudgers joined the conversation.

Those of us trained in sales have always known that if you "act enthusiatic, then you'll become enthusiastic".

Each batch of Botox needs to go through the LD50 test on countless nonhuman animals. That means a point at which 50% of the animals tested die must be established. Anybody who for the sake of vanity would use this stuff has no emotions in the first place. People who use this stuff and don't care about the suffering of others deserve exactly what they get. To He*l with all of them. Which, if there is a god, is exactly where they'll wind up because of the suffering they've caused.

By Oberon123 (not verified) on 21 Apr 2010 #permalink

If that is the case, what keeps setting off Nancy Palosi?

Wow, you certainly did get a massive troll invasion here.

...I'm going to second what Dave says, and also say that there are too many confounding issues for the conclusions of this paper to be taken as stands. Feedback, not just from one's own face but even more importantly from those people with whom you are interacting, is hugely important for how emotion is judged and then further develops.

As a side note, I have heard all the standard advice to smile or deliberately relax one's face in order to improve mood. Let's just say, I am not entirely convinced. My own mood generally improves when I get the chance to snarl freely, go figure. ;-) Crucially, my mood improves most when I am free to express my full emotions facially, and my mood degrades when I need to wear a false expression. When I'm feeling depressed, cynical, frustrated or angry, forcing my face to relax or to smile actually seems to make me more frustrated and tense because it does not allow me to acknowledge or convey what I really feel. Are there any studies which focus on manipulation of expression in "real world" situations where there are other (and stronger, more 'real') mood prompts than simply reading emotive words?

Also, when you state involuntary facial expressions can evoke emotions, above, how do you know that it works in this order? The study which deliberately manipulated facial expression by forcing people to hold a pen certain ways does provide some evidence that facial expression is congruent with emotion, but the second study could more easily show that reading certain words evokes certain feelings which evoke involuntary expressions.

...As a further side note, less relevant to this, I think it is worth noting that use of botox injections is not always for cosmetic purposes. It is can also be used to treat neuralgia and severe drug-resistant migraine. Deliberate paralysis of nerves can be clinically indicated, a medical treatment. I would think that in many of these cases, any potential damage to emotional feedback responses in conversation would be more than outweighed by the benefit that relief of chronic severe pain brings to one's interactions and life outlook in general.

By Luna_the_cat (not verified) on 21 Apr 2010 #permalink

Great Post Mo,
I took a workshop from Dr. Paul Elman (Mr. Emotional Awareness) and he said, (not exact wording) "A woman with facial Botox sure is pretty, but has NO sex appeal" meaning that one without emotional communication is well...just dull. It is our expressions that births character and charisma.

@ Moriah, i agree, keep smiling!
@Luna the Cat botox is not just for cosmetics....true, it also help treat people with nerve disorders and even helps treat chronic sweating!

Great post and lots of food for thought. A lot of the comments are quite extreme and show a lack of experience with or understanding of people's average experience with Botox. First of all, it's extremely safe. There have been no deaths or severe problems from the cosmetic use of the name-brand Botox. In therapeutic treatment, e.g. for crossed-eyes or muscle spasms, larger amounts are used and it is riskier.
Second, it's just not that big a deal. If you get so worked up over Botox, then you should get equally worked up over people wearing leather shoes or wearing contact lenses. For the average person, such as myself, Botox means a few less eye wrinkles and less-apparent frown lines. Almost no one uses botox for the lower face and so it is not affecting people's smiles. The main use is for forehead wrinkles and frown lines. So big woop - less frowning and squinting!

Before getting in verbal tangles about what it means, it might be a good idea to look at the original paper. The size of the effects is really rather small. There isn't a lot to discuss.