{"id":527,"date":"2023-10-09T13:21:17","date_gmt":"2023-10-09T13:21:17","guid":{"rendered":"https:\/\/facialfeedback.org\/?page_id=527"},"modified":"2025-11-20T02:12:40","modified_gmt":"2025-11-20T02:12:40","slug":"summary","status":"publish","type":"page","link":"https:\/\/facialfeedback.org\/?page_id=527","title":{"rendered":"Summary and Next Steps"},"content":{"rendered":"\n

Altered Facial Feedback May Be a Missing Link in Mental Health Disorders<\/h2>\n\n\n
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Exaggerated facial feedback may be a missing link in the development of mental health disorders such as depression and anxiety.
Image by brgfx<\/a> on Freepik<\/figcaption><\/figure>\n<\/div>\n\n\n

Exaggerated facial feedback from altered facial muscles and connective tissue due to TMD may be a “missing link” <\/strong>in understanding the development of clinical anxiety and depression\u2014connecting psychological challenges to abnormal and enduring physiological responses. Mental health challenges begin when stressful life events initiate negative or even catastrophic interpretations (Fenn & Byrne, 2013). Negative thoughts also trigger stressful facial expressions. Multiple studies show that facial expressions initiate or intensify emotions (Strack et al., 1988; Soussignan, 2002; Larsen et al., 2003; Lewis, 2012). Even without emotional stimulus, sad and angry facial expressions activate the amygdala\u2014where negative emotions are processed (Hennenlotter et al., 2008; LeDoux, 2000). The strength of facial expressions seems to make a difference in emotional outcomes, as it correlates with cortisol levels and cardiovascular responses (Lerner, 2007; Kraft & Pressman, 2012; Pressman et al., 2021) as well as the magnitude of amygdala activation (Heller et al., 2014). With the face so involved in emotional responses, it is logical that facial injuries may alter the magnitude of those responses.<\/p>\n\n\n\n

TMD May Amplify Facial Feedback Responses<\/h2>\n\n\n\n

Researchers indicate that TMD facial injuries could alter normal autonomic responses through hyperactivity in the temporalis and masseter muscles <\/strong>and joints (Auerbach et al., 2001), which would then exaggerate facial feedback and amplify emotional responses. Stress-induced TMD alterations could occur during prolonged or intense psychological distress (Namvar, 2021), such as during university studies or during battle. They might also occur from trauma, childhood neglect, or abuse\u2014known risk factors for depression (Lippard & Nemeroff, 2020). Many people with TMD and depression may likely go undiagnosed, as randomly selected study participants were diagnosed with both conditions (Restrepo et al., 2021; Al-Khotani et al., 2021). <\/p>\n\n\n\n

TMD and Mental Health Disorders May Be Bidirectional<\/h2>\n\n\n\n

TMD and mental health disorders are frequently comorbid (seen together) and likely bidirectional. <\/strong>The adverse effects of either could initiate and maintain the other, making these disorders cyclical. Understanding the connection between TMD, depression, and anxiety may help in healing all these disorders. The early success of BTX treatment for depression suggests that facial feedback contributes to depression\u2014and immobilizing facial muscles may assist in recovery. Psychological treatments have proven effective in treating TMD (Turk et al., 1996; Auerbach, 2001; Li & Leung, 2021). Diagnosing and treating TMD in depressed patients may also speed recovery from depression. However, no studies yet to date have yet confirmed this assumption. Future research may help resolve these theories.<\/p>\n\n\n

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\"TMD<\/figure>\n<\/div>\n\n\n

Next Steps\u2014Facial Feedback and Mental Health<\/h2>\n\n\n\n

Research conducted at Cardiff University in Cardiff, Wales, measured the impact of TMD on facial feedback responses. Future research could assess patients with mental health challenges for TMD and include TMD treatment if needed.<\/p>\n\n\n\n

Last updated November 19, 2025<\/p>\n\n\n\n

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Read the full report<\/a><\/div>\n<\/div>\n\n\n\n
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This report was written by Katherine Wright, a post-graduate student of
Harvard Extension School.<\/figcaption><\/figure>\n<\/div><\/div>\n\n\n\n
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Additional research on TMD and facial feedback found that targeted facial activity reduced depression in TMD patients. Results of study will be published soon.<\/figcaption><\/figure>\n<\/div><\/div>\n<\/div>\n\n\n\n
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References<\/strong><\/p>\n\n\n\n

Al-Khotani, A., Meisha, D. E., Al Sayegh, S., Hedenberg-Magnusson, B., Ernberg, M., & Christidis, N. (2021). The association between psychological symptoms and self-reported temporomandibular disorders pain symptoms in children and adolescents. Frontiers in Oral Health, 2<\/em>, 675709\u2013675709. https:\/\/doi.org\/10.3389\/froh.2021.675709<\/a> <\/p>\n\n\n\n

Auerbach, S.M., Laskin, D. M., Frantsve, L. M. E., & Orr, T. (2001). Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. Journal of Oral and Maxillofacial Surgery, 59<\/em>(6), 628\u2013633. https:\/\/doi.org\/10.1053\/joms.2001.23371 <\/a><\/p>\n\n\n\n

Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT<\/em>, 6<\/em>(9), 579\u2013585. https:\/\/doi.org\/10.1177\/1755738012471029<\/a> <\/p>\n\n\n\n

Heller, A. S., Lapate, R. C., Mayer, K. E., & Davidson, R. J. (2014). The face of negative affect: Trial-by-trial corrugator responses to negative pictures are positively associated with amygdala and negatively associated with ventromedial prefrontal cortex activity. Journal of Cognitive Neuroscience, 26<\/em>(9), 2102\u20132110. https:\/\/doi.org\/10.1162\/jocn_a_00622  Hennenlotter, A., Dresel, C., Castrop, F., Ceballos-Baumann, A. O., Wohlschl\u00e4ger, A. M., & Haslinger, B. (2008). The link between facial feedback and neural activity within central circuitries of emotion\u2014New insights from botulinum toxin\u2013induced denervation of frown muscles. Cerebral Cortex, 19<\/em>(3), 537\u2013542. https:\/\/doi.org\/10.1093\/cercor\/bhn104<\/a> <\/p>\n\n\n\n

Kraft, T. L., & Pressman, S. D. (2012). Grin and bear It: The influence of manipulated facial expression on the stress response. Psychological Science, 23<\/em>(11), 1372\u20131378. https:\/\/doi.org\/10.1177\/0956797612445312<\/a> <\/p>\n\n\n\n

Larsen, J.T., Norris, C. J., & Cacioppo, J. T. (2003). Effects of positive and negative affect on electromyographic activity over zygomaticus major and corrugator supercilii. Psychophysiology, 40<\/em>(5), 776\u2013785. https:\/\/doi.org\/10.1111\/1469-8986.00078<\/a> <\/p>\n\n\n\n

Ledoux, J.E. (2000). Emotion circuits in the brain. Annual Review of Neuroscience, 23<\/em>(1), 155\u2013 184. https:\/\/doi.org\/10.1146\/annurev.neuro.23.1.155<\/a> <\/p>\n\n\n\n

Lerner, J.S., Dahl, R. E., Hariri, A. R., & Taylor, S. E. (2007). Facial expressions of emotion reveal neuroendocrine and cardiovascular stress responses. Biological Psychiatry (1969), 61<\/em>(2), 253\u2013260. https:\/\/doi.org\/10.1016\/j.biopsych.2006.08.016<\/a> <\/p>\n\n\n\n

Lewis, M.B. (2012). Exploring the positive and negative implications of facial feedback. Emotion, 12<\/em>(4), 852\u2013859. https:\/\/doi.org\/10.1037\/a0029275<\/a> <\/p>\n\n\n\n

Li, D.T.S., & Leung, Y. Y. (2021). Temporomandibular disorders: Current concepts and controversies in diagnosis and management. Diagnostics (Basel), 11<\/em>(3), 459. https:\/\/doi.org\/10.3390\/diagnostics11030459<\/a> <\/p>\n\n\n\n

Lippard, E.T.C. & Nemeroff, C. B. (2020). The devastating clinical consequences of child Abuse and neglect: Increased disease vulnerability and poor treatment response in mood disorders. The American Journal of Psychiatry<\/em>, 177<\/em>(1), 20\u201336. https:\/\/doi.org\/10.1176\/appi.ajp.2019.19010020<\/a> <\/p>\n\n\n\n

Namvar, M.A., Afkari, B. F., Moslemkhani, C., Mansoori, K., & Dadashi, M. (2021). The relationship between depression and anxiety with temporomandibular disorder symptoms in dental students. M\u00e6dica, 16<\/em>(4), 590\u2013594. https:\/\/doi.org\/10.26574\/maedica.2021.16.4.590<\/a> <\/p>\n\n\n\n

Pressman, S.D., Acevedo, A. M., Hammond, K. V., & Kraft-Feil, T. L. (2021). Smile (or grimace) through the pain? The effects of experimentally manipulated facial expressions on needle-injection responses. Emotion (Washington, D.C.), 21<\/em>(6), 1188\u20131203. https:\/\/doi.org\/10.1037\/emo0000913<\/a> <\/p>\n\n\n\n

Restrepo, C., Ortiz, A. M., Henao, A. C., & Manrique, R. (2021). Association between psychological factors and temporomandibular disorders in adolescents of rural and urban zones. BMC Oral Health, 21<\/em>(1), 140\u2013140. https:\/\/doi.org\/10.1186\/s12903-021-01485-4<\/a> <\/p>\n\n\n\n

Soussignan, R. (2002). Duchenne smile, emotional experience, and autonomic reactivity: A test of the facial feedback hypothesis. Emotion, 2<\/em>(1), 52\u201374. https:\/\/doi.org\/10.1037\/1528- 3542.2.1.52<\/a> <\/p>\n\n\n\n

Strack, F., Martin, L. L., & Stepper, S. (1988). Inhibiting and facilitating conditions of the human smile. Journal of Personality and Social Psychology, 54<\/em>(5), 768\u2013777. https:\/\/doi.org\/10.1037\/0022-3514.54.5.768<\/a> <\/p>\n\n\n\n

Turk, D.C., Rudy, T. E., Kubinski, J. A., Zaki, H. S., & Greco, C. M. (1996). Dysfunctional patients with temporomandibular disorders. Journal of Consulting and Clinical Psychology, 64<\/em>(1), 139\u2013146. https:\/\/doi.org\/10.1037\/0022-006X.64.1.139<\/a> <\/p>\n","protected":false},"excerpt":{"rendered":"

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