Transcript Emotions: Theoretical models and clinical implications

Emotions: Theoretical models
and clinical implications
Baudic, S*. et Duchamp, G.H.E**.
* Inserm U792, Physiopathologie et Pharmacologie Clinique
de la Douleur, Hôpital Ambroise Paré, Boulogne.
** Laboratoire d’informatique - UMR CNRS 7030, Institut
Galilée - Université Paris Nord, Villetaneuse.
Introduction
Relationships between theory and clinical
practice
Theory
Consistent exchanges
Clinical
Practice
These interactions are essential for the evolution of
the discipline and the patients themselves.
Introduction (cont’d)
When the model is erroneous
No change for the
patient or the results
are insatisfying
Model
It’s necessary
to improve or remove
the model
=> Clinical practice lends support to theory
Introduction (cont’d)
When the therapeutic strategies are erroneous
No change for the
patient or the results
are insatisfying
Therapeutic
strategies
It’s necessary
to review the
semiology and the
functional analysis
=> Theory improves the management of patients
How to define emotions?
They have 2 dimensions (expressive
and cognitive)
They are different from
reflex reactions or long
lasting affective
schemata such as
affects (Ekman 1984).
They are a dynamic sequence of
different variables (Scherer 1984).
How to define emotions?
Emotions
Fear, Sadness, Anger,
Disgust, happiness
How to define emotions?
Emotions
Mood
Fear, Sadness, Anger,
Disgust
Depressed, Irritable
How to define emotions?
Emotions
Mood
Fear, Sadness, Anger,
Disgust
Depressed, Irritable
Interpersonal stance Distant, cold, supportive
How to define emotions?
Emotions
Mood
Fear, Sadness, Anger,
Disgust
Depressed, Irritable
Interpersonal stance Distant, cold, supportive
Attitudes
Loving, hating,
How to define emotions?
Emotions
Mood
Fear, Sadness, Anger,
Disgust
Depressed, Irritable
Interpersonal stance Distant, cold, supportive
Attitudes
Loving, hating,
Personality Traits
Anxious, nervious
Major theories of emotions
Two different, opposing, models: cognitive
and biological.
- Cognitivists consider that cognition plays an
integral role in emotions.
- Biologists consider that emotions and
cognition are two distinct systems.
=> Papez’s circuit
=> LeDoux ‘s model
(1937)
Thalamus
The Limbic system
Other structures
are involved in
the emotional
circuit such as
the amygdala
(plays the main
role) and the
prefrontal cortex
Amygdala
LeDoux’s Model
LeDoux and al. (1984) who are concerned by fear only, provided
anatomical and experimental support to Papez’s dual route model.
Sensorial and prefrontal cortices
Direct and fast …
Thalamus
Emotional Stimulus
Amygdala
Emotional Response
=> the amygdala (and not the hypothalamus) is the structure where
information coming from outside acquires emotional significance.
Clinical implications
Neuropsychological researches
Normal subjects => emotions serve as a retrieval cue
Alzheimer’s disease => What is happening ?
This disease that leads to
dramatic memory deficit
involves the amygdala
Clinical implications (cont’d)
Cognitive Neuropsychology of memory
(Tulving 1972)
Explicit memory
Implicit memory
Conditioning
Episodic memory
Semantic memory
Priming
Procedural memory
Clinical implications (cont’d)
Cognitive Neuropsychology of memory
(Tulving 1972)
Explicit memory
Implicit memory
Conditioning
Episodic memory
Semantic memory
Priming
Procedural memory
Clinical implications (cont’d)
Episodic memory
Recall tests
consisting of two
short stories that are
identical except for
one passage in each
story: one was
emotionally charged
(arousing story) and
the other (neutral
story) was not.
(Kazui et al 2000)
Clinical implications (cont’d)
Episodic memory
- AD disrupts memory enhancement for verbal
emotional information (Kensinger et al 2004)
- Emotional memory is normal for pleasant stimuli but
abnormal for unpleasant ones (Hamann et al 2000)
Implicit memory
- Priming effect was restricted to negative targets
(Padovan et al 2002).
- AD patients showed a distinct impairment in fear
conditioning (Hamann et al 2002).
=> skin-conductance responses
Clinical implications (cont’d)
Therapeutic actions:
• Rehabilitation of emotions is based on aspects of
emotional commucation such as prosody.
• Rehabilitation of memory
=> It is based on emotions which improve recall of
events or facts (Kazui 2000)
=> Effet of music as a mnemonic device
Clinical implications (cont’d)
Researches in cognitive and behavioural therapy
• Panic disorder => a good model for studying fear.
Vicious cycle of catastrophic fears (Clark 1990)
External agent
Anticipation anxiety
Fear: perception of
threat
Physical symptoms
Dysfunctional thoughts
Clinical implications (cont’d)
Therapeutic actions (exposure and cognitive restructuring)
are based on classical conditioning theories
(Pavlov 1928).
Innocuous conditioned
Stimulus (CS)
1
Unconditioned fear
responses (URs)
Red square
+
Aversive unconditioned
Stimulus (US)
Loud noise
2
Conditioned responses
(CRs)
Clinical implications (cont’d)
Therapeutic actions:
• Exposure: placing someone in the avoided situation
until the anxiety decreases completely.
• Cognitive Restructuring: patients are encouraged to
consider the evidence and think of alternative possible
outcome following the experience of bodily cues.
Clinical implications (cont’d)
LeDoux’s model establishes a relationship between emotions and
cognitive factors.
Cognitive restructuring ?
Sensoriel and prefrontal cortices
Thalamus
Amygdala
Exposure ?
Emotional Stimulus
Emotional Response
It provides a theoretical framework for developing new therapeutic
strategies, focuses on emotions which are neglected in the management
of patients.
Conclusions
• Theories provide a better comprehension of
brain functioning.
• This comprehension leads to deep changes
in clinical practice (tools of evaluation,
strategies of rehabilitation).
• Conversely, patient’s deficits give rise to new
therories or contributes to improve existing
models.
• An interdisciplinary approach is required to
make some progresses.