Transcript Emotions: Theoretical models and clinical implications

Emotions: Theoretical models
and clinical implications
Baudic, S*. et Duchamp, G.
Inserm U792, Physiopathologie et Pharmacologie Clinique
de la Douleur, Hôpital Ambroise Paré, Boulogne.
Introduction
The aim of the today talk is to show that researchers
and clinicians can interact together rather exist side
by side without any real contact. I try to show you
that interactions are essential for the evolution of the
discipline and for the patients.
The topic depictes in a first part, the cognitive and
biological models of emotions.
The second part considers the implication of theories
in the management of patients with:
- Alzheimer’s disease (organic disorder)
- Panic disorder (functional disorder).
Introduction
The study of emotions is hampered by several
conceptual problems:
The major one concerns the relationship between
emotions and cognition.
- Biologists consider that emotions and cognition
are two distinct systems.
- Cognitivists consider that cognition plays an
integral role in emotions.
How to define emotions?
Emotions:
- have 2 dimensions (expressive and cognitive)
- are of episodic nature, different from reflex reactions or
long lasting affective schemata such as affects (Ekman
1984).
- are a dynamic sequence of different variables: subjective
feelings, motor expression, physiological activation,
cognitive evaluation and motivation (Scherer 1984).
How to define emotions?
Emotions
Mood
Fear, Sadness, Anger,
Disgust
Depressed, Irritable
Interpersonal stance Distant, cold, supportive
Attitudes
Loving, hating,
Personality Trait
Anxious, nervious
Overview of major theories
Psychological theories of emotions
Two major models: componential and hierarchical.
Componential models
The major components of the emotion construct are:
- subjective experience,
- physiological responses,
- motor expression.
Called the “emotional response trial”
But also: cognition and motivation
Componential models differ strongly with respect to the
amount of attention paid to these different components.
Overview of major theories
Hierarchical models
This classification distinguishes structural from
developmental models
• Structural models
=> emotions are hierachically organized
- numerous discrete emotions at a basic level
- few emotional dimensions at a higher level
Overview of major theories
 Emotional dimensions
Valence
plesantness
Elation
Pleasure
Arousal
rest
Apprenhension
activation
Fear
Terror
unpleasantness
The basic emotions in red are the building blocks of
emotion systems
Overview of major theories
• Developmental models
They are based on the activity of three functional levels:
- the sensorimotor,
- the schematic,
- the conceptual.
The sensorimotor level is the basic interactive schemata
of human species. It involves a set of expressivemotor programs that are innate and universal.
Overview of major theories
The schematic level includes “emotional schemata” which
are different for each individual as they spring from the
association of the basic emotions of the sensorimotor
level and the individual experience.
The conceptual level is based on mechanisms of
consciousness and long term memory. It stores the
abstract notions such as “what are emotions?” or “which
situations provoke them?”
Overview of major theories
Biological theories of emotions
Two major models like their cognitive counterparts :
componential and hierarchical.
Componential models
Emotions are set up by several components which are
subserved by different anatomical structures.
=> Motor expression: Hypothalamus is involved in
generation of autonomic reactions
Overview of major theories
Hierarchical models have a phylogenetic perspective
Brains structures subserving emotions may be based on
complexity of operations performed at different levels.
=>The highest brain structures inhibit, modulate and
extend (rather than replace) the earliest functional
systems
=> Brain stem and hypothalamus are involved in fightflight attitude, the more basic impulse
=> Cingulate gyrus which is the more recent structure of
the limbic system is involved in emotinal reactions.
(1937)
Thalamus
LeDoux’s Model
LeDoux and colleagues (1984) that are concerned by fear only provided
anatomical and experimental support to the Papez’ dual route model.
Sensoriel and prefrontal cortices
Thalamus
Emotional Stimulus
Amygdala
Emotional Response
=> the amygdala (and not the hypothalamus) is the structure where
information coming from the outside acquires emotional signification.
The Limbic system
Other structures
were involved in
the emotional
circuit such as
the amygdala
and the
orbitofrontal
cortex
Clinical implications
Neuropsychological researches
Normal controls => emotions serve as a retrieval cue
Alzheimer’s disease => What is happening ?
This disease that leads to dramatic memory deficit
involves amygdala
Clinical implications
Cognitive Neuropsychology of memory
(Tulving 1972)
Explicit memory
Implicit memory
Conditioning
Episodic memory
Semantic memory
Priming
Procedural memory
Clinical implications
Episodic memory
- Recall of AD patients is better for emotional than
neutral stimuli (Kazui et al. 2000)
Better for neutral stimuli embedded in an emotional
context
- AD disrupts memory enhancement for verbal emotional
information (Kensinger et al 2004)
Implicit memory
- Priming effect was restricted to negative targets
(Padovan et al 2002).
Clinical implications
Therapeutic actions:
• Rehabilitation of emotions is based on aspects of
emotional communication such as prosody.
• Rehabilitation of memory
=> is based on emotions which improve recall of events
or facts (Kazui 2000)
=> Effet of music as a mnemonic device
Clinical implications
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
Therapeutic actions (exposure and cognitive restructuring)
are based on classical conditioning theories (Pavlov
1928).
Innocuous conditioned
Stimulus (CS)
Unconditioned fear
responses (URs)
+
Aversive unconditioned
Stimulus (US)
Conditioned responses
(CRs) that share similar
characteristics
Clinical implications
Therapeutic actions:
• Exposure: placing someone in the avoided situation
until the anxiety decreases completely.
• The disappearance of anxiety is called Extinction
• Cognitive Restructuring: patients are encouraged to
consider the evidence and think of alternative
possible outcome following the experience of bodily
cues.
Clinical implications
LeDoux’s model provides a theoretical framework for
developing of new therapeutic actions focus on emotions
which are neglected in the management of patients.
Cognitive restructuring ?
Sensoriel and prefrontal cortices
Thalamus
Amygdala
Exposure ?
Emotional Stimulus
Emotional Response
It establishes a relationship between emotions and cognitive factors. Therapeutic
effect of cognitive restructuring is mediated by the neocortical route.
Conclusions
Theories provides a better comprehension of brain
functioning.
This comprehension leads to profunds changes in clinical
practice (tools of evaluation, strategies of rehabilitation).
Inversely, single patients’ deficit give rise to new therories
or contributes to improve existing models.
Exchange between theory and clinical practice contributes
to progressive adjustment between knowlegde on the
brain functioning and the management of patients.