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

TheoryClinicalPractice

Relationships between theory and clinical practice

Consistent exchanges

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

It’s necessaryto improve or remove

the model

Model

=> Clinical practice lends support to theory

Introduction (cont’d)

When the therapeutic strategies are erroneous

It’s necessaryto review the

semiology and the functional analysis

Therapeuticstrategies

=> Theory improves the management of patients

No change for the patient or the results

are insatisfying

They are a dynamic sequence of

different variables (Scherer 1984).

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).

How to define emotions?

Emotions Fear, Sadness, Anger, Disgust, happiness

How to define emotions?

Emotions Fear, Sadness, Anger, Disgust

Mood Depressed, Irritable

How to define emotions?

Emotions Fear, Sadness, Anger, Disgust

Mood Depressed, Irritable

Interpersonal stance Distant, cold, supportive

How to define emotions?

Emotions Fear, Sadness, Anger, Disgust

Mood Depressed, Irritable

Interpersonal stance Distant, cold, supportive

Attitudes Loving, hating,

How to define emotions?

Emotions Fear, Sadness, Anger, Disgust

Mood 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

Thalamus

(1937)

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 ModelLeDoux and al. (1984) who are concerned by fear only, provided

anatomical and experimental support to Papez’s dual route model.

Sensorial and prefrontal cortices

Thalamus Amygdala

Emotional Stimulus Emotional Response

=> the amygdala (and not the hypothalamus) is the structure where information coming from outside acquires emotional significance.

Direct and fast …

Neuropsychological researches

Normal subjects => emotions serve as a retrieval cue

Alzheimer’s disease => What is happening ?

Clinical implications

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

Episodic memory

Semantic memory

Conditioning

Priming

Procedural memory

Clinical implications (cont’d)

Cognitive Neuropsychology of memory (Tulving 1972)

Explicit memory Implicit memory

Episodic memory

Semantic memory

Conditioning

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)

Physical symptoms

Anticipation anxiety

Dysfunctional thoughts

Fear: perception of threat

External agent

Clinical implications (cont’d)

Therapeutic actions (exposure and cognitive restructuring) are based on classical conditioning theories

(Pavlov 1928).

Innocuous conditioned

Stimulus (CS)

Red square

+

Aversive unconditioned

Stimulus (US)

Loud noise

Unconditioned fear responses (URs)

Conditioned responses (CRs)

1

2

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.

Sensoriel and prefrontal cortices

Thalamus Amygdala

Emotional Stimulus Emotional Response

Cognitive restructuring ?

Exposure ?

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.