emotions: theoretical models and clinical implications
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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. - PowerPoint PPT PresentationTRANSCRIPT
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.