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.

Relationships between theory and clinical practice Introduction Relationships between theory and clinical practice Clinical Practice Theory Consistent exchanges These interactions are essential for the evolution of the discipline and the patients themselves.

Introduction (cont’d) When the model is erroneous Model No change for the patient or the results are insatisfying It’s necessary to improve or remove the model => Clinical practice lends support to theory

Introduction (cont’d) When the therapeutic strategies are erroneous Therapeutic strategies No change for the patient or the results are insatisfying 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 Interpersonal stance Fear, Sadness, Anger, Disgust Mood Depressed, Irritable Interpersonal stance Distant, cold, supportive

How to define emotions? Emotions Mood Interpersonal stance Attitudes Fear, Sadness, Anger, Disgust Mood Depressed, Irritable Interpersonal stance Distant, cold, supportive Attitudes Loving, hating,

How to define emotions? Emotions Mood Interpersonal stance Attitudes 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

(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 Thalamus Amygdala 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 Thalamus Amygdala Emotional Stimulus Emotional Response Direct and fast … => 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 Priming Semantic memory Procedural memory

Clinical implications (cont’d) Cognitive Neuropsychology of memory (Tulving 1972) Explicit memory Implicit memory Conditioning Episodic memory Priming Semantic memory Procedural memory

Clinical implications (cont’d) Episodic memory (Kazui et al 2000) 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.

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). 1 Innocuous conditioned Stimulus (CS) Red square + Aversive unconditioned Stimulus (US) Loud noise Unconditioned fear responses (URs) 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 Emotional Stimulus Emotional Response 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.