1. 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.
$LIPN, Université de Paris XIII, France

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

3. Introduction (cont’d)
When the model is erroneous
Theory
Clinical
Practice
It’s necessary
to improve or remove the model
Consequence: no evolution for the discipline

4. Introduction (cont’d)
When the clinical analysis is erroneous
Clinic
Practice
Theory
It’s necessary
to review the semiology and the functional analysis
Consequence: no evolution for the patients

5. 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).

6. How to define emotions? Emotions
Fear, Sadness, Anger, Disgust, happiness

7. How to define emotions? Emotions Mood Fear, Sadness, Anger, Disgust
Depressed, Irritable

8. How to define emotions? Emotions Mood Interpersonal stance
Fear, Sadness, Anger, Disgust
Mood
Depressed, Irritable
Interpersonal stance
Distant, cold, supportive

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

10. 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

11. Major theories of emotions
Two different, opposing, models: psychological and biological.
Cognitivists consider that cognition plays an integral role in emotions.
Biologists consider that emotions and cognition are two distinct systems.
=> LeDoux ‘s model.

12. (1937)
Thalamus

13. The Limbic system
Other structures are involved in the emotional circuit such as the amygdala (plays the main role) and the prefrontal cortex
Amygdala

14. 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.

15. 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

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

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

18. 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.

19. 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

20. 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

21. 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

22. Clinical implications (cont’d)
Therapeutic actions (exposure and cognitive restructuring) are based on classical conditioning theories
(Pavlov 1928).
Innocuous conditioned
Stimulus (CS) +
Aversive unconditioned
Stimulus (US)
Unconditioned fear responses (URs)
Conditioned responses (CRs) 1 2

23. 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.

24. 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 also provides a theoretical framework for developing new therapeutic actions, focuses on emotions which are neglected in the management of patients.

25. 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 deficit give rise to new theories or contributes to improve existing models.
An interdisciplinary approach is required to make some progresses.

26. As a concluding remark : major theories
Emotional dimensions
Valence
plesantness
Elation
Pleasure
Arousal
rest
Apprenhension
activation
Fear
Terror
unpleasantness
The basic emotions (in red) are considered as the building blocks of the emotional system