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College notes Affective Science and Psychopathology (SOW-PSB3DH45E)
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College notes from the course Affective Science and Psychopathology (SOW-PSB3DH45E), written in the academic year 2022/2023, in English
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Affective Science and Psychopathology Lecture NotesLecture 1: An Introduction to Affective Science
Learning objectives week 1
1. Summarize in what form affect and its regulation might be disrupted in
psychopathological processes
2. Reflect on the recent state of affairs and possible improvements in psychological
clinical practice by use of affective science
3. Argue how transdiagnostic models can contribute to understanding origin and
maintenance of psychopathology, yet also come with potential challenges
Affective processes
Affect (affictus = to have been influenced/attacked) involves an evaluation of a situation as
salient (important to us and to our goals) & thereby triggering an evolutionary adaptive
response. Consist of different levels that could work together but are also distinct to some
extent:
- Subjective (negative or positive feelings) components (experience part)
- Behavioral (motor expression or inclination) components
- Physiological (brain/body) components
James Gross’ modal model: you encounter a situation, you pay
attention to it, then you appraise it (evaluate it) and then there is an
affective response. This is more a temporal way of looking at affective
processes. There are different ways to regulate the situation (upper
part of the picture)
Affective science
The scientific study of affective processes. On the picture on the right, you
can see a scheme for some of the most prominent affective processes, like
mood, stress, affective disposition (trait e.g., being anxious). The arrows
show the amount of embodiment on the horizontal axis (to what extent
there is a strong physiological component) and event-focus on the vertical
axis (to what extent these events occur in a specific time in relation to a
specific event that occurred). As you can see affective dispositions don’t have a strong
embodiment (might be anxious, but doesn’t mean you are bodily aroused all the time) and
there is low event-focus (not specifically related to one event). Mood can be triggered more
by an event and stress is also higher (often specific reason) and emotions are even higher on
event-focus, because they are very discrete responses. In embodiment emotions and stress
also tend to be higher than mood and affective dispositions
Affective science & psychopathology
Affective symptoms in psychopathology
Central in affective disorders (depression, bipolar disorder, anxiety)
- Worldwide, depressive disturbances rank number 1 in ‘years lost due to disability’
(11.5%; WHO)
- Anxiety disorders are the most common form of psychopathology in US and NL
Affective disturbance is also present in almost every other psychological disorder
- Emotional flattening (schizophrenia, psychopathy)
, - High sensitivity to reward (addiction)
- Being hyposensitive to social emotional cues (autism)
- Explosive emotional responding (conduct disorder, borderline)
The nature of emotional disturbance
But what exactly is going wrong in affective processes? ‘I feel too much. That’s what’s going
on.’, Do you think one can feel too much? Or just feel in the wrong ways?
Categories of affective disturbance
Emotional reactivity problems
- Emotional intensity (over- or underreactions)
- Emotional duration (too short or long)
- Emotional frequency (too little or frequent)
- Emotion type (inappropriate)
Emotion regulation problems
- Awareness (over or under)
- Goals (excessive dampening or searching for the peak)
- Strategies (overuse or wrong implementation)
How can we use affective science to improve understanding and treatment of
psychopathology?
The typical approach over the last decades
- Get patients with disorder A (defined by DSM) and get healthy control group. Match
groups carefully, roughly the same characteristics within the two groups. Compare
groups on affective process X (on the process you are interested in). Significance
indicates a/no substrate for mental disorder
- Get a group of patients with disorder B (defined by DSM). Test efficacy of
experimental treatment X versus control treatment Y. significance indicates
treatment efficacy
The state of mental health science
Efficacy of psychological and pharmacological treatment for mental disorder is +/- 50%. How
can we change this? What are we lacking in terms of understanding and treatment? Likely
reasons for the lack of higher efficacy despite all the research:
1. Clinical heterogeneity. Psychiatric syndromes are hugely diverse: for depression, two
patients could share only one symptom. E.g., 636.120 unique symptom profiles to
match a diagnosis of PTSD
2. Lack of mechanistic understanding. Lack of mechanistic specificity understanding
precludes tailored treatment. In science we have thought a lot in a simplistic way,
why are people showing these disorders? Something like ‘depression’ is a vague
concept that people at the DSM-board thought of, but it doesn’t mean that they
reflect specific mechanistic
This is illustrated by the following case
The complex reality of clinical practice: a case
,Many different diagnoses could make sense here (social anxiety,
schizophrenia, PTSD, agoraphobia), in this case the person was
actually diagnosed with 4 disorders. Cases are often very complex and
this one doesn’t have to been seen as unique
Comorbidity and the need for a transdiagnostic perspective
Possible explanations:
- Poor discriminant validity, diagnosis for disorders isn’t specific
enough
- One disorder may act as a risk factor for another
o Primary versus secondary disorder?
- Common risk (predisposing, precipitating or
perpetuating), they could occur at different stages of
the disease
The grouping of disorders by the DSM does not reflect a mechanistic level
Goals of DSM: develop a system to provide specific, reliable diagnosis based on clinical
experience. Problem: this does not necessarily reflect the mechanism that we try to find
with research. Scientific mechanistic research needs to focus on symptoms rather than
syndromes. Result:
- A gap between the goals of current clinical diagnosis and scientific studies
- Research on one disorder – isolated from parallel research to other disorders, not a
lot of ‘cross talk’ between research fields on different disorders, even though
disorders have a lot of overlap
From a disorder focus…
The DSM has been the key driving force behind the current ‘disorder focus’
Advantages:
- Common language for communication
o Between clinicians, scientists, etc.
Disadvantages:
- A specific diagnosis can be at the cost of a complex clinical reality at the level of the
patient
- Implicitly, the DSM treats each disorder as an independent, separated, entity
(comorbidity happens)
- Implicitly, it assumes that the disorders are abruptly distinct from ‘normal behavior’,
seeing patients as different from the controls
- Arbitrary cut-offs not so extremely evidence based as one would hope
… to a transdiagnostic focus
- Focusing on processes that contribute to the aetiology (where did symptoms come
from) and maintenance of symptoms across diagnostic borders/disorders
- Functional approach
o Dissect the syndrome in component parts
o Focus on individual patient and central problematic behavior, specific tailored
therapy
o Focus on common processes of etiology or maintenance
, Advantages of a transdiagnostic perspective
1. Could deal better with comorbidity
- Kessler et al (1993)
o 79.4% of the lifetime disorders presented comorbid disorders
o On average, patients suffered from 2.1 disorders per person
- Patients are rarely ‘pure’
- Overlap among patients within a diagnosis sometimes smaller than between
2. The heterogeneous disorders in the current diagnostic system are each made up of
dysfunctional versions of processes that vary along continua in the general
population
- Compare the ‘abnormal’ versus ‘normal’ view of the DSM
- These dysfunctional processes are observed in a number of different disorders
3. Treatment development
- Greater transfer of theoretical and treatment advances across disorders
- Specify treatment components that are effective across disorders
Widely adopted transdiagnostic approach: RDOC
People with different labels (e.g., mid depression,
major depressive disorder, bipolar) are put in one
big group. you integrate different bits of data and
based on this data you categorize people.
Continuous, data-based, but also met with criticism
(e.g., overly biological)
disadvantages and shortcoming of a transdiagnostic
perspective
- Why do people with different psychological disorders sometimes present so
differently (i.e., divergent trajectories)?
o Wy does one individual with a particular transdiagnostic risk factor develop
one set of symptoms while another with the same transdiagnostic risk factor
develops another set of symptoms?
Same process, different themes, or ‘current concerns’?
- How can one transdiagnostic risk factor lead to multiple disorders (i.e., multifinality)?
o E.g., stress is known to be an important trigger for the onset or relapse of
disorders
Lecture 2: Emotion Control
Emotional control
Affective cues automatically activate (approach-avoidance) action tendencies. Control over
emotional action tendencies is essential for everyday interactions. Emotion is embedded
with action, if we want to control our emotions we want to try to control automatic action
tendencies
outline
1. Theoretical background on emotion as an action tendency
2. Controlling emotional actions
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