Affective Science and Psychopathology (SOWPSB3DH45E)
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Week 1 – Introduction
What do we say when we say affective science?
Affective processes
Involves an evaluation of a situation as salient and thereby triggering an
evolutionary adaptive response
Consist of different levels:
- Subjective (negative or positive feeling)
components
- Behavioural (motor expression or inclination)
James Gross' modal model
components
- Physiological (brain/body) components
Affective science
The scientific study of affective processes
Embodiment: how strong the physical
component is to the affective disposition
Event-focus: to what extent the affective
disposition is couples to a specific event
A scheme for some of the most prominent affective processes
Affective processes from a functional perspective
Response tendencies that generally help maximize our well-being
- Getting stressed for an exam
- Getting angry at a student for handing in a paper too late
- Showing happiness when the person you love approaches you
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’
- Anxiety disorders are the most common form of psychopathology in
US and NL
Affective disturbance is 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)
1
,Categories of affective disturbances
Emotional reactivity problems
- Emotional intensity (over- or underreactions)
- Emotional duration (too short or too 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
The state of mental health science
Efficacy of psychological and pharmacological treatment for mental
disorder is +/- 50%
Likely reasons for the lack of higher efficacy despite all the research:
- Clinical heterogeneity
Psychiatric syndromes are hugely diverse:
For depression; two patients could share only one symptom
e.g. 632.120 unique symptoms profiles to match a diagnosis of PTSD
- Lack of mechanistic understanding
Lack of mechanistic specificity understanding precludes tailored
treatment
Comorbidity and the need for a transdiagnostic perspective
Possible explanations
- Poor discriminant validity
- One disorder may act as a risk factor for another
- Primary versus secondary disorder?
- Common risk (predisposing, precipitating, or perpetuating)
2
,The grouping of disorders by the DSM does not reflect a mechanistic level
Goal 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
From a disorder focus…
The DSM has been the key driving force behind the current ‘disorder focus’
Advantages:
- Common language for communication
- 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
- Implicitly, it assumes that the disorders are abruptly distinct from
‘normal behaviour’
- Arbitrary cut-offs not so extremely evidence based as one would
hope
…to a transdiagnostic perspective
- Focussing on processes that contribute to the aetiology and maintenance
of symptoms across diagnostic borders/disorders
- Functional approach
- Dissect the syndrome in component parts
- Focus on the individual patient and central problematic behaviour,
specific tailored therapy
- Focus on common processes of aetiology or maintenance
Advantages of a transdiagnostic perspective
3
, Could deal better with comorbidity
- Kessler et al (1993)
79.4% of the lifetime disorders presented with one (25.5%) or two
(53.9%) comorbid disorders (so 3 in total)
On average, patients suffered from 2.1 disorders per person
- Point prevalence: 50% of patients with an anxiety disorder had at
least one additional anxiety disorder or depression
- Patients are rarely ‘pure’
- Overlap among patients within a diagnosis sometimes smaller than
between
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
Treatment development
- Greater transfer of theoretical and treatment advances across
disorders
- Specify treatment components that are effective across disorders
Disadvantages and shortcomings of a transdiagnostic perspective
Why do people with different psychological disorders sometimes present so
differently? (i.e., divergent trajectories)?
- Why 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)?
- E.g., stress is known to be an important trigger for the onset or
relapse of disorders
Research Domain Criteria (RDoC): a different approach
Large initiative in the US, supported by NIMH
4
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