EMOTION, DEPRESSION, ANXIETY

Emotion: brief responses (physiological, psychological, behavioral) to a specific object or situation; socially

functional.

• Distinguish “emotion” from “mood”: moods are non-specific, longer-lasting emotional states.

CATEGORIZING EMOTIONS

Basic emotions (proposed by Paul Ekman): anger, disgust, fear, happiness, sadness, and surprise

• Innate, universal (found across different cultures cultures), short-lasting

o Evidence: congenitally blind athletes exhibit the same expressions as sighted athletes

• Have tight correspondence with facial expressions: facial expressions are automatic, and one’s emotions can

be revealed by them.

o Duchenne smile: regarded as true smile. Key feature is the contraction of muscles at the lip corners

and eye corners.

Complex emotions: such as pride, jealousy, etc.; long-lasting

• Depend on cultural, social, or situational factors; no universal facial expressions attached to them

• Multiple cortical and subcortical systems are involved in these complex emotions.

DIMENSIONS OF EMOTIONS

Emotions vary along certain continuums:

• Emotions vary along a valence dimension (from unpleasant to pleasant) and an

arousal dimension (from calm to excited).

NEURAL SYSTEMS INVOLVED IN EMOTION

Main structures: amygdala, orbitofrontal cortex,

anterior cingulate cortex, insula, basal ganglia

Amygdala: almond-shaped, part of the medial

temporal lobe. Most connected structure in the brain.

Amygdala function

• Fear-related processing

o Amygdala damage in humans impairs

the recognition of fear

• Arousal/salience/vigilance

o Current view: amygdala is sensitive to high arousal in general, which

serve to increase the readiness of response to salient stimuli.

o LeDoux’s theory: Two neural systems processing emotions in parallel:

▪ Low road: through subcortical structures, i.e., thalamus—

amygdala. Quick but shallow processing, enabling fast reaction to

stimuli (e.g., fight or flight responses)

▪ High road: through the cortex; thalamus—sensory cortices—

amygdala. Slow but sophisticated processing, finer analysis of the stimuli.

• VIGILANCE, SALIENCE: Amygdala responds to high arousing positive and negative stimuli

EMOTION REGULATION

Successful emotion regulation means we are able to exert self-control over natural emotional responses.

Emotion Regulation Strategies

• Antecedent-focused ER: since emotions have triggers, this set of strategies focuses on changing the input to

change the emotion as a result.

o Situation selection: one can choose not to go into the emotion-evoking situation

o Situation modification: when in the situation, one can still change aspects of the situation to make it

not as provoking

o Attentional deployment: when in the situation, one can also choose to pay selective attention to

aspects of the situation that are not as provoking [cognitive distraction]

o Reappraisal: reinterpret the situation to change its emotional impact.

• Response-focused ER: changing the output. After an emotion is already elicited, trying to modify the

emotional response

o Suppression: changing the internal experience and external expression of unwanted affect. Ex: in a

professional setting, even if you are irritated by unfriendly evaluations of your work, you try not to

show angry expression and stay composed.

• Self-compassion/acceptance

Emotion regulation and the brain

• Emotion downregulation (e.g., using reappraisal)

o Recruits prefrontal and parietal control regions to modulate the activity in

the emotion regions such as amygdala.

o In healthy subjects, the VMPFC can decrease amygdala activity during

emotion-regulation. But in depressed patients, the opposite effect occurs

(increased AMY activity).

Summary: Brain regions involved in Emotions

• No single brain area is responsible for all emotions. Emotions involve interactions among a diverse set of

neural structures

ANXIETY

Wide variety of anxiety disorders, which differ by the objects or situations that induce them, but all share features

of excessive anxiety and related behavioral disturbances.

PANIC DISORDER

- DSM-5 diagnosis: unexpected panic attacks & related anxiety for at least a month.

- A discrete period of intense fear in which 4 of the following symptoms abruptly develop and peak within 10

minutes: Palpitations or rapid heart rate, Sweating, Trembling or shaking, Shortness of breath, Feeling of choking,

Chest pain or discomfort, Nausea, Chills or heat sensations, Paresthesias, Feeling dizzy or faint, Derealization or

depersonalization, Fear of losing control or going crazy, Fear of dying.

- Causes: Genetic, Major life stresses, Drug/alcohol abuse.

- Treatment: 70-90% treatment response! Psychotherapy: Cognitive-behavioral therapy (CBT); Medication: anti-

anxiety medication and some anti-depressants.

GENERALIZED ANXIETY DISORDER (GAD)

- DSM-5 diagnosis: excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more

often than not for at least six months and is clearly excessive.

- The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (1 in

children): Edginess or restlessness; Tiring easily; more fatigued than usual; Impaired concentration or feeling as

though the mind goes blank; Irritability (which may or may not be observable to others); Increased muscle aches or

soreness; Difficulty sleeping.

- Causes: A family history of anxiety; Stressful situations (e.g., personal or family illnesses); childhood abuse;

excessive use of caffeine or tobacco.

- Treatment: Psychotherapy: Cognitive-behavioral therapy; Medication: anti-anxiety medication and some anti-

depressants.

OBSESSIVE-COMPULSIVE DISORDER (OCD)

- - DSM-5 diagnosis: Characterized by: obsessive thoughts (obsessions) about harm and/or behaviors (compulsions)

that significantly impact daily life; individual attempts to ignore or suppress the obsessions or compulsions or to

neutralize them with some other thought or action (i.e., by performing a compulsion); Obsessions or compulsions

are time-consuming (more than one 1h/day) or cause clinically significant distress or impairment; Disturbance is

not caused by a substance (e.g., a drug of abuse, a medication), another medical condition (e.g., head trauma), or

another mental disorder.

PHOBIAS

1). SPECIFIC Phobias.

- DSM 5 Diagnosis: an illogical fear of a specific object or phenomenon, which disrupts daily functioning.

- Common types: (1) Blood/injury/injection; (2) Situational; (3) Natural environment; (4) Animals.

- Symptoms: Immediate feeling of intense fear, anxiety and panic when exposed/think about the source of fear;

Awareness that the fears are unreasonable or exaggerated but feeling powerless to control them; Worsening

anxiety as the situation or object gets closer; Doing everything possible to avoid the object or situation or enduring

it with intense anxiety or fear; Difficulty functioning normally because of fear; Physical reactions and sensations.

- Causes: Genetics- the most heritable anxiety disorders; Negative experiences; Changes in brain function.

- Treatment: Psychotherapy: CBT – Exposure & response prevention; Medication: anti-anxiety medication and

some anti-depressants.

2). Social Phobias.

- DSM 5 Diagnosis: Persistent, intense fear or anxiety about specific social situations because people believe they

may be judged, embarrassed or humiliated; Avoidance of anxiety-producing social situations or enduring them with

intense fear or anxiety; Excessive anxiety that's out of proportion to the situation; Anxiety or distress that interferes

with daily living; Fear or anxiety not better explained by other conditions.

- Causes (see figure).

- Treatment: Psychotherapy: CBT – Exposure & response prevention; Medication: anti-

anxiety medication and some anti-depressants

DEPRESSION

- The clinical diagnosis of depression is called the major depressive disorder or MDD. MDD diagnosis requires at

least one major depression episode- either depressed mood or decreased interest for at least 2 weeks, significant

distress and/or the inability to engage in daily tasks and anhedonia- loss of the ability to feel pleasure.

- DSM 5 Diagnosis: 5 of the following 9 symptoms (including one/both of the first two) for extensive amounts of

time almost every day: (1) Depressed mood; (2) Diminished interest in pleasure in almost all activities; (3)

Significant weight loss or gain/increase or decrease in appetite; (4) Insomnia or hypersomnia; (5) Psychomotor

irritation or retardation; (6) Feeling tired or a loss of energy; (7) Feeling worthless or excessive inappropriate guilt;

(8) Reduced ability to concentrate; (9) Repetitive thoughts about death, suicidal ideation or attempt.

- Causes: Biological factors: Genetic causes (mood disorders run in families); Changes in hormone levels; Medical

illnesses; Environmental causes: stressful life events, early adversity, etc.; Social factors: Loneliness; Psychological

factors: Coping style, Problem-solving style; Attributional styles (e.g., pessimism).

- Brain changes: 1. Changes in brain chemistry: Serotonin5HT and NorepinephrineNE; 2. Structural changes:

Reduced gray matter volume (GMV) in the hippocampus, thalamus, frontal cortex, and prefrontal cortex; Enlarged

amygdala (acutely) vs. reduced (chronically).; 3). Functional changes: Networks of brain areas are under- and over-

activated in individuals with depression.

- Treatment: Psychotherapy; Pharmacotherapy; Neurostimulation (Repetitive transcranial magnetic stimulation,

Deep brain stimulation, electroconvulsive therapy).