Putting the “mental” back in “mental disorders”: a perspective from research on fear and anxiety

Abstract

Mental health problems often involve clusters of symptoms that include subjective (conscious) experiences as well as behavioral and/or physiological responses. Because the bodily responses are readily measured objectively, these have come to be emphasized when developing treatments and assessing their effectiveness. On the other hand, the subjective experience of the patient reported during a clinical interview is often viewed as a weak correlate of psychopathology. To the extent that subjective symptoms are related to the underlying problem, it is often assumed that they will be taken care of if the more objective behavioral and physiological symptoms are properly treated. Decades of research on anxiety disorders, however, show that behavioral and physiological symptoms do not correlate as strongly with subjective experiences as is typically assumed. Further, the treatments developed using more objective symptoms as a marker of psychopathology have mostly been disappointing in effectiveness. Given that “mental” disorders are named for, and defined by, their subjective mental qualities, it is perhaps not surprising, in retrospect, that treatments that have sidelined mental qualities have not been especially effective. These negative attitudes about subjective experience took root in psychiatry and allied fields decades ago when there were few avenues for scientifically studying subjective experience. Today, however, cognitive neuroscience research on consciousness is thriving, and offers a viable and novel scientific approach that could help achieve a deeper understanding of mental disorders and their treatment.

Perceptually Visible but Emotionally Subliminal Stimuli to Improve Exposure Therapies

“…Can we reduce fear by merely extinguishing its physiological outputs? Researchers investigating emotions should cautiously infer such an inseparable association between subjective states and their physiological correlates, Taschereau-Dumouchel and colleagues claimed [ 1 ]. The authors pointed out that “treatments developed using more objective symptoms as a marker of psychopathology have mostly been disappointing in effectiveness”, inviting future researchers to base new therapeutic protocols on subjective measures (e.g., self-reports) [ 1 ] or on their specific psychophysiological correlates [ 2 ].…”

“…Here, we collect this invitation by introducing an emotion-centered classification of subliminal stimuli to «put the “mental” back» in the scientific debate concerning the therapeutic efficacy of subliminal exposure therapies: in our opinion, the issue raised by Taschereau-Dumouchel and colleagues [ 1 ] cannot leave this emerging research line out of consideration.…”

Drawing the experience dynamics of meditation

“…Similar analogies exist in early Buddhist scriptures, describing sensory experiences and mental events, such as feelings, perceptions and volitions, to flow in a constantly changing “mind stream” 18 . It remains a challenge to reliably capture the stream of consciousness, which would enable the study of the dynamics of continuous experiences, such as altered states of consciousness, flow states 19 , or the affective states associated with mental disorders 20 .…”

Electrophysiological normative responses to emotional, neutral, and cigarette-related images

“…Hence, selecting stimuli solely based on the evaluative dimension to investigate physiological correlates of emotional processes might be problematic for several reasons. First, subjective experiences of emotion and biologically derived measures of affect are known to be poorly correlated (Taschereau-Dumouchel et al, 2022). Second, conscious evaluations are fully formed a few seconds after pictures are presented, at the end of a cascade of processes that also include appraisal.…”