Disorders of Emotion: Causes and ConsequencesAuthor(s): S. RachmanSource: Psychological Inquiry, Vol. 2, No. 1 (1991), pp. 86-87Published by: Taylor & Francis, Ltd.Stable URL: http://www.jstor.org/stable/1449423 .

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86 COMMENTARIES

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Disorders of Emotion: Causes and Consequences

S. Rachman University of British Columbia

In most models of psychopathology, inappropriate experi- ences of emotion constitute the psychological problem, or at least are regarded as a manifestation of the problem. In Bar- low's view, however, the psychological problem, notably anxiety or dysthymia, often is the product of these inap- propriate experiences of emotion. These emotional experi- ences are the cause, not the problem. What leads Barlow to reach this unusual conclusion?

Making good use of recently accumulated information about the nature of panic and panic disorder, his point of departure is the observation that after a person experiences one or a few episodes of panic, there is a strong likelihood that in the succeeding days and weeks he or she will develop anxious apprehension. It is this anxious apprehension, and its consequences, including notably extensive avoidance be- havior, that constitutes the psychological problem. This point is very well taken, for all too often the consequences of the panic episode are overlooked; research attention is con- centrated on the episode itself to the exclusion of other important features.

A key fact for Barlow is that many people experience panics but fail to develop panic disorder or any other disor- der. He contrasts people who develop problems because of their inappropriate emotion (here, panic) with those who experience episodes of panic but do not go on to develop anxious apprehension or the other abnormal consequences that characterize panic disorder. In Barlow's view, those people who develop problems after one or more episodes of panic, the inappropriate emotion, are experiencing "uncon- trollable and threatening" events which they are unable to deal with. As a result, the inappropriate emotion becomes the focus of anxiety or dysthymia. Barlow's theory differs from the biological theory of panic disorder, most persuasively argued by Klein (1987), and the cognitive theory of panic disorder, argued equally persuasively by Clark (1986, 1988).

Klein maintains that the anxious apprehension observed after episodes of panic, and the associated avoidance behav- ior and other problems, are consequences of the emergence of a biological dysfunction. Clark and other cognitive theo- rists, on the other hand, have argued that the episodes of panic are caused by catastrophic misinterpretations of bodily sensations, and accordingly, the anxious apprehension and associated problems flow directly from the faulty cognitions.

The biological theory and the cognitive theory are present-

ly undergoing intensive investigation and we can reasonably expect some important conclusions within the next 2 or 3 years (see Rachman & Maser, 1988). It is not immediately obvious how Barlow's model can be brought into the ring with these two major competitors, particularly as his model is multifactorial and absorbs certain aspects of the cognitive and biological theories.

Part of the problem arises from a lack of clarity about the exclusiveness of Barlow's model. It is not entirely clear when anxiety and/or dysthymia are always and necessarily the result of experiencing inappropriate and uncontrollable emotions. Is this sequence inevitable, and is this the only or main path to the development of anxiety and dysthymic problems?

If Barlow is arguing that inappropriate experiences of (un- controllable) emotion are merely one path that can lead to the development of anxiety or dysthymia, then it becomes more difficult to carry out comparisons between the theories.

The difficulty in designing comparative tests of the valid- ity of Barlow's model is increased by the extension of his scheme to include depression, anger, and mania. Before em- barking on a test to compare Barlow's theory to its com- petitors, one would need to know whether the inappropriate experience of emotion is the only path to depression, and to anger, and to mania. On the internal evidence of the article, it appears that this is not what Barlow intends; rather, he seems to be arguing that the inappropriate experience of uncon- trollable emotion is merely one path on the way to the devel- opment of anxiety, dysthymia, depression, and so on. This appears to be a more plausible model, but also more difficult to come to grips with, to test. If anxiety, depression, mania, and the rest can develop for other reasons and in other ways, the demonstration of other causes of these disorders would not weaken Barlow's model. If I am correct that Barlow is not arguing for an exclusive track from the inappropriate experience of emotion to anxiety, depression, and so on, then he has before him the large task of completing the integration of his model with existing explanations for these disorders. (For example, actual or threatened loss can play a part in the genesis of depression, and threat is known to be a major cause of anxiety.)

The model will also need to explain the nature and causes of the originating inappropriate emotions; what exactly are they and why do they arise? And do we mean inappropriate

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COMMENTARIES 87

experiences of (appropriate) emotion, or the experience of an emotion that is always inappropriate, or both of these forms?

In the process of constructing his model, Barlow makes several refreshing and innovative analyses of each type of disorder. Much of his article appears to me to be sustainable and strongly argued. His subtle analysis of the complex rela- tionship between anxiety and depression, neatly summarized in the phrase that "almost all depressed patients are anxious, but not all anxious patients are depressed," is particularly useful. He could, however, make better use of Eysenck's (1967) work, in that the concept of neuroticism combines anxiety and depression; it is neuroticism, not anxiety, that is normally distributed and that has a genetic loading.

On the other hand, Barlow's attempt to revive the distinc- tion between fear and anxiety, so often attempted and so seldom successful, encounters numerous difficulties; it is difficult to see how he can deal with the problem of irrational fears, and whether social phobias are an expression of fear or anxiety. The list of problems can be extended but would serve no purpose, particularly as the distinction seems to be an unimportant part of his model, and the model would not suffer in the least if the distinction between fear and anxiety were simply omitted.

Building on his extension of the model to include stress disorders, especially anger, I think that more progress can be made by setting aside one of his assumptions and replacing it with another. Instead of arguing that, "fear is characterized by a lack of control, anger by a sense of control and mastery," it can be said that in many instances anger is an expression of a lack of control. In this way, it can be brought closer to the general argument in which inappropriate experiences of (un- controllable) emotion are said to be the cause of anxiety/ dysthymia. It is not difficult to think of everyday and experi- mental examples of anger arising from inadequate control or from the loss of control; moreover, when anger is encoun- tered as a clinical problem, it seldom presents as too great a sense of control or mastery. To the contrary, the clinical problem arises from the fact that the person lacks control of his or her anger, or is unable to control it satisfactorily- hence the problem.

With this altered view of anger, it becomes easier to inte- grate the concept into Barlow's model. Inappropriate experi- ences of emotion are said to become "the focus of anxiety or dysthymia in that the emotions themselves are experienced as uncontrollable and threatening with adequate coping being difficult or impossible." Inappropriate and uncon- trollable experiences of anger are, one suspects, as powerful as other emotions as a source of dysthymia and anxiety.

Pursuing this view of anger, it is worth noticing that in many cases people who take significant amounts of Valium often display inexplicable anger and aggression (Bond & Lader, 1979). It is possible that the people who experience this seemingly paradoxical effect from a tranquilizing drug are initially responding anxiously to some threat. However, if the tranquilizing Valium reduces the person's fear, but the threat remains present, then perhaps the threat produces not fear, but anger. If the anger is inappropriate and uncontrolla- ble, dysthymia might emerge.

Barlow correctly points out that many patients with stress- related psychophysiological disorders, such as hypertension, "display little or no anxiety or dysthymia," but rather are

given to expressions of anger or aggression. These people are more likely to end up with a diagnosis of personality disorder than one of anxiety disorder.

We can now turn to a consideration of the clinical and treatment implications of Barlow's model. If anxiety/dys- thymia arise from inappropriate experiences of uncontrolla- ble emotions, several tactics can be suggested. First, the person can be helped to reduce the inappropriate experiences of emotion and replace them with more appropriate emotion. Second, and probably in parallel with the first tactic, the affected person can be helped to gain increasing control of these emotional experiences. If either, or preferably both, of these tactics are successful, then anxiety/dysthymia should not develop. If it is already present, the reduction of inap- propriate experiences of emotion, and the increase in control over those episodes that cannot be prevented, should lead to a reduction in anxiety/dysthymia. It follows from this analysis that psychological and pharmacological techniques should be effective in reducing anxiety/dysthymia. Drugs and psy- chological therapy are capable of reducing the inappropriate episodes of emotion and both of them confer a degree of controllability. It can also be deduced that any treatment technique, either pharmacological or psychological, that fails to reduce the frequency of episodes of inappropriate emotion, and fails to reduce the uncontrollability of those experiences, will be of scant therapeutic value (or as in the case of Valium, if it replaces one form of inappropriate emo- tion with another). Of course, there is a major problem em- bedded in this analysis, and it goes back to a point made at the outset. It is not readily apparent how Barlow's model can be comparatively tested against two of its major competitors. Until Barlow's model is refined, it is difficult to see how differential and testable predictions can be generated.

To conclude, the model appears to need clarification and development, but Barlow's analyses of each type of disorder are enlightening and provide both pleasure and profit. Per- haps the strongest feature of Barlow's model is the correct emphasis on the consequences of inappropriate emotional experiences, especially panic. Distress often is followed by a degree of disablement.

Note

S. Rachman, Department of Psychology, University of British Colubmia, 2136 West Mall, Vancouver, British Co- lumbia, V6T 1Y7, Canada.

References

Bond, A., & Lader, M. (1979). Benzodiazepines and aggression. In M. Sandler (Ed.), Psychopharmacology of aggression (pp. 173-182). New York: Raven.

Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470.

Clark, D. M. (1988). A cognitive model of panic attacks. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 71-90). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

Eysenck, H. J. (1967). The biological basis of personality. Springfield, IL: Thomas.

Klein, D. (1987). Anxiety reconceptualized. In D. Klein (Ed.), Anxiety (pp. 1-35). Basel, Switzerland: Karger.

Rachman, S., & Maser, J. D. (Eds.). (1988). Panic: Psychological per- spectives. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

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