Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Mar;27(3):1322-1330.
doi: 10.1038/s41380-021-01395-5. Epub 2022 Jan 26.

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

Vincent Taschereau-Dumouchel  1   2 , Matthias Michel  3 , Hakwan Lau  4 , Stefan G Hofmann  5   6 , Joseph E LeDoux  7   8
Affiliations
Review

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

Vincent Taschereau-Dumouchel et al. Mol Psychiatry. 2022 Mar.

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.

PubMed Disclaimer

Conflict of interest statement

SGH receives compensation for his work as editor from SpringerNature and the Association for Psychological Science, and as an advisor from the Palo Alto Health Sciences Otsuka Pharmaceuticals, and for his work as a Subject Matter Expert from John Wiley & Sons, Inc. and SilverCloud Health, Inc. He also receives royalties and payments for his editorial work from various publishers. JELD receives royalties from his books. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Discordance and desynchrony in light of a higher-order perspective.
Threatening stimuli often lead to subjective fear via the higher-order circuit, and trigger bodily reactions (behavioral and physiological responses) via the defensive survival circuit, in parallel. This higher-order model can account for situations where subjective and objective responses are discordant or desynchronous. For instance, blocking physiological reactions (X1) dissociates them from conditioned or forecasted actions and/or conscious experiences, while blocking physiological reactions (X2) dissociates those from behavior reactions and/or conscious experience. Similar logic applies to X3 and X4. ANS autonomic nervous system.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602. doi: 10.1001/archpsyc.62.6.593. - DOI - PubMed
    1. LeDoux JE. The emotional brain: the mysterious underpinnings of emotional life. Simon and Schuster; 1996.
    1. LeDoux JE. Anxious: using the brain to understand and treat fear and anxiety. Penguin; 2015.
    1. Morrison FG, Ressler KJ. From the neurobiology of extinction to improved clinical treatments. Depress Anxiety. 2014;31:279–90. doi: 10.1002/da.22214. - DOI - PMC - PubMed
    1. Perusini JN, Fanselow MS. Neurobehavioral perspectives on the distinction between fear and anxiety. Learn Mem. 2015;22:417–25. doi: 10.1101/lm.039180.115. - DOI - PMC - PubMed

Publication types