Emotions, Their Disorders, and Precision in Theory Construction

Barlow's contributions to the field of anxiety-disorder research have been monumental. They include not only empirical studies on the etiology, diagnosis, classification, and treatment of anxiety disorders, but through personal effort, persuasion, and willingness to listen, he has, almost singlehandedly among psychologists, bridged the disciplinary gap in this field with psychiatry. Among his books, Anxiety and Its Disorders (1988) stands alone as the most comprehensive single-authored text in the world on this subject. In his target article, "Disorders of Emotion," he distills several chapters from that text. For this reason, the reader would do well to keep the text at his or her side, because several important terms are defined there but not here. Chapters 2, 6, and 7 are particularly helpful in this regard. Although the reader is led to believe at the start of the article that basic cognitive psychology and emotion theory would be used in the service of explaining clinical phenomena, this is not quite the case. The crux of the argument seems to be that overactivity in specific emotions can lead to emotional disorders, due to a process of cognitive elaboration involving a sense of vulnerability and helplessness. Accordingly, there is a causative sequence implied: (a) Basic emotions "fire inappropriately," causing (b) the phenomenological experience of unpredictability and uncontrollability, leading to (c) emotional disorders (as anxiety and dysthymia in Barlow's Figure 4). Barlow's theory represents a laudatory attempt to synthesize a voluminous theoretical and clinical literature, whose roots go back to Schacter's model of emotion, and the cognitive appraisal models of Lazarus (Lazarus, Kanner, & Folkman, 1980), Beck (Beck, 1976), Alloy (Alloy, Kelly, Mineka, & Clements, 1990), Abramson (Abramson, Alloy, & Metalsky, 1988), and others. Unfortunately, in addition to the problems ever-attendant on such models (e.g., of replicating Schacter and Singer's (1962) original effect; of defining the nature of the appraisal process; and of providing plausible scientific validation of introspective reports), several other difficulties arise in implementing the theory. These difficulties relate to precision: There are many ambiguities in presentation, leaving the reader wistful for what might have been. At times, we worried that we were missing the "big issues," but in the end we concluded that the repeated lack of clarity and precision was the biggest issue. Although such concerns involved terminology to some degree, the problems included substantive theoretical issues as well. One of the potentially valuable contributions made in this article is the use of "anxious apprehension," but a more complete definition and use of the concept is found in Barlow (1988). There, anxiety, or anxious apprehension, is said to be a cognitive structure whose "essence is arousal-driven apprehension" (p. 235). In the target article, anxious apprehension is introduced, but not used consistently. For example, one finds: "For this reason at least a 1-month period of anxiety over having another panic attack is a defining characteristic of panic disorder . " We suspect that "anxiety" here really means anxious apprehension, but the reader cannot confidently make this substitution throughout the article. A case in point is the discussion of self-report instruments that might help in discriminating anxiety and depression. Here anxious apprehension cannot be simply substituted for anxiety. We are also concerned about the loose usage of the term vulnerable, which here serves only to gloss over our ignorance and does not contribute to the predictive value of the theory. The article speaks of "the vulnerable individual," shared "common biological vulnerabilities," "a general proneness to develop anxiety or depression rather than a specific vulnerability for anxiety and depression itself," and "a psychological vulnerability. " If we knew the specific variables that produce panic, the notion of vulnerability would be obsolete or at least refer back to a known knowledge base. When we read that an individual is vulnerable to panic, we tend to forget that the specific cause-and-effect relationships that operationally define this disorder of emotion are still unknown. One use of theory is to specify testable cause-andeffect relationships that make the phrase "a common set of biological and psychological vulnerabilities" scientifically useful. The theory presented here does not do this in an obvious manner. Defining who is at risk is never clear. Several sections emphasize biological vulnerability; others stress the importance of early experience with loss of control. Some interaction of biological and experiential factors is generally viewed as posing a risk in all mental disorders. A new theory might have advanced the field by a more rigorous account of the relative importance of these factors in disorders of emotion. Panic represents one disorder probably involving biological vulnerability, in which there has been, during the past decade, an explosion of studies. Theorists such as Gray (1982, 1985) and Cloninger (1986; Cloninger, Martin, Guze, & Clayton, 1990) have attempted to bring together biological, psychological, and clinical findings to create a relatively new, heuristic view of anxiety. Others have reviewed the biological data with the aim of integrating biological and psychological phenomena (e.g., Maser & Woods, 1990). Barlow's article does not address the issues raised by biological research on panic except to speak generally about "biological vulnerability. " There are important biological issues, although this is not the place to discuss them in any depth (see Maser & Woods, 1990). One might ask how psychological variables can modulate physiological events (Sanderson, Rapee, & Barlow, 1989), as well as the reverse (Pitts & McClure, 1967), or