Researchers at Amsterdam Emotional Memory Lab assess the importance of emotional memory in mental health and the network theory.

How do we understand mental health?


Psychological science has been trying to understand what exactly causes mental illness, such as depression, anxiety, or eating disorders. Different theories assume that symptoms arise from past experiences in interaction with biological risk factors, and use this as guidance for treatment.


A new trend says that we should move away from finding the underlying cause and rather explain disorders by its interacting symptoms. But is this indeed the way to go?


This is the question that Inga Marie Freund, Arnoud Arntz, Renée Visser, and Merel Kindt at the Amsterdam Emotional Memory Lab located at the University of Amsterdam, have been puzzling about. Together they are critically assessing the role of emotional memory in mental health conditions.


Read their original article:

Image Source: Black Salmon/ Shutterstock




Hello and welcome to ResearchPod. Thank you for joining us today.  


In this episode, we will be looking at the work of Inga Marie Freund, Arnoud Arntz, Renée Visser, and Merel Kindt at the University of Amsterdam. This team of researchers recently published research exploring the strengths and limitations of an emerging approach used to study mental health conditions, including conditions such as depression, anxiety, and substance abuse. The new approach is known as the ‘network theory of mental health disorders’.  


The network theory sharply contrasts with the traditional way of working in the field of mental health. Currently, the diagnosis and treatment of mental health conditions are based on a classification system, where you are labelled with a specific condition if you meet the criteria of a specific set of symptoms. Inspired by the study of other complex phenomena, ranging from economic trends to social interactions, computer systems, and the spread of viruses and diseases, the network theory views a mental health condition as a complex system – rather than just a list of symptoms.  


As the name suggests, the network theory represents mental health conditions as networks of multiple interacting symptoms. The idea is that when a symptom within a network becomes activated, it can trigger the onset of other symptoms it is linked to. For example, a patient’s constant worrying and overthinking could lead to trouble sleeping, resulting in them experiencing greater fatigue and a depressed mood during the day. The activation of these symptoms may then, in turn, further exacerbate the initial symptoms, creating what they refer to as ‘feedback loops’. So, in our example, the fatigue and depressed mood may subsequently feed back into more worrying. You can see how this can quickly become a vicious, self-sustaining cycle, which is very difficult to break out of.  


Freund, Arntz, Visser, and Kindt, a team of researchers at the University of Amsterdam, set out to critically evaluate the network theory of mental disorders, to better understand its possible value and application in treatment settings. The researchers have recently published a paper that appraises the benefits of this relatively new approach to conceptualising mental health conditions, while also exploring factors that could limit its clinical utility.   


 The network theory of mental health conditions has many potential benefits. Most notably, it effectively captures the complexity and interconnected nature of mental health. It is very common for people with such conditions to present symptoms associated with a variety of different conditions and thus receive multiple diagnoses. For example, an individual that is addicted to cocaine or alcohol could also experience anxiety and depression. And the network theory actually offers an explanation for this common pattern of interconnectedness between symptoms across mental disorders.


With that said, one of the key strengths of the network theory is that it can be particularly useful for looking at the relationships between co-existing symptoms and different mental health conditions – or co-morbidity. Co-morbidity is when a patient is diagnosed with more than one condition. By mapping individual symptoms and the links between them, clinicians could gain increased insight into how different diagnoses are connected to each other to develop new treatment methods for co-morbid conditions. At the same time, if each patient could have their own unique network of interconnected symptoms mapped, this could help make existing treatments more individualised. 


Despite these potential benefits, the network theory also has its limitations. Compared to the traditional way of diagnosing and treating mental health conditions the network theory does not consider a root cause or causative factors that could explain the onset of symptoms. So rather than underlying causes like genetics, social upbringing, and childhood adversity playing a role in the development of mental health conditions, the network theory posits that it is the symptoms themselves that ultimately cause the condition through their interconnectedness – and that spread of symptom activation, like we discussed earlier.   


However, the authors of this paper think differently. Based on more traditional psychological theories, they believe that emotional memories formed by adverse experiences lie at the root of mental health conditions. Yet the nature of the network theory leaves no room for emotional memory or other underlying causes of mental health conditions. As such, the network theory neglects decades of research and existing theories that have advanced clinical practice throughout the years. As a result, in their journal article, the authors powerfully argue that emotional memory is an important concept that should not be disregarded in the study and treatment of mental health conditions.  


During our lives, we feel a wide range of emotions in response to what we experience, and experiences that evoke particularly strong emotional reactions are stored in the form of ‘emotional memories’. Experimental studies on both humans and animals have consistently shown that emotional memories shape our beliefs and behaviours. This can be a good thing because it means we are learning from our past in order to avoid making the same mistakes in the future. For example, if you witnessed a car accident, you may be more careful when crossing the street or when driving yourself. But at the same time, this learning and these emotional memories can become dysfunctional and may stand in the way. So, if the fear of having a car accident becomes obsessive, you could experience panic at the thought of having to sit behind the steering wheel and, therefore, feel like you cannot step into a car ever again.  


When an emotional memory becomes activated, it may sometimes prompt automatic and dysfunctional thoughts and actions, such as the tendency to avoid certain situations – like the car – or to lean on food, drugs, or gambling to numb that emotional memory, or to have emotional outbursts. In line with this, adverse experiences during childhood, including neglect, sexual, physical, or emotional abuse, being bullied in school, and parents divorcing, have been found to increase the risk of developing mental disorders. 


As emotional memory is viewed as an underlying cause of symptoms, it is not surprising that it is also an important concept in psychotherapy. In fact, emotional memories are actually targeted in multiple types of psychotherapies. During exposure therapy, a patient might be exposed to situations or objects that trigger feelings of fear because they remind them of their past learning experiences. For example, patients who are afraid of dogs because they witnessed a dog attacking a child, for instance, are encouraged to expose themselves first to the sound and smells of dogs and later to facing and touching dogs. More specifically, one might start by learning to feel comfortable stroking a small dog like a chihuahua and eventually build up to stroking a big German shepherd. By taking these steps to endure psychological and physiological discomfort during these triggering situations, within experiences that may actually sound enjoyable for people who do not fear dogs, the patient has to face and tolerate the strong negative emotions that may arise. And in this way, through exposure therapy, the patient creates new safe emotional memories associated with dogs that can help supplant previous negative associations, lessening future negative emotional responses to similar triggers.


Besides physical exposure, emotional memories can also be addressed in a different way. For example, a patient might be asked to mentally recall or imagine past events that triggered strong emotional reactions, such as being neglected by a parent or teased by peers. The therapist guides them through the experience, helping the patient to uncover their emotions and their needs that were not met in that specific situation. Ultimately, this allows the patient to process their intense emotions associated with the past event that they might have been avoiding and which may have contributed to the onset as well as the maintenance of their symptoms.  


While emotional memory seems to be an entry point to treatment and is a concept that therapists often work with, it currently remains unclear exactly how it influences mental health. The researchers remain open to the possibility that perhaps emotional memory is merely a narrative, albeit with a convincing rationale, used to explain symptoms of mental health conditions – but may not necessarily be a driving force of symptoms. So, it remains to be empirically tested whether emotional memories are indeed a crucial concept for scientific theories of mental health conditions. And once this is established, the authors suggest evaluating whether including emotional memory in a network of symptoms could improve the diagnosis and treatment of mental health conditions. Perhaps it is possible to reap the benefits of both traditional and new theories, combining existing knowledge with innovative ideas to advance the field through an integrated approach. This is what Freund, Arntz, Visser, and Kindt are currently working on at the Amsterdam Emotional Memory Lab. 


That’s all for this episode – You can find a link to the researchers’ paper in the show notes below. thanks for listening and stay subscribed to ResearchPod for more of the latest science and ideas. 


See you again soon. 

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