The “Human Emotions” and the new “Perrotta Human Emotions Model” (PHEM-2): Structural and functional updates to the first model

Background: The first version of the Perrotta Human Emotions Model (PHEM) responded to the need for better structuring, in a functional framework, of emotions and sentiments, giving the proper role to anxiety, according to a neurobiological perspective, in a strategic scheme, but needs structural and functional corrections.

Methods: Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests.

Results: Statistical comparison of data obtained by administering PHEM-1 versus data obtained by administering PHEM-2 reported an R = 0.999, with p = ≤0.001, as is the case when testing clinical utility by assessing it using MMPI-2-RF and PICI-2.

Conclusion: This research confirms the clinical usefulness of administering the PHEM-2, compared with the previous version, during psychotherapeutic encounters conducted according to the brief or otherwise integrated strategic approach.

Background

The technical requirement of the Perrotta Human Emotions Model (PHEM) [1]

The first version of the Perrotta Human Emotions Model (PHEM) responded to the need for better structuring, in a functional framework, of emotions and sentiments, giving the proper role to anxiety, according to a neurobiological perspective, in a strategic scheme that originated from sensations (captured through the sense organs) and evolved into perception, thanks to anxiety (understood in the functional sense) intervening as a fluidizing and activating mechanism of human cognitive processes. At this point, perception (as a reprocessing of sensation) necessarily had to confront defence mechanisms, the internal system of needs, personal constructs (experientially derived), beliefs and conditioning social influences, all the way to psychological traumas and their adaptations, whether functional or dysfunctional, before being in turn returned by the system as “subjective normative content” (or final perception). In this complicated and multiphasic process, the role of emotional states (or emotions) was central, as it was because of them that the emotional-behavioural reactions (or sentiments, in response to internal and external stimuli) occurred. Thus, the first version of the Perrotta Human Emotions Model (PHEM) was presented as an Italian response to the structural and functional criticality of the analyzed models, such as those of James-Lange, Cannon-Bard, Watson, Darwin, Ekman, Cowen-Keltner, Schachter-Singer and Mandler, which were extremely reductive in listing emotions and sentiments (a), did not take into account in an organized manner the difference between sensations perceptions, emotions, sentiments, affects, needs, and instinctual drives (b), did not emphasize the role of anxiety in the functional and dysfunctional mechanisms of emotions (c), did not take into account the psychopathological implications of emotions from a dysfunctional perspective (d), and did not give enough emphasis to the difference between emotional state and emotional-behavioural reaction (e). This theoretical basis is also perfectly preserved in the second model.

The structural elements of the Perrotta Human Emotions Model (PHEM) [1]

To address the structural and functional deficiencies noted, the PHEM (in its first version) was structured according to the following assumptions:

1. The perceptual system (or operation): A person’s Perceptual System (or Functioning) is composed of two structures: a) “the sensory area”, that is, the human senses that capture the elements of external space in the form of sensations; b) “the perceptual area”, that is, the processing of sensations according to a process that consists of three stages: the “elaborative moment”, the “normative moment”, and the “restitutive moment”. In the first moment (I), the elaborative moment, the sensory signal captured by one of the human senses is transmitted following the neuroanatomical pathways according to the sense involved in the specific process; in the second moment (II), the normative one, the first elaborated perception is confronted with a whole series of psychic elements of the mind, which shape it according to them, namely, the emotions managed by the “Self” (first ego function), the defense mechanisms managed by the “Superego” (second ego function), on which then the internal system of needs, personal constructs (experientially derived), beliefs and conditioning social influences are based; in the third moment (III), the restitutive one, a new perceptual processing is thus returned with respect to the one obtained from sensations, which may be affected not only by registration errors arising from sensory distortions but also by systematic errors and psychic dysfunctional processes arising from psychopathological conditions. For these reasons, this process is always considered subjective and unique because it cannot be duplicated or repeated by another person in its final result.
2. The role of anxiety in the perceptual process: Generally, we discuss the role of dysfunctional anxiety in different psychopathological conditions and how it fuels them. Rarely, in the clinical setting, is the role of functional anxiety, that is, the psychophysical activation mechanism that allows us to interact with external and internal space through cognitive and adaptive activation, extolled: in fact, anxiety allows us to activate different cognitive processes, such as attention and perception; it allows us to react to external events according to adaptive attack-escape and emergent mechanisms (in the presence of a threat or danger); it allows us to put in place emotional-behavioural reactions necessary for adaptation with the external environment; it allows us to trigger adaptive cardiovascular and neurovegetative bodily mechanisms. It becomes dysfunctional only when the self (first ego function, according to the PICI-2 model) fails to manage primary emotions and these dysfunctionally hyperactivate the defence mechanisms managed by the superego (second ego function), fostering exaggerated reactions to the point of true chronic psychopathologies such as anxiety disorder and panic attacks. Therefore, in the proposed model, anxiety is not considered an emotion but reverts to being that functional and adaptive mechanism, in itself neutral, consistent with neurobiological dictates, that allows adaptation concerning the environment; in essence, the feeding of the whole circuit that becomes an enhancer of dysfunctionality and maladaptation only if such is the management of the specific basic emotion.
3. The distinction between “emotional states” and “emotional-behavioural reactions”: The proposed model is structured based on a continuous process that originates from sensations (captured through the sense organs) and evolves into perception, thanks to (functional) anxiety that intervenes as a fluidizing and activating mechanism of human cognitive processes. At this point, perception (as the reprocessing of sensation) is confronted in its final, restitutive version with the person’s “normative content” (Self and Superego, according to the new PICI-2 theorization), which is formed from birth and over the years starting with attachment content and continuing with familial and relational patterns, defence mechanisms (which are triggered based on the 2 primary emotions), the internal system of needs, personal constructs (experientially derived), beliefs and conditioning social influences, to psychological traumas and their dysfunctional adaptations. In this process, the role of emotional states (or emotions) is central, as it is through them that emotional-behavioural reactions occur, concerning internal and external stimuli: In essence, “emotional states” (or emotions) are basic modes that our mind knows (and “installed” by default) by which we can adapt to internal and external circumstances, while “emotional-behavioural reactions” (or sentiments) are subjective emotional experiences experienced by the person due to the interaction of basic emotions with anxiety, and/or with the combination of two or more basic emotions. It is a model that ensures both the structural and functional continuity between emotions/emotional states and sentiments/emotional-behavioural reactions, but more importantly explains the complexity of emotional thinking with the possibility of experiencing (starting from one of the two basic emotions) one or more sentiments, even simultaneously, and then always coming to prefer a single pathway of expression.
4. The distinction between “sensation”, “perception”, “anxiety”, “emotion”, “sentiments”, “affection”, “need”, “desire”, “necessity”, and “instinctual instinct”

In summary: “sensation” is the result of the interaction between the sense organ and the return of the content; “perception” is the reprocessing of the sensation, and can be first-level (when the sensation is processed at the neurobiological stage) or second-level (when the neurobiologically processed sensation passes a second evaluation screen by the person’s normative content, and then is returned through behaviors); “anxiety” is the circuit feeder; “emotion” is a basic mode that enables us to adapt to internal and external circumstances; “sentiments” is an emotional-behavioral reaction or subjective emotional experience experienced by the person due to the interaction of basic emotions with anxiety, and/or with the combination of feelings, again with the aim of perfecting one’s adaptation; discomfort is a state of mind, such as tension or hyperactivity or hypoactivity, that occurs when the person experiences different feelings, depending on the factual situations; “affect” is a feeling of attachment to someone or something, including material ones, exclusively related to the basic emotion of pleasure and particularly (but not exclusively) to friendship and love feelings; “need” is the instinctual impulse that arises to satisfy a desire and presupposes a state of necessity that if not satisfied brings suffering and frustration; “desire” is the object of need; “necessity” is the degree of importance and impellency that need goes to satisfy; “instinctual drive (or impulse)”, differing in part from the Freudian concept, is any conscious or unconscious manifestation of a need. This construct, therefore, is based on the idea that every action/behaviour arises from a need (or instinctual drive) that seeks satisfaction.

These structural elements are also retained in the second model but are modified in the part where basic emotions and feelings are distinguished in detail, for the reasons given in the next section.

The functional elements of the Perrotta Human Emotions Model (PHEM) [1]

Thus, referring back to the PICI-2 model and the role of anxiety as a natural activator and/or enhancer (and not as a basic emotion, as mistakenly believed until now), the origin of all psychopathologies, according to the model under consideration, is to be found in the dysfunctional management of one or both basic emotions (anguish and pleasure) and not in anxiety: in fact, working in psychotherapy on the basic emotions and then on the sentiments makes it possible to unblock anxiety (and not the opposite) and consequently the vicious circle that feeds the psychopathological condition. The more entrenched the problem is and the more you have not mastered your “emotional alphabet”, the more complicated it will be to unravel the knot at the origin of the dysfunctional condition. Indeed, the proposed model suggests the list of 2 basic emotional states (or emotions), 14 first-level emotional-behavioural reactions (or sentiments), 42 second-level and 96 third-level, for a total of 2 basic emotions and 152 sentiments. The reason for the presence of only two basic emotions (“anguish”, understood as the absence of pleasure, and “pleasure”, understood as the absence of anguish) is that all of them can be traced back to these identified: fear, anger, sadness, guilt, disgust and many others derive from anguish, unlike their placement in other theoretical models where they responded to an autonomous need for emotional representation; on closer inspection, all of them originate precisely from anguish, which dysfunctionally managed gives rise to being, cascading. Just like the Freudian duality of the reality principle (conscious) and the pleasure principle (unconscious), the same pattern insists here: anguish for reality and pleasure for pleasure, where anguish is the consequence of not being able to fulfil one’s desires as imagined regardless, and pleasure is the origin of the human unconscious structure, understood as the realization of whatever one wants without limits, boundaries, and consequences. The proposed model, therefore, takes into account, complementing each other, both dysfunctional and functional sentimental components; the distinction, therefore, lies in the case-by-case assessment concerning the adaptive effects of such emotional states and emotional-behavioural reactions. Thus, the paradigm underlying PHEM is to work directly on the person’s emotional alphabet and analysis of his or her own emotions to intervene indirectly on the anxiety that feeds and potentiates the toxic, maladaptive, dysfunctional, and pathological pattern. These functional elements are retained for the purposes but revolutionized in the method, according to the directions found in the following paragraph.

The critical issues of the Perrotta Human Emotions Model (PHEM)

During the exercise of clinical and research activity, carried out from January 2021 to June 2023 (30 months), the application of PHEM, in its first version, demonstrated the following shortcomings:

1. Categorization of emotions and sentiments: The model identifies anguish and pleasure as two basic emotions, while all derivations are considered sentiments, subdivided into three ascending orders (first, second, and third levels); however, this approach during the clinical sessions with the recruited subjects engendered much confusion, as they had been accustomed according to the models recognized in the literature, in which dozens of emotions stand out and sentiments were relegated exclusively to those of friendship, love, and hate. This new approach therefore forced the therapist in charge to devote a session to the didactic and formative component to change the patient’s cognitive plane, while still noting objective difficulties in absorbing the model from the conscious plane to the conscious plane.
2. The absence of separation between emotional, feeling, and behavioural profiles: The model identifies 2 emotions and 152 sentiments, but among them, more than 60% are complex reactions or links derived from emotions and sentiments. This approach, however, fostered resistance in therapy sessions regarding the transition between conscious and conscious planes concerning one’s emotional dynamics. This is likely to have happened in that the patient to arrive at emotional maturity must first know how to recognize inner states and his or her own needs and wants, link such inner experiences with the resulting behavioral acting out, to defuse any reinforcers that maintain toxic patterns.
3. The absence of a clinically oriented framing: The model merely identifies by adaptive trajectories (without using this wording) emotions and sentiments, but does not also extend the analysis to related (complex) reactions and bonds, behavioural styles, and personality traits; such shortcomings made its application during clinical sessions more complicated, having to spend more time on diagnostic identification.

Based on these critical issues, the “Perrotta Human Emotions Model - version 2” (PHEM-2) was developed to meet the need to provide a structural and functional intervention on the model to enable its better application in psychotherapeutic and clinical settings.

Aims and objectives of the study

It was found that updating the Perrotta Human Emotions Model (PHEM) was an academic and clinical need worthy of further investigation, as structural and functional vulnerabilities were found to need intervention. Based on this purpose, the working group decided to pursue the following objectives: a) to refine the model presented in its current first version, based on the clinical outcomes obtained during the support, care, and psychological therapy sessions, with the patients who are part of the selected population sample; b) to test the modified model, in its second edition, during the new three follow-up sessions, stipulated in the therapeutic contract stipulated with the patients who are part of the selected population sample.

Materials and methods

The present research work drew from the materials used in drafting the first edition of the Perrotta Human Emotions Model (PHEM) [1] to make structural and functional changes. Because of these changes, a glossary of all terms used in the new model was prepared, enriching the materials of the first edition. To define the argumentative context of each of the terms used, the search engines of Treccani [2] and Zanichelli [3] were consulted, while Oxford [4] and Hoepli [5] were used for the English translation. In the Italian language, the term “sentimento” is translated into English as “feeling”, however, it is preferred to use the literal archaic term “sentiment”, to facilitate the use of the term “feeling” as a terminological umbrella that can group both emotions and precisely sentiments; this in the Italian-to-English translation can lead to confusion but with such specification, the error is eliminated. The methods used are three (subsequent): 1) Implementation and translation of the Perrotta Human Emotions Model (PHEM), in its second version, concerning their emotional and perceptual-cognitive experience; 2) Clinical interview, based on narrative-anamnestic and documentary evidence and the basis of the Perrotta Human Emotions Model (PHEM-2) [1] and the administration of the Minnesota Multiphasic Personality Inventory – 2 – RF (MMPI-2-RF) [6-8] and the Perrotta Integrative Clinical Interviews - 2 (PICI-2) [9]; 3) administration of a score scale from 0 to 10 (where 0 corresponds to no negative impact of the symptom and 10 corresponds to Maximum negative impact), to monitor the progress. The phases of the research were divided thus: a) remodelling the critical elements, both structural and functional, of the first edition of the Perrotta Human Emotions Model (PHEM-1); b) selection of the population sample, according to the parameters indicated in the following paragraph; c) clinical interview, with the population sample, and administration of psychometric tests; d) remodelling of the model, in second version; e) data processing following administration of the PHEM-2 and comparison of data obtained.

Setting and partecipants

The requirements decided for the selection of the sample population (inclusion criteria) are:

1. Age Range: 18 - 67 years;
2. Gender: M/F defined;
3. Sexual orientation: heterosexual;
4. Physical health and robust constitution;
5. Presence of diagnosis of personality disorder or taking psychopharmacological therapy for the manifestation of psychiatric symptoms;
6. The previous psychological course of at least 3 completed clinical sessions (3 meetings lasting about 50 minutes each), for research purposes, supported by the first author of this paper.

The following exclusion criteria were also considered:

1. Patients who underwent the clinical pathway, for research purposes, before May 31, 2022, or completed it after June 30, 2022.
2. Patients who have not withdrawn the informed consent or have not delivered it with signature, as of June 30, 2022.
3. Patients who, after the completed clinical course, suffered from psychiatric symptomatology that required psychopharmacological support or were referred to other psychological and/or psychiatric specialists.
4. Patients with foreign citizenship, not of Italian origin, and with language difficulties.

There were 140 patients included, while those excluded from the study were 218.

In the period January 2021-June 2022, PHEM-1 was administered, to the entire population sample; the same sample was then retested in the period September 2022-August 2023 with the administration of PHEM-2.

The selected setting, taking into account the protracted pandemic period (already in progress since the beginning of the present research), is the online platform via Skype and Video call WhatsApp, both for the clinical interview and for the administration.

The present research work was carried out from January 2021 to August 2023 (32 months).

The selected population clinical sample, which meets the requirements, is 140 participants, divided into five groups (Table 1); the following table shows individual clinical reasons (Table 2).

Results

The second edition of the Perrotta Human Emotions Model (PHEM-2)

In the second edition, the model is restructured to allow a better understanding of the emotional element of the cognitive-behavioural profile. Thus, 226 possible adaptive trajectories are identified, divided according to 2 adaptive modes (anguish and pleasure): from the first mode originate 6 emotions (guilt, disgust, frustration, fear, anger, and sadness), while from the second mode originate 4 emotions (affect, joy, interest and decency), which in turn give rise to 19 feelings for the first mode and 15 feelings for the second mode. In total, the new model identifies 2 adaptive modes, 10 emotions, and 34 feelings. For each of these, the model recognizes 226 adaptive reactions, as many as there are trajectories. Finally, for each trajectory, the model identifies 22 adaptive responses (5 for the first mode and 17 for the second) and 8 behavioural styles (4 for the first mode and 4 for the second), correlating them with 8 different functionals (4 for the first mode) and dysfunctional (4 for the second) personality traits (Table 3).

The new model lends itself to a more structured operation than the first version, which was limited only to identifying basic emotions and feelings graded in 3 levels; the new version assumes that there are 226 possible adaptive trajectories (AT), each of which originates from a factual circumstance that triggers an emotional pressure in the subject that responds with the specific trajectory; thus, each trajectory can originate from only 2 possible adaptive modes such as anguish and pleasure (AM), each of which triggers a reaction that gives rise to an emotional state (ES) and a feeling state understood as a complex evolution of emotion (SS). Accordingly, each trajectory is linked to an adaptive reaction (AR) and an adaptive response (AC), which generate certain behavioural styles (BS) in specific personality traits (PT). Take, for example, the first trajectory (AT/1): anguish (AM/1) can generate guilt (ES/1) and remorse (SS/1), triggering immolation (AR/1) and pain (AC/1), grafted into a dramatic personality framework (PT/1) and aggressive behavioural style (BS/1).

Comparison of outcomes, when administering the first (PHEM-1) and second (PHEM-2) editions of the Perrotta Human Emotions Model

To assess the clinical usefulness of PHEM-2 to the previous version, the same symptom severity rating scale (subjective rating on a 0-10 scale, scaling technique [10,11]) was administered during the penta-cycle of therapeutic sessions by the same therapist who had carried out the same intervention in the clinical group in which PHEM-1 was used. The five sessions, both during the application of PHEM-1 and PHEM-2, were conducted according to the short strategic approach therapeutic modality [12-16] and supplemented by cognitive-behavioural and dynamic correctives [17-24]. Below in the table are the values obtained, with reference graphs (Table 4, Figure 1). Statistical comparison of data obtained by administering PHEM-1 versus data obtained by administering PHEM-2 reported an R = 0.999, with p = ≤0.001.

Figure 1: Difference in averages for scores related to the results after the 5 sessions, between PHEM-1/PHEM-2 administrations.

To evaluate the clinical usefulness of PHEM-2, compared with PHEM-1, the MMPI-2-RF, and PICI-2 were repeatedly administered, obtaining the following results: a) At the MMPI-2-RF, mean scores for each scale elevated by more than 65 points decreased from 6.4% to 9.7%; b) At PICI-2, mean scores for each scale over 5/9 points elevated decreased from 18% to 27%. Statistical comparison of data obtained by administering PHEM-1 versus data obtained by administering PHEM-2 reported an R = 0.999, with p = ≤0.001.

Discussions and limits

The new updated version of the PHEM (PHEM-2) retains the main scaffolding of the first version concerning the perceptual system, the “more functional” concept of anxiety, the operational distinctions between emotions and sentiments (which then give rise to adaptive trajectories), and the central role of the adaptive modalities of anguish and pleasure, as well as sensations, perceptions, affects, needs, necessities, and instincts; however, aware that the model is dynamic in its structure and function, the noted shortcomings related to sentimental categorizations, cognitive profiles resulting from the emotional process, and the absence of a precise framing of the dysfunctional personality component were the reasons that prompted the need to update the first edition model.

From a structural point of view, PHEM-2 is perpetually and constantly being updated, the universe of emotions being still in many ways unexplored territory, but this second version has the merit, compared with past models and the first version, of explaining emotional language as an integrated and not separate function, structured by progressive logical connections and functional to communicative reason, making it possible to study human behaviour from a cognitive perspective and to evaluate individual adaptive trajectories, understood as paths that are far from illogical, but connected to an internal dimension based on needs and necessities, concerning one’s subjective experience and adaptation with the surrounding environment. In this way, each trajectory draws a precise adaptive line that the subject can investigate and compare with his or her own experience, taking into account that the subject can also enact more than one trajectory at a time, per specific event. In detail, in the table are the definitions of the structural and functional components of PHEM-2 (Table 5).

Based on theoretical experience, the updated second edition model was then compared with the same population sample, of equal numerosity and distribution, to be able to assess its clinical impact. It was preferred to administer it to the same population sample as PHEM-1, as it was considered less impactful to the therapeutic work carried out through PHEM-1 than to the risk of having a new population sample that had phonological characteristics, both adaptive and maladaptive, that was partially or different, despite all the accommodations that could be used, as the psychic dimension is always subjective and unique, both in structural and functional.

From the comparison, as already reported in the results section of this paper, it is clear that the positive impact of PHEM-2 is far greater than that of the previous version, standing at an average severity score of 4.05/10 compared to 5.84/10 for PHEM-1 (-1.79/10), after the five sessions budgeted. In particular, it is possible to take note of the fact that the use of PHEM-2 has an extremely positive effect on borderline patients (-3.66), and to a lesser though still significant extent, also on bipolar (-2.18), depressive (-2.01), narcissistic (-2.0) and neurotic patients with panic disorder (-2.3) and obsessive-compulsive disorder (-1.95). On the other hand, improvement is slight with phobic-somatic (-1.52), addicted to and/or substance behavioural conduct (-1.57), and anxious (-1.7) patients, while there are almost zero improvements in psychotic patients (-0.75), by their fragmentation of the plane of reality (Table 5, Figure 1] Same statistical result was obtained when evaluating the clinical utility of PHEM-2 versus PHEM-1, in accordance also with recent neuroscientific findings on emotions, language, and communication [25-45].

The limitations detectable in this study, in the authors’ opinion, relate to the theoretical construct of the PHEM model, which is constantly evolving and changing, the small size of the population sample, the use of the same population sample that had already received initial treatment by administration of PHEM-1 (and thus it is not possible to determine whether the first intervention left permanent positive outcomes impacting the second administration), and the need to use PHEM-2 according to a brief or otherwise integrated strategic psychotherapeutic approach.

Conclusion

In conclusion, this research confirms the clinical usefulness of administering the PHEM-2, compared with the previous version, during psychotherapeutic encounters conducted according to the brief or otherwise integrated strategic approach, to improve the patient’s awareness of his or her emotional dimension, thereby honing skills that he or she does not master.

Institutional review board statement

All participants were assured of compliance with the ethical requirements of the Charter of Human Rights, the Declaration of Helsinki in its most up-to-date version, the Oviedo Convention, the guidelines of the National Bioethics Committee, the standards of “Good Clinical Practice” (GCP) in the most recent version, the national and international codes of ethics of reference, as well as the fundamental principles of state law and international laws according to the updated guidelines on observation studies and clinical trial studies.

Informed consent statement

Subjects who gave regularly informed consent agreements were recruited; moreover, these subjects requested and obtained from GP, as the sole examiner and project manager, not to meet the other study collaborators, thus remaining completely anonymous.

Data availability statement

The subjects who participated in the study requested and obtained that GP be the sole examiner during the therapeutic sessions and that all other authors be aware of the participant’s data in an exclusively anonymous form.

The authors who contributed to the work are 3. We report below the contribution of each author: GP was responsible for the design and execution (recruitment, data collection, statistical analysis) of the study; VB and SE supervised the drafting of the manuscript and the development of the sections and translations, concerning the updates of the new model. All authors read and approved the final manuscript.

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