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Antoine Bechara

Xavier Noel

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Grand challenge of psychopathology in the years to come

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Grand Challenge of psychopathology in the years to come

Bechara, Antoine

Noël, Xavier

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www.frontiersin.org April 2010 | Volume 1 | Article 11 | 1
OPINION ARTICLE
published: 22 April 2010
doi: 10.3389/fpsyg.2010.00011
Grand challenge of psychopathology in the years to come
Antoine Bechara1,2* and Xavier Noël3
1 Department of Psychology, University of Southern California, CA, USA
2 McGill University, Montreal, QC, Canada
3 Department of Psychiatry, Université Libre de Bruxelles, Bruxelles, Belgium
*Correspondence: bechara@usc.edu
It is an honor to begin our role as Co-Editors 
of ‘Frontiers in Psychopathology’, a new 
journal that aims for the promotion of 
multidisciplinary research that combines 
cognition and the mechanisms by which 
affect and emotion come to modify these 
cognitive states and vice versa, thus con-
tributing to a variety of conditions associ-
ated with psychological suffering. Although 
behavioral research has long supported the 
dual process models of a more refl ective, 
explicit, consciously deliberative system 
(System 2), and more impulsive, auto-
matic, and implicit system (System 1) 
(Kahneman, 2003), psychopathology and 
cognitive neuroscience have uncovered 
credence to this duality in many condi-
tions where abnormal functioning within 
the cognitive/brain processes underlying 
these dual systems, or their interactions, 
lead to a variety of psychopathological 
conditions. Especially important is the aim 
to understand the mechanisms underlying 
these implicit cognitive processes, which 
we defi ne as introspectively unidentifi ed 
(or inaccurately identifi ed) traces of past 
experience, which can modulate feeling, 
thought, or action” (Geenwald and Banaji, 
1995; De Houwer, 2006). In this realm, one 
can expect to make signifi cant progress in 
advancing these explanatory models, which 
explore the relationship between attentional 
bias, a process that has long been rooted in 
experimental psychopathology, and mem-
ory bias, a process that has been rooted as 
well in basic memory or in social cognition 
research. The relative contribution of these 
processes to the genesis of explicit represen-
tations (e.g., craving for drugs), and their 
manipulation through cognitive processes 
related to working memory, represents an 
exciting avenue for years to come. More 
generally, there remains much work to do in 
order to identify those cognitive and affec-
tive processes as well as their brain substrate 
involved in the development of maladapta-
tive actions (e.g., from drug use to addictive 
behavior).
In our opinion, little remains known 
about the phenomena of psychological suf-
fering and cognitive processes that under-
pin it. However, the effort undertaken to 
establish a better clinical approach to these 
problems takes an interesting direction. For 
instance, craving episodes typically begin 
with apparently spontaneous thoughts 
about wanting or needing an appetitive 
target. This often occurs in the form of 
an affectively charged image of a reward 
target and its consumption (e.g., alcohol) 
(May et al., 2004). Such a thought then 
begins to linger in working memory to the 
extent that in an individual, for instance, 
with an alcohol-disorder, a simple verbal 
mention of alcohol can lead to a cascade 
of neurocognitive events that ultimately 
end up in impulsive drinking (Kavanagh 
et al., 2009). This is but one example of the 
many reasons why we hope that multidis-
ciplinary research aimed at examining the 
interplay between cognition and emotion 
in clinical phenomena, which we would like 
to promote in this journal, will serve as a 
primary resource for years to come. Such 
an aim will certainly require contributions 
from work provided by researchers in sev-
eral different disciplines including cognitive 
science, social, clinical and developmental 
psychology, as well as neuropsychology and 
behavioral neuroscience.
One of us (Antoine Bechara) recalls per-
fectly well in the early 1990s when he came 
to Iowa to study the decision-making capa-
bilities of patients who have suffered injury 
to the ventromedial sector of their prefron-
tal cortex. At the time, the  decision-making 
defi cit seen in these patients presented a 
puzzling defect because their impair-
ment was so obvious in their real life, but 
there was no laboratory probe to detect 
and measure this impairment. The reason 
was that all neuropsychology tests at the 
time were purely cognitive in perspective, 
and these patients happened to be intact 
cognitively speaking. This challenge was 
overcome, and progress was made in 
understanding the neurocognitive nature 
of this decision-making impairment after 
the development of what became known 
as the Iowa Gambling Task (IGT) (Bechara 
et al., 1994, 2000). At the time, the IGT was 
so unusual because it was not only cogni-
tively complex, but it involved in a large 
part the use of reward and punishment 
during its performance. This was basi-
cally unheard of at the time, and skeptics 
were numerous in predicting its failure. 
However, it turned out that the develop-
ment of the IGT enabled researchers, for 
the fi rst time, to detect these patients’ elu-
sive decision-making impairment in the 
laboratory, measure it, and investigate its 
possible causes. This work has certainly 
drawn attention to the potential value in 
studying the neural basis of decision-mak-
ing, and in bringing this question to the 
laboratory through the use of structured 
decision-making tasks involving choices 
that mimic real-life situations, in the way 
they factor uncertainty, reward, and pun-
ishment. Not only that, this line of work 
has gone beyond the boundaries of study-
ing patients with neurological injury and 
proved to be valuable in understanding 
the underlying pathology of numerous 
psychopathological conditions, such as 
addiction, obsessive-compulsive disorders, 
impulse control disorders, bipolar disor-
ders, anxiety disorders, and even eating 
disorders, to just name a few (Best et al., 
2002; van Honk et al., 2002; Apkarian, 
et al., 2004; Bechara and Martin, 2004; 
Cavedini et al., 2004; Davis et al., 2004; 
Whitney et al., 2004; Jollant et al., 2005; 
Malloy-Diniz et al., 2007).
The IGT is only one example that 
illustrates the revolution from the 
strictly cognitive to the multidisciplinary 
 cognitive-affective approach to under-
standing the underlying brain mechanisms 
of many psychopathological conditions. 
Although numerous tasks that employ 
behavioral assessments of affective states 
have been developed and are currently in 
Frontiers in Psychology | Psychopathology  April 2010 | Volume 1 | Article 11 | 2
Bechara and Noël Grand challenge of psychopathology in the years to come
Davis, C., Levitan, R. D., Muglia, P., Bewell, C., and Kennedy, 
J. L. (2004). Decision-making defi cits and overeating: a 
risk model for obesity. Obes. Res. 12, 929–935.
De Houwer, J. (2006). “What are implicit measures and 
why are we using them?” in Handbook of Implicit 
Coghnition and addiction, eds R. W. Wiers, and A. W. 
Stacy (Thousand Oaks, CA: Sage) 11–28.
Geenwald, A., and Banaji, M. (1995). Implicit social cog-
nition: attitudes, self-esteem, and stereotypes. Psychol. 
Rev. 102, 4–27.
Jollant, F., Bellivier, F., Lobyer, M., Astruc, B., Torres, S., 
Verdier, R., Castelnau, D., Malafosse, A., and Courtet, 
P. (2005). Impaired decision-making in scuicide 
attempters. Am. J. Psychiatry 162, 304–310.
Kahneman, D. (2003). A perspective on judgment and 
choice. Am. Psychologist 58, 697–720.
Kavanagh, D. J., May, J., and Andrade, J. (2009). Tests of 
the elaborated intrusion theory of craving and desire: 
features of alcohol craving during treatment for an 
alcohol disorder. Br. J. Clin. Psychol. 48, 241–254.
Malloy-Diniz, L., Fuentes, D., Borges-Leite, W., Correa, 
H., and Bechara, A. (2007). Impulsive behavior in 
adults with attention defi cit/hyperactivity disorder: 
characterization of attentional, motor and cognitive 
impulsiveness. J. Int. Neuropsychol. Soc. 13, 693–698.
May, J., Andrade, J., Panabokke, N, and Kavanagh, D. 
(2004). Images of desire: cognitive models of crav-
ing. Memory 12, 447–461.
van Honk, J., Hermans, E. J., Putman, P., Montague, B., and 
Schutter, D. (2002). Defective somatic markers in sub-
clinical psychopathy. Neuroreport 13, 1025–1027.
Whitney, K. A., Fastnau, P. S., Evans, J. D., and Lysaker, P. 
H. (2004). Comparative neuropsychological function 
in obsessive-compulsive disorder and schizophrenia 
with and without obsessive-compulsive symptoms. 
Schizophr. Res. 69, 75–83.
Received: 26 March 2010; accepted: 31 March 2010; pub-
lished online: 22 April 2010.
Citation: Bechara A and Noël X (2010) Grand challenge 
of psychopathology in the years to come. Front. Psychology 
1:11. doi: 10.3389/fpsyg.2010.00011
This article was submitted to Frontiers in Psychopathology, 
a specialty of Frontiers in Psychology.
Copyright © 2010 Bechara and Noël. This is an open-access 
article subject to an exclusive license agreement between 
the authors and the Frontiers Research Foundation, which 
permits unrestricted use, distribution, and reproduction 
in any medium, provided the original authors and source 
are credited.
highly salient, there is much to expect from 
new interventions directly targeting both 
automatic and non-automatic processes 
related to this complex phenomenon.
In sum, the Grand Challenge for psycho-
pathology is to integrate biology, informa-
tion processing, subjective experience, and 
therapeutic interventions, and understand 
how they relate to certain clinical phe-
nomena, especially those in the realm of 
psychopathology. This journal will be a 
home to articles that advance knowledge 
and understanding of psychopathology, in 
terms of etiology and dynamics of change, 
for years to come. At this critical time, inte-
grative approaches are viewed as the most 
promising avenue to understanding psycho-
pathological states, and our ultimate aim is 
to have this journal as the key resource that 
promote such a research.
REFERENCES
Apkarian, A. V., Sosa, Y., Krauss, B. R., Thomas, P. S., 
Fredrickson, B. E., Levy, R. E., Harden, R. N., and 
Chialvo, D. R. (2004). Chronic pain patients are 
impaired on an emotional decision-making task. 
Pain 108, 129–136.
Bechara, A., Damasio, A. R., Damasio, H., and Anderson, 
S. W. (1994). Insensitivity to future consequences fol-
lowing damage to human prefrontal cortex. Cognition 
50, 7–15.
Bechara, A., and Martin, E. (2004). Impaired decision-
making related to working memory defi cits in sub-
stance addicts. Neuropsychology 18, 152–162.
Bechara, A., Tranel, D., and Damasio, H. (2000). 
Characterization of the decision-making impairment 
of patients with bilateral lesions of the ventromedial 
prefrontal cortex. Brain 123, 2189–2202.
Best, M., Williams, J. M., and Coccaro, E. F. (2002). 
Evidence for a dysfunctional prefrontal circuit in 
patients with an impulsive aggressive disorder. Proc. 
Natl. Acad. Sci. U.S.A. 99, 8448–8453.
Cavedini, P., Bassi, T., Ubbiali, A., Casolari, A., Giordani, S., 
Zorzi, C., and Bellodi, L. (2004). Neuropsychological 
investigation of decision-making in anorexia nervosa. 
Psychiatry Res. 127, 259–266.
use, the fi eld as a whole is still, relatively 
speaking, in its infancy. For instance, there 
is now a fl ourishing science in novel areas 
such as “neuroeconomics”, which relies 
on so many measures that tap into brain 
processes concerned with reward, punish-
ment, valuation, and the like, but relatively 
so little has been applied from these newly 
emerging fi elds to various areas of psy-
chopathology. This is such a signifi cant 
and novel area that we hope to capture in 
our journal. Indeed, we would certainly like 
to cover in our journal all new advances 
in the use of behavioral measurements of 
affect-cognition, including those used in 
the “neuroeconomics” fi eld, to understand 
the underlying brain dysfunction of specifi c 
psychopathological states. We see the past as 
primarily driven by conceptions rooted in 
cognitive theories. We see the future as a key 
period for signifi cant advances in knowl-
edge using multidisciplinary approaches 
that include measures of affect and emo-
tion. However, our vision is not restricted 
to this area alone, but our philosophy is to 
be multidisciplinary no matter what. This 
is much to expect from contributions con-
cerned with the interplay between cogni-
tive neuropsychology, clinical psychology, 
experimental psychology, social psychology 
and brain sciences, applied principally to 
human psychopathology.
In addition, we would like to emphasize 
the fact that our grand challenge is not in 
just understanding basic mechanisms of 
psychopathological states, but also in trans-
lating available knowledge to potential ther-
apies that minimize psychological suffering. 
For instance, following the hypothesis that 
the development of an addictive behavior 
parallels the increase in sensitized reaction 
to drug cues, which causes them to become 


Characterization of the decision-making impairment of patients with bilateral lesions of the ventromedial prefrontal cortex.

Chronic pain patients are impaired on an emotional decision-making task.

Evidence for a dysfunctional prefrontal circuit in patients with an impulsive aggressive disorder.

Impaired decisionmaking related to working memory deﬁ cits in substance addicts.

Insensitivity to future consequences following damage to human prefrontal cortex.

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Grand Challenge of Psychopathology in the Years to Come

Grand Challenge of Psychopathology in the Years to Come

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