Cite this asPerrotta G, Basiletti V, Eleuteri S (2023) The “Human Emotions” and the new “Perrotta Human Emotions Model” (PHEM-2): Structural and functional updates to the first model. Open J Trauma 7(1): 022-034. DOI: 10.17352/ojt.000043
Copyright© 2023 Perrotta G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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.
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.
To address the structural and functional deficiencies noted, the PHEM (in its first version) was structured according to the following assumptions:
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.
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.
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:
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.
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.
The present research work drew from the materials used in drafting the first edition of the Perrotta Human Emotions Model (PHEM)  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  and Zanichelli  were consulted, while Oxford  and Hoepli  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)  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) ; 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.
The requirements decided for the selection of the sample population (inclusion criteria) are:
The following exclusion criteria were also considered:
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).
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).
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.
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.
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.
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.
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.
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.
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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