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Nuts & Bolts Plan for Today Exam Grades uploaded to Canvas in the next 48 hours Item #51 will be dropped Reminder: 4point extra credit opportunity (see syllabus for details) Lecture: Lahey, Barlow, and [opMonal] Ormel papers EmoMonal disorders: symptoms & burden Informed ciMzens and taxpayers Takehome criMcal thinking quesMons No class on Thursday (SAS meeMng in SF / ADAA meeMng in Miami)
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Page 1: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Nuts  &  Bolts  Plan  for  Today  Exam  –  Grades  uploaded  to  Canvas  in  the  next  48  hours  –  Item  #51  will  be  dropped  –  Reminder:  4-­‐point  extra  credit  opportunity  (see  syllabus  for  details)  

 Lecture:  Lahey,  Barlow,  and  [opMonal]  Ormel  papers  –  EmoMonal  disorders:  symptoms  &  burden  –  Informed  ciMzens  and  taxpayers  

Take-­‐home  criMcal  thinking  quesMons    No  class  on  Thursday  (SAS  meeMng  in  SF  /  ADAA  meeMng  in  Miami)    

Page 2: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

PSYC  210:    

How  does  T&P  contribute  to  emoMonal  disorders?  

 Part  1  of  3  

 Focus  on  N/NE  

   AJ  Shackman  7  April  2015  

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Take  Care  of  Yourself  &  One  Another  

Page 4: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Today’s  Conceptual  Roadmap  •  What  are  the  emoMonal  disorders?  Why  are  they  a  big  deal?  

•  Why  is  N/NE  a  risk  factor  for  mulMple  diagnoses?    – What  does  this  mean  for  our  understanding  of  the  emo6onal  disorders?    

–  For  the  DSM  (the  ‘Bible’  of  psychiatric  diagnoses)?  

•  What  is  the  ‘common  denominator’  shared  by  N/NE  and  the  emoMonal  disorders?  –  Shared  biology?  – Other  kinds  of  core  features  

Page 5: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Today’s  Conceptual  Roadmap  •  What  are  the  emoMonal  disorders?  Why  are  they  a  big  deal?  

•  Why  is  N/NE  a  risk  factor  for  mulMple  diagnoses?    – What  does  this  mean  for  our  understanding  of  the  emo6onal  disorders?    

–  For  the  DSM  (the  ‘Bible’  of  psychiatric  diagnoses)?  

•  What  is  the  ‘common  denominator’  shared  by  N/NE  and  the  emoMonal  disorders?  –  Shared  biology?  – Other  kinds  of  core  features  

Page 6: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Today’s  Conceptual  Roadmap  •  What  are  the  emoMonal  disorders?  Why  are  they  a  big  deal?  

•  Why  is  N/NE  a  risk  factor  for  mulMple  diagnoses?    – What  does  this  mean  for  our  understanding  of  the  emo6onal  disorders?    

–  For  the  DSM  (the  ‘Bible’  of  psychiatric  diagnoses)?  

•  What  is  the  ‘common  denominator’  shared  by  N/NE  and  the  emoMonal  disorders?  –  Shared  biology?  – Other  kinds  of  core  features  

Page 7: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Today’s  Conceptual  Roadmap  •  What  are  the  emoMonal  disorders?  Why  are  they  a  big  deal?  

•  Why  is  N/NE  a  risk  factor  for  mulMple  diagnoses?    – What  does  this  mean  for  our  understanding  of  the  emo6onal  disorders?    

–  For  the  DSM  (the  ‘Bible’  of  psychiatric  diagnoses)?  

•  What  is  the  ‘common  denominator’  shared  by  N/NE  and  the  emoMonal  disorders?  –  Shared  biology?  – Other  kinds  of  core  features  

Page 8: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Today’s  Conceptual  Roadmap  •  What  are  the  emoMonal  disorders?  Why  are  they  a  big  deal?  

•  Why  is  N/NE  a  risk  factor  for  mulMple  diagnoses?    – What  does  this  mean  for  our  understanding  of  the  emo6onal  disorders?    

–  For  the  DSM  (the  ‘Bible’  of  psychiatric  diagnoses)?  

•  What  is  the  ‘common  denominator’  shared  by  N/NE  and  the  emoMonal  disorders?  –  Shared  biology?  – Other  kinds  of  core  features?  

Page 9: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

SecMon  1:  What  is  N/NE  and  how  is  it  related  to  emoMonal  disorders  

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Students:  What  are  key  features  of  N/NE?  

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NeuroMcism  /  NegaMve  EmoMonality  (N/NE)  

Caspi  et  al.  ARP  2005;  Barlow  et  al.  CPS  2013  

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N/NE:  Boiling  It  Down  

Caspi  et  al.  ARP  2005;  Barlow  et  al.  CPS  2013  

EmoMon  •  suscepAbility  to  negaAve  moods  

 Appraisal  

•  experience  the  world  as  distressing  or  threatening    MoMvaMon  

•  aversive  /  defensive;  tendency  to      work  hard  to  avoid  punishment  

 

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N/NE:  Boiling  It  Down  

Caspi  et  al.  ARP  2005;  Barlow  et  al.  CPS  2013  

EmoMon  •  suscepAbility  to  negaAve  moods  

 Appraisal  

•  experience  the  world  as  distressing  or  threatening    MoMvaMon  

•  aversive  /  defensive;  tendency  to      work  hard  to  avoid  punishment  

 

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N/NE:  Boiling  It  Down  

Caspi  et  al.  ARP  2005;  Barlow  et  al.  CPS  2013  

EmoMon  •  suscepAbility  to  negaAve  moods  

 Appraisal  

•  experience  the  world  as  distressing  or  threatening    MoMvaMon  

•  aversive  /  defensive;  tendency  to      work  hard  to  avoid  punishment  

 

Page 15: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

N/NE:  Boiling  It  Down  EmoMon  

•  suscepAbility  to  negaAve  moods    Appraisal  

•  experience  the  world  as  distressing  or  threatening    MoMvaMon  

•  aversive  /  defensive;  tendency  to      work  hard  to  avoid  punishment  

 Like  Caspi,  David  Barlow  emphasizes  the    similariMes  between  different  models  and  measures  of  NegaMve  EmoMonality  (NE)  

•  NeuroAcism    •  Behavioral  InhibiAon  System  (BIS)  •  (Childhood)  Behavioral  InhibiAon  (BI)  •  NegaAve  AffecAvity  (NA)  •  Trait  Anxiety  (STAI)  •  Harm  Avoidance  (HA)   Caspi  et  al.  ARP  2005;  Barlow  et  al.  CPS  2013  

Lumper!  

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Students:  What  is  the  significance?  

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                                                                                                                                                                         Lahey  Amer  Psychol  2009  

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For  comparison  purposes,  a  Cohen’s  d  of  1.04  is  equivalent  to    R  =  .46  (21%  shared  variance)    

                                                                                                                                                                         Lahey  Amer  Psychol  2009  

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For  comparison  purposes,  a  Cohen’s  d  of  1.04  is  equivalent  to    R  =  .46  (21%  shared  variance)    ~1  SD  difference  

                                                                                                                                                                         Lahey  Amer  Psychol  2009  

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 (I  do  not  expect  you  to  retain  the  specifics  

of  the  next  few  slides,  just  the  gist)  

SecMon  2:  Crash  course  in  emoMonal  disorders  

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EmoMonal  Dx  are  a  Big  Deal  

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Emo6onal  Dx  Are  a  Big  Deal    -­‐  tremendous  suffering    -­‐  tremendous  economic  burden    -­‐  aggravate  other  problems  and  disorders    

EmoMonal  Dx  are  a  Big  Deal  

Page 23: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Anxiety  Dx:  Signs    

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Anxiety  Dx:  Signs    

Students  –  What  are  the  key  features  of  the  anxiety  disorders?  

Page 25: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Anxiety  Dx:  Signs    

Page 26: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Anxiety  Dx:  Signs    

Family  of  Disorders  •  Generalized  Anxiety  (GAD))    General  •  Panic          About  aJacks  •  Post-­‐TraumaAc  Stress  (PTSD)    About  trauma  cues    •  Social  Anxiety  /  Social  Phobia    About  social  interacLons  •  Other  Specific  Phobias      e.g.,  dogs,  spiders  

 

Page 27: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Anxiety  Dx:  Signs    

Family  of  Disorders  •  Generalized  Anxiety  (GAD))    General  •  Panic          About  aJacks  •  Post-­‐TraumaAc  Stress  (PTSD)    About  trauma  cues    •  Social  Anxiety  /  Social  Phobia    About  social  interacLons  •  Other  Specific  Phobias      e.g.,  dogs,  spiders  

 

Page 28: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Anxiety  Dx:  Very  Common    

Page 29: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Anxiety  disorders  are  the  most    common  family  of  mental    Illnesses,  affecAng  40M  U.S.    adults  

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Anxiety  Dx:  Very  Common    

Page 30: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Anxiety  disorders  are  the  most    common  family  of  mental    Illnesses,  affecAng  40M  U.S.    adults  

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Anxiety  Dx:  Very  Common    

More  Lme  for  cumulaLve  damage  

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Anxiety  Dx:  Snares  Many  Teens    

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Page 32: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Anxiety  disorders  affect    1  in  4  teens    Teens  with  untreated  anxiety    disorders  are  at  higher  risk  for    performing  poorly  in  school,    missing  out  on  important  social  experiences  with  peers  and    others,  and  substance  abuse  

Anxiety  Dx:  Snares  Many  Teens    

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Page 33: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Anxiety  disorders  affect    1  in  4  teens    Teens  with  untreated  anxiety    disorders  are  at  higher  risk  for    performing  poorly  in  school,    missing  out  on  important  social  experiences  with  peers  and    others,  and  substance  abuse  

Anxiety  Dx:  Snares  Many  Teens    

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

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Anxiety  Dx:  Under-­‐Treated  

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Page 35: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Anxiety  Dx:  Under-­‐Treated  

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

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Anxiety  Dx:  Expensive  

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Page 37: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Cost  the  U.S.  >$42B/yr,    one-­‐third  of  the    country's  $148  billion    total  mental  health  bill        All  in  all,  ~10%  of  Medicaid  funding  pays  for  mental  health  care  and  ~20%  of  state/local  health  programs  pay  for  mental  health  care          

Anxiety  Dx:  Expensive  

hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Page 38: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Major  Depressive  Disorder  (MDD)  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

MDD:  Signs    

Students  –  What  are  the  key  features  of  depression?  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

MDD:  Signs    

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

MDD:  Diagn.  Criteria  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

MDD:  Common  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

MDD:  Common  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

MDD:  Common  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Burden:  MDD  is  the  leading  disorder  

DALY  =  disability-­‐adjusted  life-­‐year  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Burden:  MDD  is  the  leading  disorder  

DALY  =  disability-­‐adjusted  life-­‐year  

Page 47: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

I  want  to  belabor  this  point  for  a  moment…  

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World-­‐wide  stats  from  the  World  Health  OrganizaAon  (WHO)  

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World-­‐wide  stats  from  the  World  Health  OrganizaAon  (WHO)  

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World-­‐wide  stats  from  the  World  Health  OrganizaAon  (WHO)  

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1  Euro  =  $1.09  

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1  Euro  =  $1.09  

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1  Euro  =  $1.09  

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1  Euro  =  $1.09  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Mood  Disorders:  Under-­‐Treated  

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hSp://www.adaa.org/about-­‐adaa/press-­‐room/facts-­‐staAsAcs  &  hSp://www.nimh.nih.gov/StaAsAcs/index.shtml    

Mood  Disorders:  Under-­‐Treated  

Page 57: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Boeom  Line—    N/NE  confers    substan6al  risk  for  emo6onal  disorders  and  emo6onal  disorders  are  a  big  deal    Whadya  mean  ‘risk’?  

Page 58: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Boeom  Line—    N/NE  confers    substan6al  risk  for  emo6onal  disorders  and  emo6onal  disorders  are  a  big  deal    Whadya  mean  ‘risk’?  

Page 59: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

N/NE  is  …      •  The  strongest  predictor  of  categorical  emoAonal  disorder  diagnoses  

(Kotov  et  al.,  2010)  

•  The  strongest  predictor  of  conLnuous  symptoms  (self-­‐report  and  clinical  raAngs)  that  cut  across  disorders    

•  Especially  strongly  linked  to  general  distress/negaAve  affecAvity  (e.g.,  depressed  mood,  anxious  mood,  worry),  which  lies  at  the  core  of  the  emoAonal  disorders  

•  Remains  predicAve  of  anxiety  and  depression  symptoms  even  aler  eliminaAng  overlapping  content  (Uliaszek  et  al.,  2009)  •  I  feel  depressed  (DSM)  vs.  I  feel  blue  (N/NE)  

                                                               

                                                                                                             Lahey  Amer  Psychol  2009;  cf.  Kotov  et  al  Psych  Bull  2010;  Watson  &Naragon-­‐Gainey  CPS  2014    

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N/NE  is  …      •  The  strongest  predictor  of  categorical  emoAonal  disorder  diagnoses  

(Kotov  et  al.,  2010)  

•  The  strongest  predictor  of  conLnuous  symptoms  (self-­‐report  and  clinical  raAngs)  that  cut  across  disorders    

•  Especially  strongly  linked  to  general  distress/negaAve  affecAvity  (e.g.,  depressed  mood,  anxious  mood,  worry),  which  lies  at  the  core  of  the  emoAonal  disorders  

•  Remains  predicAve  of  anxiety  and  depression  symptoms  even  aler  eliminaAng  overlapping  content  (Uliaszek  et  al.,  2009)  •  I  feel  depressed  (DSM)  vs.  I  feel  blue  (N/NE)  

                                                               

                                                                                                             Lahey  Amer  Psychol  2009;  cf.  Kotov  et  al  Psych  Bull  2010;  Watson  &Naragon-­‐Gainey  CPS  2014    

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N/NE  is  …      •  The  strongest  predictor  of  categorical  emoAonal  disorder  diagnoses  

(Kotov  et  al.,  2010)  

•  The  strongest  predictor  of  conLnuous  symptoms  (self-­‐report  and  clinical  raAngs)  that  cut  across  disorders    

•  Especially  strongly  linked  to  general  distress/negaAve  affecAvity  (e.g.,  depressed  mood,  anxious  mood,  worry),  that  lies  at  the  core  of  the  emoAonal  disorders  

•  Remains  predicAve  of  anxiety  and  depression  symptoms  even  aler  eliminaAng  overlapping  content  (Uliaszek  et  al.,  2009)  •  I  feel  depressed  (DSM)  vs.  I  feel  blue  (N/NE)  

                                                               

                                                                                                             Lahey  Amer  Psychol  2009;  cf.  Kotov  et  al  Psych  Bull  2010;  Watson  &Naragon-­‐Gainey  CPS  2014    

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N/NE  is  …      •  The  strongest  predictor  of  categorical  emoAonal  disorder  diagnoses  

(Kotov  et  al.,  2010)  

•  The  strongest  predictor  of  conLnuous  symptoms  (self-­‐report  and  clinical  raAngs)  that  cut  across  disorders    

•  Especially  strongly  linked  to  general  distress/negaAve  affecAvity  (e.g.,  depressed  mood,  anxious  mood,  worry),  that  lies  at  the  core  of  the  emoAonal  disorders  

•  Remains  predicAve  of  anxiety  and  depression  symptoms  even  aler  eliminaAng  overlapping  content  (Uliaszek  et  al.,  2009)  •  I  feel  depressed  (DSM)  vs.  I  feel  blue  (N/NE)  

                                                               

                                                                                                             Lahey  Amer  Psychol  2009;  cf.  Kotov  et  al  Psych  Bull  2010;  Watson  &Naragon-­‐Gainey  CPS  2014    

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Why?  

???  Risk  

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???  

MDD  

MulMple  Disorders  

Why  does  N/NE  confer  risk  for  mulMple  disorders?  

Risk  

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SecMon  3.  Why  is  N/NE  a  ‘TransdiagnosMc  Risk  Factor’  ?  

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David  Barlow  (BU)  

Among  the  most  prominent  living  anxiety  researchers    Key  member  of  the  team  that  wrote  DSM-­‐IV  

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Barlow  Argues  that  N/NE  and  EmoMon  Disorders  Reflect  a  Common  

TransdiagnosMc  Cause  

For  convergent  evidence,  see  Ormel  et  al  CPR  2013  

ANX   DEP  N/NE  

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Barlow  Argues  that  N/NE  and  EmoMon  Disorders  Reflect  a  Common  

TransdiagnosMc  Cause  A  common  cause  gives  rise  to  features  that  are  shared  hallmarks  of  anxiety,  depression,  and  N/NE    

This  would  explain  why  N/NE    confers  liability  for  mulAple  emoAonal  disorders    They  are  not  categorically  different  enAAes  

ANX   DEP  N/NE  

For  convergent  evidence,  see  Ormel  et  al  CPR  2013  

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Barlow  Argues  that  N/NE  and  EmoMon  Disorders  Reflect  a  Common  

TransdiagnosMc  Cause  A  common  cause  gives  rise  to  features  that  are  shared  hallmarks  of  anxiety,  depression,  and  N/NE    

This  would  explain  why  N/NE    confers  liability  for  mulAple  emoAonal  disorders    Because  they  are  not  categorically  different  enAAes  

ANX   DEP  N/NE  

Internalizing  Spectrum  Of  Disorders  

(a.k.a.  EmoMonal  Dx’es)    

For  convergent  evidence,  see  Ormel  et  al  CPR  2013  

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Barlow  offers  6  lines  of  evidence  

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#1:  Disorders  are  not  categorically  disMnct  Factor  analyses  indicate  broad  spectra,  not  discrete  diagnoses  

•  Dump  in  the  symptoms  (‘diagnosMc  criteria’)  that  are  used  by  the  DSM  to  define  all  of  the  emoMonal  disorders  

•  Do  you  get  factors  corresponding  to  the  DSM  diagnoses?    •  E.g.,  MDD  vs.  GAD  vs.  PTSD  etc.  

•  No!    You  get  broad  spectra  of  ‘internalizing’  symptoms    

NO!   YES!  

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#1:  Disorders  are  not  categorically  disMnct  Factor  analyses  indicate  broad  spectra,  not  discrete  diagnoses  

•  Dump  in  the  symptoms  (‘diagnosMc  criteria’)  that  are  used  by  the  DSM  to  define  all  of  the  emoMonal  disorders  

•  Do  you  get  factors  corresponding  to  the  DSM  diagnoses?    •  E.g.,  MDD  vs.  GAD  vs.  PTSD  etc.  

•  No!    You  get  broad  spectra  of  ‘internalizing’  symptoms    

NO!   YES!  

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#1:  Disorders  are  not  categorically  disMnct  Factor  analyses  indicate  broad  spectra,  not  discrete  diagnoses  

•  Dump  in  the  symptoms  (‘diagnosMc  criteria’)  that  are  used  by  the  DSM  to  define  all  of  the  emoMonal  disorders  

•  Do  you  get  factors  corresponding  to  the  DSM  diagnoses?    •  E.g.,  MDD  vs.  GAD  vs.  PTSD  etc.  

•  No!    You  get  broad  spectra  of  ‘internalizing’  symptoms    

NO!   YES!  

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What  does  a  spectrum  look  like  to  a  psychiatric  sta6s6cian?  

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#1:  Disorders  are  not  categorically  disMnct  

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#1:  Disorders  are  not  categorically  disMnct  

0000  

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#1:  Disorders  are  not  categorically  disMnct  Third  and  last  example  

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#1:  Disorders  are  not  categorically  disMnct  Can  re-­‐represent  each  of  the  categorical    diagnoses  as    “scores”  on  two  correlated    dimensions  (Distress  and  Fear)    The  “scores”  do  a  beeer  job  predicMng    deleterious  future  outcomes  than  the  diagnoses    Boeom  Lines  #1.  DSM  diagnoses  are  not  real  natural  kinds,  they  are  clinically  convenient  short-­‐hand  descripMons  of  symptom  clusters    #2.  Evidence  suggests  that  the  symptoms  that    define  the  disorders  reflect  2  highly  correlated  factors  (‘latent’  dimensions),  which  helps  to    explain  why,  for  example,  MDD  and  GAD    Frequentlyco-­‐occur      

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#1:  Disorders  are  not  categorically  disMnct  Can  re-­‐represent  each  of  the  categorical    diagnoses  as    “scores”  on  two  correlated    dimensions  (Distress  and  Fear)    The  “scores”  do  a  beeer  job  predicMng    deleterious  future  outcomes  than  the  diagnoses    2  Boeom  Lines  #1.  DSM  diagnoses  are  not  real  natural  kinds,  they  are  clinically  convenient  short-­‐hand  descripMons  of  symptom  clusters    #2.  Evidence  suggests  that  the  symptoms  that    define  the  disorders  reflect  2  highly  correlated  factors  (Distress  &  Fear  =  Internalizing),  which    helps  to  explain  why,  for  example,  MDD  and  GAD    open  co-­‐occur  and  why  N/NE  predicts  both      

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#1:  Disorders  are  not  categorically  disMnct  Can  re-­‐represent  each  of  the  categorical    diagnoses  as    “scores”  on  two  correlated    dimensions  (Distress  and  Fear)    The  “scores”  do  a  beeer  job  predicMng    deleterious  future  outcomes  than  the  diagnoses    2  Boeom  Lines  #1.  DSM  diagnoses  are  not  real  natural  kinds,  they  are  clinically  convenient  short-­‐hand  descripMons  of  symptom  clusters  (sound  familiar?)    #2.  Evidence  suggests  that  the  symptoms  that    define  the  disorders  reflect  2  highly  correlated  factors  (Distress  &  Fear  =  Internalizing),  which    helps  to  explain  why,  for  example,  MDD  and  GAD    open  co-­‐occur  and  why  N/NE  predicts  both      

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#1:  Disorders  are  not  categorically  disMnct  Can  re-­‐represent  each  of  the  categorical    diagnoses  as    “scores”  on  two  correlated    dimensions  (Distress  and  Fear)    The  “scores”  do  a  beeer  job  predicMng    deleterious  future  outcomes  than  the  diagnoses    2  Boeom  Lines  #1.  DSM  diagnoses  are  not  real  natural  kinds,  they  are  clinically  convenient  short-­‐hand  descripMons  of  symptom  clusters  (sound  familiar?)    #2.  Evidence  suggests  that  the  symptoms  that    define  the  disorders  reflect  2  highly  correlated  factors  (Distress  &  Fear  =  Internalizing),  which    helps  to  explain  why,  for  example,  MDD  and  GAD    open  co-­‐occur  and  why  N/NE  predicts  both      

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Not  just  the  symptoms  that    ‘hang  together’  

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#2:  EmoMonal  Dx’es  are  Highly  Comorbid  Consistent  with  the  factor  analysis  of  symptoms,    

•  Individuals  diagnosed  with  one  emoAonal  disorder  olen  meet  diagnosAc  criteria  for  one  or  more  other  emoAonal  disorders  

•  Tend  to  hang  together  in  nature  

•  Suggests  that  they  reflect  different  manifestaAons  of  one  or  a  limited  number  of  aberrant  mechanisms  

•  Which  helps  to  explain  why  N/NE  predicts  mulAple  emoAonal  disorders  

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#2:  EmoMonal  Dx’es  are  Highly  Comorbid  Consistent  with  the  factor  analysis  of  symptoms,    

•  Individuals  diagnosed  with  one  emoAonal  disorder  olen  meet  diagnosAc  criteria  for  one  or  more  other  emoAonal  disorders  

 e.g.,  Nearly  50%  of  those  Dx’ed  with  depression  are  also  diagnosed      with  an  anxiety  disorder    

•  Like  the  symptoms,  the  disorders  tend  to  hang  together  in  the  clinic  

•  Suggests  that  they  reflect  different  manifestaAons  of  one  or  a  limited  number  of  aberrant  mechanisms  

•  Common  mechanism(s)  helps  to  explain  why  N/NE  predicts  mulAple  emoAonal  disorders  

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#2:  EmoMonal  Dx’es  are  Highly  Comorbid  Consistent  with  the  factor  analysis  of  symptoms,    

•  Individuals  diagnosed  with  one  emoAonal  disorder  olen  meet  diagnosAc  criteria  for  one  or  more  other  emoAonal  disorders  

 e.g.,  Nearly  50%  of  those  Dx’ed  with  depression  are  also  diagnosed      with  an  anxiety  disorder    

•  Like  the  symptoms,  the  disorders  tend  to  hang  together  in  the  clinic  

•  Suggests  that  they  reflect  different  manifestaAons  of  one  or  a  limited  number  of  aberrant  mechanisms  

•  Common  mechanism(s)  helps  to  explain  why  N/NE  predicts  mulAple  emoAonal  disorders  

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#2:  EmoMonal  Dx’es  are  Highly  Comorbid  Consistent  with  the  factor  analysis  of  symptoms,    

•  Individuals  diagnosed  with  one  emoAonal  disorder  olen  meet  diagnosAc  criteria  for  one  or  more  other  emoAonal  disorders  

 e.g.,  Nearly  50%  of  those  Dx’ed  with  depression  are  also  diagnosed      with  an  anxiety  disorder    

•  Like  the  symptoms,  the  disorders  tend  to  hang  together  in  the  clinic  

•  Suggests  that  they  reflect  different  manifestaAons  of  one  or  a  limited  number  of  aberrant  mechanisms.  Common  mechanism(s)  helps  to  explain  why  N/NE  predicts  mulAple  emoAonal  disorders  

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#3.  Things  that  Alter  One  Disorder  Tend  to  Alter  the  Others    

(and  N/NE)  in  a  Similar  Way  

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#3:  Overlapping  Treatment  Effects  Treatments  targeMng  one  emoMonal  disorder  open  improve  other,  non-­‐targeted  symptoms  as  well  as  N/NE    

•  CogniAve-­‐behavioral  therapy  for  generalized  anxiety  disorder  can  produce  improvements  in  depressive  symptoms  

•  Pharmacological  treatments  for  MDD  reduce  N/NE  

•  Treatment  effects  and  T&P  hang  together,  suggesAng  that    •  The  disorders  reflect  a  limited  number  of  underlying  mechanisms  •  One  of  which  appears  to  be  N/NE  •  Helps  to  explain  why  N/NE  is  a  risk  factor  for  mulAple  emoAonal  disorders  

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#3:  Overlapping  Treatment  Effects  Treatments  targeMng  one  emoMonal  disorder  open  improve  other,  non-­‐targeted  symptoms  as  well  as  N/NE    

•  CogniAve-­‐behavioral  therapy  for  generalized  anxiety  disorder  can  produce  improvements  in  depressive  symptoms  

•  Pharmacological  treatments  for  MDD  reduce  N/NE  

•  Treatment  effects  and  T&P  hang  together,  suggesAng  that    •  The  disorders  reflect  a  limited  number  of  underlying  mechanisms  •  Which  we  can  conceptualize  as  N/NE  or  a  common  cause  •  Helps  to  explain  why  N/NE  is  a  risk  factor  for  mulAple  emoAonal  disorders  

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#3:  Overlapping  Treatment  Effects  Treatments  targeMng  one  emoMonal  disorder  open  improve  other,  non-­‐targeted  symptoms  as  well  as  N/NE    

•  CogniAve-­‐behavioral  therapy  for  generalized  anxiety  disorder  can  produce  improvements  in  depressive  symptoms  

•  Pharmacological  treatments  for  MDD  reduce  N/NE  

•  Treatment  effects  and  T&P  hang  together,  suggesAng  that    •  The  disorders  reflect  a  limited  number  of  underlying  mechanisms  •  Which  we  can  conceptualize  as  N/NE  or  a  common  cause  •  Helps  to  explain  why  N/NE  is  a  risk  factor  for  mulAple  emoAonal  disorders  

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#3:  Overlapping  Treatment  Effects  Treatments  targeMng  one  emoMonal  disorder  open  improve  other,  non-­‐targeted  symptoms  as  well  as  N/NE    

•  CogniAve-­‐behavioral  therapy  for  generalized  anxiety  disorder  can  produce  improvements  in  depressive  symptoms  

•  Pharmacological  treatments  for  MDD  reduce  N/NE  

•  Treatment  effects  and  T&P  hang  together,  suggesAng  that    •  The  disorders  reflect  a  limited  number  of  underlying  mechanisms  •  Which  we  can  conceptualize  as  N/NE  or  a  common  cause  •  Helps  to  explain  why  N/NE  is  a  risk  factor  for  mulAple  emoAonal  disorders  

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The  opposite  effect  is  also  true    

Bad  things  increase  depression,  anxiety,  and  N/NE  in  tandem  

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#4:  Shared  Environmental  ‘Pathogens’  Mirroring  the  treatment  evidence,  negaMve  events  that  increase  the  risk  for  developing  one  emoMonal  disorder  tend  to  increase  the  risk  of  developing  the  others    

•  E.g.,  stress,  early  adversity,  conflict,  unemployment,  abuse/maltreatment  

•  All  increase  the  risk  of  developing  a  diagnosable  emoAonal  disorder  

 There  is  some  evidence  that  they  can  also  elevate  N/NE    This  is  consistent  with  a  shared/common  biological  vulnerability  and  can  explain  why  N/NE  predicts  mulMple  emoMonal  disorders  

 

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#4:  Shared  Environmental  ‘Pathogens’  Mirroring  the  treatment  evidence,  negaMve  events  that  increase  the  risk  for  developing  one  emoMonal  disorder  tend  to  increase  the  risk  of  developing  the  others    

•  E.g.,  stress,  early  adversity,  conflict,  unemployment,  abuse/maltreatment  

•  All  increase  the  risk  of  developing  a  diagnosable  emoAonal  disorder  

 There  is  evidence  that  they  also  elevate  N/NE    This  is  consistent  with  a  shared/common  biological  vulnerability  and  can  explain  why  N/NE  predicts  mulMple  emoMonal  disorders  

 

Page 95: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

#4:  Shared  Environmental  ‘Pathogens’  Mirroring  the  treatment  evidence,  negaMve  events  that  increase  the  risk  for  developing  one  emoMonal  disorder  tend  to  increase  the  risk  of  developing  the  others    

•  E.g.,  stress,  early  adversity,  conflict,  unemployment,  abuse/maltreatment  

•  All  increase  the  risk  of  developing  a  diagnosable  emoAonal  disorder  

 There  is  evidence  that  they  also  elevate  N/NE    This  is  consistent  with  a  shared/common  biological  vulnerability  and  can  explain  why  N/NE  predicts  mulMple  emoMonal  disorders  

 

Page 96: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

#4:  Shared  Environmental  ‘Pathogens’  Mirroring  the  treatment  evidence,  negaMve  events  that  increase  the  risk  for  developing  one  emoMonal  disorder  tend  to  increase  the  risk  of  developing  the  others    

•  E.g.,  stress,  early  adversity,  conflict,  unemployment,  abuse/maltreatment  

•  All  increase  the  risk  of  developing  a  diagnosable  emoAonal  disorder  

 There  is  evidence  that  they  also  elevate  N/NE    This  is  consistent  with  a  shared/common  biological  vulnerability  and  can  explain  why  N/NE  predicts  mulMple  emoMonal  disorders  

 

Page 97: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Bateson  Can  J  Psychiatry  2011    

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Bateson  Can  J  Psychiatry  2011    

Page 99: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

#4:  Shared  Environmental  ‘Pathogens’  Mirroring  the  treatment  evidence,  negaMve  events  that  increase  the  risk  for  developing  one  emoMonal  disorder  tend  to  increase  the  risk  of  developing  the  others    

•  E.g.,  stress,  early  adversity,  conflict,  unemployment,  abuse/maltreatment  

•  All  increase  the  risk  of  developing  a  diagnosable  emoAonal  disorder  

 There  is  evidence  that  they  also  elevate  N/NE    This  is  consistent  with  a  shared/common  biological  vulnerability  and  can  explain  why  N/NE  predicts  mulMple  emoMonal  disorders  

 

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#5:  Shared  Genes  (Heritability)  The  emoMonal  disorders  are  somewhat  heritable    N/NE  is  somewhat  heritable    The  variaMon  in  emoMonal  disorders  that  is  heritable  is  shared  across  mulMple  disorders  AND  N/NE    Familial  aggregaMon  and  segregaMon  

•  Families  (pedigrees)  tend  to  have  higher  or  lower  levels  of  emoAonal  disorders  AND  N/NE  

•  Individuals  within  families  with  higher  levels  of  one  tend  to  have  higher  levels  of  the  others  

•  Common  inheritance  •  Shared  geneAc  underpinnings    

Common  geneMc  substrate  would  help  to  explain  why  N/NE  is  a  risk  factor  for  mulMple  emoMonal  disorders  

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#5:  Shared  Genes  (Heritability)  The  emoMonal  disorders  are  somewhat  heritable    N/NE  is  somewhat  heritable    The  variaMon  in  emoMonal  disorders  that  is  heritable  is  shared  among  mulMple  disorders  AND  N/NE    Familial  aggregaMon  and  segregaMon  

•  Families  (pedigrees)  tend  to  have  higher  or  lower  levels  of  emoAonal  disorders  AND  N/NE  

•  Individuals  within  families  with  higher  levels  of  one  (e.g.,  anxiety)  tend  to  have  higher  levels  of  the  others  (depression,  N/NE)  

•  Common  inheritance  •  Shared  geneAc  underpinnings    

Common  geneMc  substrate,  one  shared  by  mulMple  DX’es  and  N/NE,    would  help  to  explain  why  N/NE  is  a  risk  factor  for  mulMple  emoMonal  disorders  

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#5:  Shared  Genes  (Heritability)  The  emoMonal  disorders  are  somewhat  heritable    N/NE  is  somewhat  heritable    The  variaMon  in  emoMonal  disorders  that  is  heritable  is  shared  among  mulMple  disorders  AND  N/NE  (jargon  term:  geneMcally  correlated)    Familial  aggregaMon  and  segregaMon  

•  Families  (pedigrees)  tend  to  have  higher  or  lower  levels  of  emoAonal  disorders  AND  N/NE  

•  Individuals  within  families  with  higher  levels  of  one  (e.g.,  anxiety)  tend  to  have  higher  levels  of  the  others  (depression,  N/NE)  

•  Common  inheritance  •  Shared  geneAc  underpinnings    

Common  geneMc  substrate,  one  shared  by  mulMple  DX’es  and  N/NE,    would  help  to  explain  why  N/NE  is  a  risk  factor  for  mulMple  emoMonal  disorders  

Page 103: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

#5:  Shared  Genes  (Heritability)  The  emoMonal  disorders  are  somewhat  heritable    N/NE  is  somewhat  heritable    The  variaMon  in  emoMonal  disorders  that  is  heritable  is  shared  among  mulMple  disorders  AND  N/NE  (jargon  term:  geneMcally  correlated)    Familial  aggregaMon  and  segregaMon  

•  Families  (pedigrees)  tend  to  have  higher  or  lower  levels  of  emoAonal  disorders  AND  N/NE  

•  Individuals  within  families  with  higher  levels  of  one  (e.g.,  anxiety)  tend  to  have  higher  levels  of  the  others  (depression,  N/NE)  

•  Common  inheritance  •  Shared  geneAc  underpinnings    

Common  geneMc  substrate,  one  shared  by  mulMple  DX’es  and  N/NE,    would  help  to  explain  why  N/NE  is  a  risk  factor  for  mulMple  emoMonal  disorders  

Page 104: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

#5:  Shared  Genes  (Heritability)  The  emoMonal  disorders  are  somewhat  heritable    N/NE  is  somewhat  heritable    The  variaMon  in  emoMonal  disorders  that  is  heritable  is  shared  among  mulMple  disorders  AND  N/NE  (jargon  term:  geneMcally  correlated)    Familial  aggregaMon  and  segregaMon  

•  Families  (pedigrees)  tend  to  have  higher  or  lower  levels  of  emoAonal  disorders  AND  N/NE  

•  Individuals  within  families  with  higher  levels  of  one  (e.g.,  anxiety)  tend  to  have  higher  levels  of  the  others  (depression,  N/NE)  

•  Common  inheritance  •  Shared  geneAc  underpinnings    

Common  geneMc  substrate,  one  shared  by  mulMple  DX’es  and  N/NE,    would  help  to  explain  why  N/NE  is  a  risk  factor  for  mulMple  emoMonal  disorders  

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#6:  Common  Neural  Circuit  Across  DX’es  The  emoMonal  disorders  (and  N/NE)  are  consistently  associated  with  heightened  acMvaMon  in  a  core  brain  circuit  centered  on  the  amygdala  and  anterior  insula        Shared  biological  substrates  can  explain  why  N/NE  is  a  risk  factor  for  mulMple    emoMonal  disorders                        

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#6:  Common  Neural  Circuit  Across  DX’es  The  emoMonal  disorders  (and  N/NE)  are  consistently  associated  with  heightened  acMvaMon  in  a  core  brain  circuit  centered  on  the  amygdala  and  anterior  insula        Shared  biological  substrates  can  explain  why  N/NE  is  a  risk  factor  for  mulMple    emoMonal  disorders                        

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#6:  Common  Neural  Circuit  Across  DX’es  The  emoMonal  disorders  (and  N/NE)  are  consistently  associated  with  heightened  acMvaMon  in  a  core  brain  circuit  centered  on  the  amygdala  and  anterior  insula        Shared  biological  substrates  can  explain  why  N/NE  is  a  risk  factor  for  mulMple    emoMonal  disorders                        

Across  Anxiety  Disorders  

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#6:  Common  Neural  Circuit  Across  DX’es  The  emoMonal  disorders  (and  N/NE)  are  consistently  associated  with  heightened  acMvaMon  in  a  core  brain  circuit  centered  on  the  amygdala  and  anterior  insula        Shared  biological  substrates  can  explain  why  N/NE  is  a  risk  factor  for  mulMple    emoMonal  disorders                        

Depression,  too!  

Page 109: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

#6:  Common  Neural  Circuit  Across  DX’es  The  emoMonal  disorders  (and  N/NE)  are  consistently  associated  with  heightened  acMvaMon  in  a  core  brain  circuit  centered  on  the  amygdala  and  anterior  insula        Shared  biological  substrates  can  explain  why  N/NE  is  a  risk  factor  for  mulMple    emoMonal  disorders                        

Depression,  too  

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Interim  Summary  1.   N/NE  predicts  the  emoMonal  disorders    

 (non-­‐specific  risk)  2.   Symptoms  hang  together  (internalizing  spectrum)  3.   Disorders  hang  together  (co-­‐morbidity)  

 1-­‐3  suggest  that  the  disorders  and  N/NE  reflect  a  common  cause(s)    4.   Treatments  cause  parallel,  non-­‐specific  decreases  5.   Environmental  pathogens  like  stress  cause  parallel,  non-­‐specific  

increases    4-­‐5  provide  more  mechanis6c  evidence  that  T&P  (N/NE)  and    psychopathology  (emo6onal  disorders)  reflect  a  common  substrate  

 6.   Shared  heritability,  suggesMng  shared  genes  7.   Shared  brain  circuitry  

 6-­‐7  begin  to  address  the  make-­‐up  of  the  common  cause  

Page 111: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Interim  Summary  1.   N/NE  predicts  the  emoMonal  disorders    

 (non-­‐specific  risk)  2.   Symptoms  hang  together  (internalizing  spectrum)  3.   Disorders  hang  together  (co-­‐morbidity)  

 1-­‐3  suggest  that  the  disorders  and  N/NE  reflect  a  common  cause(s)    4.   Treatments  cause  parallel,  non-­‐specific  decreases  5.   Environmental  pathogens  like  stress  cause  parallel,  non-­‐specific  

increases    4-­‐5  provide  more  mechanis6c  evidence  that  T&P  (N/NE)  and    psychopathology  (emo6onal  disorders)  reflect  a  common  substrate  

 6.   Shared  heritability,  suggesMng  shared  genes  7.   Shared  brain  circuitry  

 6-­‐7  begin  to  address  the  make-­‐up  of  the  common  cause  

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Interim  Summary  1.   N/NE  predicts  the  emoMonal  disorders    

 (non-­‐specific  risk)  2.   Symptoms  hang  together  (internalizing  spectrum)  3.   Disorders  hang  together  (co-­‐morbidity)  

 1-­‐3  suggest  that  the  disorders  and  N/NE  reflect  a  common  cause(s)    4.   Treatments  cause  parallel,  non-­‐specific  decreases  5.   Environmental  pathogens  like  stress  cause  parallel,  non-­‐specific  

increases    4-­‐5  provide  more  mechanis6c  evidence  that  T&P  (N/NE)  and    psychopathology  (emo6onal  disorders)  reflect  a  common  substrate  

 6.   Shared  heritability,  suggesMng  shared  genes  7.   Shared  brain  circuitry  

 6-­‐7  begin  to  address  the  make-­‐up  of  the  common  cause  

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Interim  Summary  1.   N/NE  predicts  the  emoMonal  disorders    

 (non-­‐specific  risk)  2.   Symptoms  hang  together  (internalizing  spectrum)  3.   Disorders  hang  together  (co-­‐morbidity)  

 1-­‐3  suggest  that  the  disorders  and  N/NE  reflect  a  common  cause(s)    4.   Treatments  cause  parallel,  non-­‐specific  decreases  5.   Environmental  pathogens  like  stress  cause  parallel,  non-­‐specific  

increases    4-­‐5  provide  more  mechanis6c  evidence  that  T&P  (N/NE)  and    psychopathology  (emo6onal  disorders)  reflect  a  common  substrate  

 6.   Shared  heritability,  suggesMng  shared  genes  7.   Shared  brain  circuitry  

 6-­‐7  begin  to  address  the  make-­‐up  of  the  common  cause  

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Interim  Summary  1.   N/NE  predicts  the  emoMonal  disorders    

 (non-­‐specific  risk)  2.   Symptoms  hang  together  (internalizing  spectrum)  3.   Disorders  hang  together  (co-­‐morbidity)  

 1-­‐3  suggest  that  the  disorders  and  N/NE  reflect  a  common  cause(s)    4.   Treatments  cause  parallel,  non-­‐specific  decreases  5.   Environmental  pathogens  like  stress  cause  parallel,  non-­‐specific  

increases    4-­‐5  provide  more  mechanis6c  evidence  that  T&P  (N/NE)  and    psychopathology  (emo6onal  disorders)  reflect  a  common  substrate  

 6.   Shared  heritability,  suggesMng  shared  genes  7.   Shared  brain  circuitry  

 6-­‐7  begin  to  address  the  make-­‐up  of  the  common  cause  

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Interim  Summary  1.   N/NE  predicts  the  emoMonal  disorders    

 (non-­‐specific  risk)  2.   Symptoms  hang  together  (internalizing  spectrum)  3.   Disorders  hang  together  (co-­‐morbidity)  

 1-­‐3  suggest  that  the  disorders  and  N/NE  reflect  a  common  cause(s)    4.   Treatments  cause  parallel,  non-­‐specific  decreases  5.   Environmental  pathogens  like  stress  cause  parallel,  non-­‐specific  

increases    4-­‐5  provide  more  mechanis6c  evidence  that  T&P  (N/NE)  and    psychopathology  (emo6onal  disorders)  reflect  a  common  substrate  

 6.   Shared  heritability,  suggesMng  shared  genes  7.   Shared  brain  circuitry  

 6-­‐7  begin  to  address  the  make-­‐up  of  the  common  cause  

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Interim  Summary  1.   N/NE  predicts  the  emoMonal  disorders    

 (non-­‐specific  risk)  2.   Symptoms  hang  together  (internalizing  spectrum)  3.   Disorders  hang  together  (co-­‐morbidity)  

 1-­‐3  suggest  that  the  disorders  and  N/NE  reflect  a  common  cause(s)    4.   Treatments  cause  parallel,  non-­‐specific  decreases  5.   Environmental  pathogens  like  stress  cause  parallel,  non-­‐specific  

increases    4-­‐5  provide  more  mechanis6c  evidence  that  T&P  (N/NE)  and    psychopathology  (emo6onal  disorders)  reflect  a  common  substrate  

 6.   Shared  heritability,  suggesMng  shared  genes  7.   Shared  brain  circuitry  

 6-­‐7  begin  to  address  the  biological  origins  of  the  common  cause  

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What  explains  who  develops    which  disorder    

(diagnos6c  specificity)?  

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The  development  of  a  parMcular  emoMonal  disorder  reflects…    

 1.  Non-­‐specific  common  cause:  Elevated  N/NE    2.  Disorder  specific,  learned  vulnerability    

 e.g.,  Why  a  specific  phobia  of  dogs?      

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The  development  of  a  parMcular  emoMonal  disorder  reflects…    

 1.  Non-­‐specific  common  cause:  Elevated  N/NE    2.  Disorder  specific,  learned  vulnerability    

 e.g.,  Why  a  specific  phobia  of  dogs?      

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The  development  of  a  parMcular  emoMonal  disorder  reflects…    

 1.  Non-­‐specific  common  cause:  Elevated  N/NE    2.  Disorder  specific,  learned  vulnerability    

 e.g.,  Why  a  specific  phobia  of  dogs?      

Page 121: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

The  development  of  a  parMcular  emoMonal  disorder  reflects…    

 1.  Non-­‐specific  common  cause:  Elevated  N/NE    2.  Disorder  specific,  learned  vulnerability    

 e.g.,  Why  a  specific  phobia  of  dogs?      

Temperamental  Risk   Specific  Learning  Experience  

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Is  N/NE  a  cause,  a  symptom,  or  simply  ‘the  same  as’  the  emo6onal  disorders?  

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N  is  a  Cause,  Not  a  Symptom  

CMD  =  Common  Mental  Disorder;  Ormel  et  al  CPR  2013  

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N  is  a  Cause,  Not  a  Symptom  

CMD  =  Common  Mental  Disorder;  Ormel  et  al  CPR  2013  

Yes  

Yes  

Yes  

Yes  

Yes  

N/NE  precedes  disorder  onset  

Page 125: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Common  Cause  Does  Not  Mean    ‘The  Same  As’  

Some  individuals  with  high  levels  of  N/NE  never  meet  diagnosAc  criteria  for  an  emoAonal  disorder    Not  altogether  clear  what  this  means  

 -­‐  e.g.,  able  to  cope  with  or  regulate  N/NE  to  maintain    sufficient    funcAon  (hence  do  not  meet  DSM  criteria)?  Perhaps  Dx  requires    N/NE  AND  poor  coping  skills  

   -­‐  e.g.,  disorder  requires  N/NE  +  another    

   -­‐  e.g.,  lower  intensity  of  N/NE  (threshold  effect)  

   -­‐  e.g.,  N/NE  reflects  a  vulnerability  (‘diathesis’);  by  chance,    some  never  experience  sufficient  stress  or  the  like  to  trigger  full-­‐  blown  disorder  

Page 126: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Common  Cause  Does  Not  Mean    ‘The  Same  As’  

Some  individuals  with  high  levels  of  N/NE  never  meet  diagnosAc  criteria  for  an  emoAonal  disorder    Not  altogether  clear  what  this  means  

 -­‐  e.g.,  able  to  cope  with  or  regulate  N/NE  to  maintain    sufficient    funcAon  (hence  do  not  meet  DSM  criteria)?  Perhaps  Dx  requires    N/NE  AND  poor  coping  skills  

   -­‐  e.g.,  disorder  requires  N/NE  +  another    

   -­‐  e.g.,  lower  intensity  of  N/NE  (threshold  effect)  

   -­‐  e.g.,  N/NE  reflects  a  vulnerability  (‘diathesis’);  by  chance,    some  never  experience  sufficient  stress  or  the  like  to  trigger  full-­‐  blown  disorder  

Page 127: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Common  Cause  Does  Not  Mean    ‘The  Same  As’  

Some  individuals  with  high  levels  of  N/NE  never  meet  diagnosAc  criteria  for  an  emoAonal  disorder    Not  altogether  clear  what  this  means  

 -­‐  e.g.,  able  to  cope  with  or  regulate  N/NE  to  maintain  sufficient    funcAon  (hence  do  not  meet  DSM  criteria)?  Perhaps  Dx  requires    N/NE  AND  poor  coping  skills  

   -­‐  e.g.,  disorder  requires  N/NE  +  another  cause,  such  as  stress  

   -­‐  e.g.,  lower  intensity  of  N/NE  (threshold  effect)  

   -­‐  e.g.,  N/NE  reflects  a  vulnerability  (‘diathesis’);  by  chance,    some  never  experience  sufficient  stress  or  the  like  to  trigger  full-­‐  blown  disorder  

Page 128: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Common  Cause  Does  Not  Mean    ‘The  Same  As’  

Some  individuals  with  high  levels  of  N/NE  never  meet  diagnosAc  criteria  for  an  emoAonal  disorder    Not  altogether  clear  what  this  means  

 -­‐  e.g.,  able  to  cope  with  or  regulate  N/NE  to  maintain  sufficient    funcAon  (hence  do  not  meet  DSM  criteria)?  Perhaps  Dx  requires    N/NE  AND  poor  coping  skills  

   -­‐  e.g.,  disorder  requires  N/NE  +  another  cause,  such  as  stress  

   -­‐  e.g.,  lower  intensity  of  N/NE  (threshold  effect)  

   -­‐  e.g.,  N/NE  reflects  a  vulnerability  (‘diathesis’);  by  chance,    some  never  experience  sufficient  stress  or  the  like  to  trigger  full-­‐  blown  disorder  

Page 129: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Common  Cause  Does  Not  Mean    ‘The  Same  As’  

Some  individuals  with  high  levels  of  N/NE  never  meet  diagnosAc  criteria  for  an  emoAonal  disorder    Not  altogether  clear  what  this  means  

 -­‐  e.g.,  able  to  cope  with  or  regulate  N/NE  to  maintain  sufficient    funcAon  (hence  do  not  meet  DSM  criteria)?  Perhaps  Dx  requires    N/NE  AND  poor  coping  skills  

   -­‐  e.g.,  disorder  requires  N/NE  +  another  cause,  such  as  stress  

   -­‐  e.g.,  lower  intensity  of  N/NE  (threshold  effect)  

   -­‐  e.g.,  N/NE  reflects  a  vulnerability  (‘diathesis’);  by  chance,    some  never  experience  sufficient  stress  or  the  like  to  trigger  full-­‐  blown  disorder  

Page 130: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Take  Home  Points  1.   There  are  substanMal  similariMes  and  co-­‐morbidity  between  the  anxiety  and  

depressive  disorders.  Spectra,  not  fundamentally  different  natural  kinds  

2.   ManipulaMons  that  decrease  (treatment)  or  increase  (negaMve  events)  one  Dx,  tend  to  have  similar  effects  on  the  others  as  well  as  N/NE  suggesMng  a  common  substrate    

3.   Elevated  levels  of  N/NE  are  a  common/shared  feature  of  the  emoMonal  disorders  (anxiety,  depression)  

4.   This  shared  phenotype  (symptoms  or  traits)  reflects  a  common  biological  substrate  (genes,  brain  circuits)  

5.   Specificity:  Why  do  some  individuals  develop  parMcular  disorders,  such  as  specific  phobia  of  dogs?    

 This  reflects  learning  and  experience  (exposure  to  aggressive  dog)      interacMng  with  the  core    vulnerability  (e.g.,  hyper-­‐reacMve  amygdala)  

 6.          All  in  all,  this  evidence  suggests  that  individual  differences  in  N/NE  and  

 EmoMonal  Disorders  are  not    fundamentally  different,  but  instead  reflect  a    common  cause  

Page 131: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Take  Home  Points  1.   There  are  substanMal  similariMes  and  co-­‐morbidity  between  the  anxiety  and  

depressive  disorders.  Spectra,  not  fundamentally  different  natural  kinds  

2.   ManipulaMons  that  decrease  (treatment)  or  increase  (negaMve  events)  one  Dx,  tend  to  have  similar  effects  on  the  others  as  well  as  N/NE  suggesMng  a  common  substrate    

3.   Elevated  levels  of  N/NE  are  a  common/shared  feature  of  the  emoMonal  disorders  (anxiety,  depression)  

4.   This  shared  phenotype  (symptoms  or  traits)  reflects  a  common  biological  substrate  (genes,  brain  circuits)  

5.   Specificity:  Why  do  some  individuals  develop  parMcular  disorders,  such  as  specific  phobia  of  dogs?    

 This  reflects  learning  and  experience  (exposure  to  aggressive  dog)      interacMng  with  the  core    vulnerability  (e.g.,  hyper-­‐reacMve  amygdala)  

 6.          All  in  all,  this  evidence  suggests  that  individual  differences  in  N/NE  and  

 EmoMonal  Disorders  are  not    fundamentally  different,  but  instead  reflect  a    common  cause  

Page 132: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Take  Home  Points  1.   There  are  substanMal  similariMes  and  co-­‐morbidity  between  the  anxiety  and  

depressive  disorders.  Spectra,  not  fundamentally  different  natural  kinds  

2.   ManipulaMons  that  decrease  (treatment)  or  increase  (negaMve  events)  one  Dx,  tend  to  have  similar  effects  on  the  others  as  well  as  N/NE  suggesMng  a  common  substrate    

3.   Elevated  levels  of  N/NE  are  a  common/shared  feature  of  the  emoMonal  disorders  (anxiety,  depression)  

4.   This  shared  phenotype  (symptoms  or  traits)  reflects  a  common  biological  substrate  (genes,  brain  circuits)  

5.   Specificity:  Why  do  some  individuals  develop  parMcular  disorders,  such  as  specific  phobia  of  dogs?    

 This  reflects  learning  and  experience  (exposure  to  aggressive  dog)      interacMng  with  the  core    vulnerability  (e.g.,  hyper-­‐reacMve  amygdala)  

 6.          All  in  all,  this  evidence  suggests  that  individual  differences  in  N/NE  and  

 EmoMonal  Disorders  are  not    fundamentally  different,  but  instead  reflect  a    common  cause  

Page 133: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Take  Home  Points  1.   There  are  substanMal  similariMes  and  co-­‐morbidity  between  the  anxiety  and  

depressive  disorders.  Spectra,  not  fundamentally  different  natural  kinds  

2.   ManipulaMons  that  decrease  (treatment)  or  increase  (negaMve  events)  one  Dx,  tend  to  have  similar  effects  on  the  others  as  well  as  N/NE  suggesMng  a  common  substrate    

3.   Elevated  levels  of  N/NE  are  a  common/shared  feature  of  the  emoMonal  disorders  (anxiety,  depression).  EmoMonal  disorders  are  a  Really  Big  Deal  

4.   This  shared  phenotype  (symptoms  or  traits)  reflects  a  common  biological  substrate  (genes,  brain  circuits)  

5.   Specificity:  Why  do  some  individuals  develop  parMcular  disorders,  such  as  specific  phobia  of  dogs?    

 This  reflects  learning  and  experience  (exposure  to  aggressive  dog)      interacMng  with  the  core    vulnerability  (e.g.,  hyper-­‐reacMve  amygdala)  

 6.          All  in  all,  this  evidence  suggests  that  individual  differences  in  N/NE  and  

 EmoMonal  Disorders  are  not    fundamentally  different,  but  instead  reflect  a    common  cause  

Page 134: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Take  Home  Points  1.   There  are  substanMal  similariMes  and  co-­‐morbidity  between  the  anxiety  and  

depressive  disorders.  Spectra,  not  fundamentally  different  natural  kinds  

2.   ManipulaMons  that  decrease  (treatment)  or  increase  (negaMve  events)  one  Dx,  tend  to  have  similar  effects  on  the  others  as  well  as  N/NE  suggesMng  a  common  substrate    

3.   Elevated  levels  of  N/NE  are  a  common/shared  feature  of  the  emoMonal  disorders  (anxiety,  depression).  EmoMonal  disorders  are  a  Really  Big  Deal  

4.   This  shared  phenotype  (symptoms  or  traits)  reflects  a  common  biological  substrate  (genes,  brain  circuits)  

5.   Specificity:  Why  do  some  individuals  develop  parMcular  disorders,  such  as  specific  phobia  of  dogs?    

 This  reflects  learning  and  experience  (exposure  to  aggressive  dog)      interacMng  with  the  core    vulnerability  (e.g.,  hyper-­‐reacMve  amygdala)  

 6.          All  in  all,  this  evidence  suggests  that  individual  differences  in  N/NE  and  

 EmoMonal  Disorders  are  not    fundamentally  different,  but  instead  reflect  a    common  cause  

Page 135: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Take  Home  Points  1.   There  are  substanMal  similariMes  and  co-­‐morbidity  between  the  anxiety  and  

depressive  disorders.  Spectra,  not  fundamentally  different  natural  kinds  

2.   ManipulaMons  that  decrease  (treatment)  or  increase  (negaMve  events)  one  Dx,  tend  to  have  similar  effects  on  the  others  as  well  as  N/NE  suggesMng  a  common  substrate    

3.   Elevated  levels  of  N/NE  are  a  common/shared  feature  of  the  emoMonal  disorders  (anxiety,  depression).  EmoMonal  disorders  are  a  Really  Big  Deal  

4.   This  shared  phenotype  (symptoms  or  traits)  reflects  a  common  biological  substrate  (genes,  brain  circuits)  

5.   Specificity:  Why  do  some  individuals  develop  parMcular  disorders,  such  as  specific  phobia  of  dogs?    

 This  reflects  learning  and  experience  (exposure  to  aggressive  dog)      interacMng  with  the  core  vulnerability  (e.g.,  hyper-­‐reacMve  amygdala)  

 6.          All  in  all,  this  evidence  suggests  that  individual  differences  in  N/NE  and  

 EmoMonal  Disorders  are  not    fundamentally  different,  but  instead  reflect  a    common  cause  

Page 136: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Take  Home  Points  1.   There  are  substanMal  similariMes  and  co-­‐morbidity  between  the  anxiety  and  

depressive  disorders.  Spectra,  not  fundamentally  different  natural  kinds  

2.   ManipulaMons  that  decrease  (treatment)  or  increase  (negaMve  events)  one  Dx,  tend  to  have  similar  effects  on  the  others  as  well  as  N/NE  suggesMng  a  common  substrate    

3.   Elevated  levels  of  N/NE  are  a  common/shared  feature  of  the  emoMonal  disorders  (anxiety,  depression).  EmoMonal  disorders  are  a  Really  Big  Deal  

4.   This  shared  phenotype  (symptoms  or  traits)  reflects  a  common  biological  substrate  (genes,  brain  circuits)  

5.   Specificity:  Why  do  some  individuals  develop  parMcular  disorders,  such  as  specific  phobia  of  dogs?    

 This  reflects  learning  and  experience  (exposure  to  aggressive  dog)      interacMng  with  the  core  vulnerability  (e.g.,  hyper-­‐reacMve  amygdala)  

 6.          All  in  all,  this  evidence  suggests  that  N/NE  and  EmoMonal  Disorders  are  not    

 fundamentally  different,  but  instead  reflect  a  common  cause  

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CriMcal  Thinking  QuesMons  (Pick  2)  

Page 138: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

CriMcal  Thinking  QuesMons  (Pick  2)  1.  Briefly  discuss  the  implicaAons  of  what  we  discussed  

today  for  a  loved  one  or  celebrity  (living  or  dead)  suffering  from  an  emoAonal  disorder  e.g.  Robin  Williams  

2.  Briefly  discuss  the  most  important  challenges  or  limitaAons  of  Barlow’s  account  and  how  future  research  could  address  them  (see  the  extra  slides  for  hints).  

3.  Choose  your  own  adventure:  We  talked  about  many  facets  of  mental  illness  and  personality  today.  Write  a  nano-­‐essay  on  whatever  facet  was  most  interesAng  to  you  (e.g.,  societal  impact  of  mental  illness,  implicaAons  for  public  healthcare,  etc.)  

Page 139: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

CriMcal  Thinking  QuesMons  (Pick  2)  1.  Briefly  discuss  the  implicaAons  of  what  we  discussed  

today  for  a  loved  one  or  celebrity  (living  or  dead)  suffering  from  an  emoAonal  disorder  e.g.  Robin  Williams  

2.  Briefly  discuss  the  most  important  challenges  or  limitaAons  of  Barlow’s  account  and  how  future  research  could  address  them  (see  the  extra  slides  for  hints).  

3.  Choose  your  own  adventure:  We  talked  about  many  facets  of  mental  illness  and  personality  today.  Write  a  nano-­‐essay  on  whatever  facet  was  most  interesAng  to  you  (e.g.,  societal  impact  of  mental  illness,  implicaAons  for  public  healthcare,  etc.)  

Page 140: Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

CriMcal  Thinking  QuesMons  (Pick  2)  1.  Briefly  discuss  the  implicaAons  of  what  we  discussed  

today  for  a  loved  one  or  celebrity  (living  or  dead)  suffering  from  an  emoAonal  disorder  e.g.  Robin  Williams  

2.  Briefly  discuss  the  most  important  challenges  or  limitaAons  of  Barlow’s  account  and  how  future  research  could  address  them.  

3.  Choose  your  own  adventure:  We  talked  about  many  facets  of  mental  illness  and  personality  today.  Write  a  nano-­‐essay  on  whatever  facet  was  most  interesAng  to  you  (e.g.,  societal  impact  of  mental  illness,  implicaAons  for  public  healthcare,  sAgma,  etc.)  

ConLnued  on  next  slide  

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CriMcal  Thinking  QuesMons  (Pick  2)  4.  There’s  growing  evidence  that  the  microfauna  in  our  intesAnes  influence  our  state  of  mind.  The  gut-­‐brain  axis  seems  to  be  bidirecAonal—the  brain  acts  on  gastrointesAnal  and  immune  funcAons  that  shape  the  gut’s  microbial  makeup,  and  gut  microbes  make  neurotransmiSers  and  metabolites  that  act  on  the  brain.      e.g.  ScienAsts  colonized  the  intesAnes  of  one  strain  of  mice  with  bacteria  taken  from  the  intesAnes  of  another  mouse  strain,  the  recipient  animals  would  take  on  aspects  of  the  donor’s  personality.  Naturally  Amid  mice  would  become  more  exploratory,  whereas  more  daring  mice  would  become  apprehensive  and  shy.      What  do  you  think?    Briefly  describe  the  potenAal  implicaAons  of  this  work  (e.g.  for  our  understanding  of  T&P,  for  psychopathology,  for  the  development  of  ‘neutriceuAcals’  (ProbioAcs  for  your  Brain,  etc.)  

Schmidt  Nature  2015;  Cryan  &  Dinan  Nature  Rev  Neuro  2012;  Collins  et  al  Nature  Rev  Microbio  2012  

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CriMcal  Thinking  QuesMons  (Pick  2)  4.  There’s  growing  evidence  that  the  microfauna  in  our  intesAnes  influence  our  state  of  mind.  The  gut-­‐brain  axis  seems  to  be  bidirecAonal—the  brain  acts  on  gastrointesAnal  and  immune  funcAons  that  shape  the  gut’s  microbial  makeup,  and  gut  microbes  make  neurotransmiSers  and  metabolites  that  act  on  the  brain.      e.g.  ScienAsts  colonized  the  intesAnes  of  one  strain  of  mice  with  bacteria  taken  from  the  intesAnes  of  another  mouse  strain,  the  recipient  animals  would  take  on  aspects  of  the  donor’s  personality.  Timid  mice  became  exploratory,  whereas  daring  mice  became  apprehensive  and  shy.      What  do  you  think?    Briefly  describe  the  potenAal  implicaAons  of  this  work  (e.g.  for  our  understanding  of  T&P,  for  psychopathology,  for  the  development  of  ‘neutriceuAcals’  (ProbioAcs  for  your  Brain,  etc.)  

Schmidt  Nature  2015;  Cryan  &  Dinan  Nature  Rev  Neuro  2012;  Collins  et  al  Nature  Rev  Microbio  2012  

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CriMcal  Thinking  QuesMons  (Pick  2)  4.  There’s  growing  evidence  that  the  microfauna  in  our  intesAnes  influence  our  state  of  mind.  The  gut-­‐brain  axis  seems  to  be  bidirecAonal—the  brain  acts  on  gastrointesAnal  and  immune  funcAons  that  shape  the  gut’s  microbial  makeup,  and  gut  microbes  make  neurotransmiSers  and  metabolites  that  act  on  the  brain.      e.g.  ScienAsts  colonized  the  intesAnes  of  one  strain  of  mice  with  bacteria  taken  from  the  intesAnes  of  another  mouse  strain,  the  recipient  animals  would  take  on  aspects  of  the  donor’s  personality.  Timid  mice  became  exploratory,  whereas  daring  mice  became  apprehensive  and  shy.      What  do  you  think?    Briefly  describe  the  potenAal  implicaAons  of  this  work  (e.g.  for  our  understanding  of  T&P,  for  psychopathology,  and  for  the  development  of  ‘neutriceuAcals’  (ProbioAcs  for  your  Brain,  etc.))  

Schmidt  Nature  2015;  Cryan  &  Dinan  Nature  Rev  Neuro  2012;  Collins  et  al  Nature  Rev  Microbio  2012  

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CriMcal  Thinking  QuesMons  (Pick  2)  5.  The  Anxiety  &  Depression  AssociaAon  of  America  (ADAA)  distributes  a  number  of  compelling  video  clips  and  other  kinds  of  informaAon  on  what  it’s  like  to  live  with  an  anxiety  disorder:    •  Stossel  Interview  Re  Anxiety  hSp://www.adaa.org/about-­‐adaa/press-­‐room/mulAmedia/stossel  

•  Glass  People  /  Anxiety  hSp://www.adaa.org/about-­‐adaa/press-­‐room/mulAmedia/glass-­‐people    •  Myths  &  MisconcepAons  hSp://www.adaa.org/understanding-­‐anxiety/myth-­‐concepAons  

What  do  you  think?    Watch  one  of  the  video  clips  or  read  the  M&M  webpage  and  then  briefly  comment  on  what  you  found  most  interesAng,  informaAve,  or  counter-­‐intuiAve.  Briefly  comment  on  how  you  might  make  use  of  this  informaAon  or  other  facts  about  mental  illness  that  we  covered  in  class  in  your  own  daily  life  (with  friends,  family  members,  or  co-­‐workers).    

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CriMcal  Thinking  QuesMons  (Pick  2)  5.  The  Anxiety  &  Depression  AssociaAon  of  America  (ADAA)  distributes  a  number  of  compelling  video  clips  and  other  kinds  of  informaAon  on  what  it’s  like  to  live  with  an  anxiety  disorder:    •  Stossel  Interview  Re  Anxiety  hSp://www.adaa.org/about-­‐adaa/press-­‐room/mulAmedia/stossel  

•  Glass  People  /  Anxiety  hSp://www.adaa.org/about-­‐adaa/press-­‐room/mulAmedia/glass-­‐people    •  Myths  &  MisconcepAons  hSp://www.adaa.org/understanding-­‐anxiety/myth-­‐concepAons  

What  do  you  think?    Watch  one  of  the  video  clips  or  read  the  M&M  webpage  and  then  briefly  comment  on  what  you  found  most  interesAng,  informaAve,  or  counter-­‐intuiAve.  Briefly  comment  on  how  you  might  make  use  of  this  informaAon  or  other  facts  about  mental  illness  that  we  covered  in  class  in  your  own  daily  life  (with  friends,  family  members,  or  co-­‐workers).    

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The  End  (No  Review  QuesMons)  

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Things  to  Consider  Tweaking  for  Spring  2014  

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N  =  NeuroAcism;  E  =  Extraversion;  D  =  DisinhibiAon;  C  =  ConscienAousness  Distress  =  GAD  +  MDD;  Fear  =  Panic  and  Phobias  

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Alex  –  these  next  few  slides  actually  make  the  point  that  MDD  and  SAD  are  really  really  similar,  which  belongs  in  

one  of  the  earlier  ppt’s    

the  ‘fun-­‐seeking’  data  are  kind  of  disturbing…suggest  that  MDD  is  more  about  PE  than  appeAAve  moAvaAon  

     

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Regarding  Weak  MDD-­‐E  RelaMons  

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Regarding  Weak  MDD-­‐E  RelaMons  Low  PE  is  supposed  to  be  the  facet  that  disMnguishes  depression  from  the  anxiety  disorders  

TriparMte  Model:  Clark  &  Watson  JAP  1991;  Watson  et  al  JAP  1995a,  b  

High  N/NE  

Low  E/PE  

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Regarding  Weak  MDD-­‐E/PE  RelaMons  Low  PE  is  supposed  to  be  the  facet  that  disMnguishes  depression  from  the  anxiety  disorders  

TriparMte  Model:  Clark  &  Watson  JAP  1991;  Watson  et  al  JAP  1995a,  b  

High  N/NE  

Low  PE  

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Regarding  Weak  MDD-­‐E  RelaMons  Weak  relaMons  may  reflect  the  use  of  a  broadband  measure  of  Extraversion,  rather  than  a  more  specific  measure  of  PosiMve  EmoMonality  

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Regarding  Weak  MDD-­‐E  RelaMons  Weak  relaMons  may  reflect  the  use  of  a  broadband  measure  of  Extraversion,  rather  than  a  more  specific  measure  of  PosiMve  EmoMonality  

Collected  mulMple  measures  of  each  facet  of  E/PE  

Results  revealed  that      1)  E/PE  =  4  Facets  =  Sociability,  PE,  ExhibiAonism/Dominance,  and  Fun-­‐Seeking    2)  Depression,  but  not  anxiety,  was  strongly  and  selecAvely  related  to  low  PE  

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Extra  Slides  

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1.   Need  to  understand  the  mechanisms  that  convey  risk  (N/NE  à  Dx)    *  What  exactly  is  that  arrow??    *  What  are  the  proximal  mechanisms  mediaAng  the  assoc.  between  T&P  and  Dx    *  Increased  reacAvity,  biased  aSenAon,  neg  appraisals,  stress  generaAon,        maladapAve  coping,  etc?  

 2.      Another  way  to  think  about  this  is,  We  need  to  dissect  N/NE  into  its  consMtuents  

 *  Mood/Feelings,  CogniAon,  Peripheral  Physiol,  Behavior,  Learning    *  May  be  helpful  to  adopt  an  endophenotype-­‐type  simplicaAon  strategy  

 3.      AdjudicaMng  between  causal  models  

 *  ManipulaAons  targeAng  N/NE  would  let  you  pick  vulnerability  vs.  common  cause    *  No  studies  have  tested  whether  Tx-­‐induced  reducAons  in  N/NE  are  separable      from  changes  in  Dx;  if  so,  evidence  favoring  vulnerability  

 4.   N/NE  is  a  transdiagnosMc  risk  factor.  We  also  need  to  understand  the  mechanisms  that  

determine  diagnosMc  divergence.    *  e.g.,  why  do  some  develop  SAD  vs.  MDD  vs.  PD?      *  Can  be  environmental  (severe  childhood  teasing  vs.  loss  of  loved  one)  or    biological  (sensiAvity  to  interocepAve  cues)  

     

Future  Challenges  

Barlow  CPS  2013/in  press;  Caspi  CPS  2013/in  press;  Ormel  et  al  CPR  2013;  Nolen-­‐Hoeksema  &  Watkins  PPS  2011  

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NeuroMcism  /  NegaMve  EmoMonality  (N/NE)  

Israel  et  al  JPSP  2014  

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Differences  in  N/NE  in  turn  reflect    

-­‐  A  disorder-­‐nonspecific  biological  vulnerability  (e.g.,  hyper-­‐reacAve  amygdala)  

-­‐  That  promotes  a  disorder  nonspecific  psychological  vulnerability  

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Shared,  trans-­‐diagnosMc  phenotype,  common  to  N/NE  and  the  Dxes  

Characterized  by      – More  frequent/intense  negaAve  emoAons  

–  Reduced  emoAonal  clarity  and  acceptance  of  emoAonal  experiences  

–  Tendency  to  experience  negaAve  emoAons  as  more  unpleasant  or  to  have  heightened  apprehension  about  the  prospect  of  feeling  distressed  or  anxious  in  the  future  (elevated  “anxiety  sensiAvity”;  anx  about  being  anxious)  

 

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Another  Hallmark  of  the  Core  Phenotype  

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Another  Hallmark  of  the  Core  Phenotype    Tendency  to  rely  on  strategies  aimed  at  reducing  negaMve  emoMons  that  paradoxically  serve  to  increase  and  maintain  negaMve  emoMons    

–  ASenAonal  avoidance    –  Other  Escape  /  Avoidance  Strategies  

 *  overt  situaAonal  avoidance  (social  anxiety  disorder/SAD,      specific  phobias,  PTSD,  depression,  agoraphobia,  PD)  

   *  worrisome  thoughts  /  ruminaAons  /  compulsions  that  serve  to    avoid  or  control  distress  (GAD,  OCD,  MDD)  

   *  Avoid  eye  contact,  stand  further  from  others,  safety  behaviors    (SAD,  PD)