Shackman Psyc210 Module13 TPandMentalDisordersFocusNE

PowerPoint Presentation

Nuts & Bolts Plan for TodayExamGrades uploaded to Canvas in the next 48 hoursItem #51 will be droppedReminder: 4-point extra credit opportunity (see syllabus for details)

Lecture: Lahey, Barlow, and [optional] Ormel papersEmotional disorders: symptoms & burdenInformed citizens and taxpayers

Take-home critical thinking questions

No class on Thursday (SAS meeting in SF / ADAA meeting in Miami) PSYC 210:

How does T&P contribute to emotional disorders?

Part 1 of 3

Focus on N/NE

AJ Shackman7 April 2015

Take Care of Yourself & One Another

Todays Conceptual RoadmapWhat are the emotional disorders? Why are they a big deal?

Why is N/NE a risk factor for multiple diagnoses? What does this mean for our understanding of the emotional disorders? For the DSM (the Bible of psychiatric diagnoses)?

What is the common denominator shared by N/NE and the emotional disorders?Shared biology?Other kinds of core features












What is the common denominator shared by N/NE and the emotional disorders?Shared biology?Other kinds of core features?

Section 1: What is N/NE and how is it related to emotional disordersStudents: What are key features of N/NE?Neuroticism / Negative Emotionality (N/NE)Caspi et al. ARP 2005; Barlow et al. CPS 2013

N/NE: Boiling It DownCaspi et al. ARP 2005; Barlow et al. CPS 2013Emotionsusceptibility to negative moods

Appraisalexperience the world as distressing or threatening

Motivationaversive / defensive; tendency to work hard to avoid punishment







N/NE: Boiling It DownEmotionsusceptibility to negative moods



Like Caspi, David Barlow emphasizes the similarities between different models andmeasures of Negative Emotionality (NE)Neuroticism Behavioral Inhibition System (BIS)(Childhood) Behavioral Inhibition (BI)Negative Affectivity (NA)Trait Anxiety (STAI)Harm Avoidance (HA)Caspi et al. ARP 2005; Barlow et al. CPS 2013Lumper!Students: What is the significance?

Lahey Amer Psychol 2009

For comparison purposes, a Cohens d of 1.04 is equivalent to

R = .46 (21% shared variance)


For comparison purposes, a Cohens d of 1.04 is equivalent to

R = .46 (21% shared variance)

~1 SD difference


(I do not expect you to retain the specifics of the next few slides, just the gist)Section 2: Crash course in emotional disorders

Emotional Dx are a Big DealEmotional Dx Are a Big Deal

- tremendous suffering

- tremendous economic burden

- aggravate other problems and disorders

Emotional Dx are a Big Dealhttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Signs http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Signs Students What are the key features of the anxiety disorders?http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Signs

http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Signs

Family of DisordersGeneralized Anxiety (GAD))GeneralPanicAbout attacksPost-Traumatic Stress (PTSD)About trauma cues Social Anxiety / Social PhobiaAbout social interactionsOther Specific Phobiase.g., dogs, spiders


Anxiety Dx: Signs

Family of DisordersGeneralized Anxiety (GAD))GeneralPanicAbout attacksPost-Traumatic Stress (PTSD)About trauma cues Social Anxiety / Social PhobiaAbout social interactionsOther Specific Phobiase.g., dogs, spiders


Anxiety Dx: Very Common Anxiety disorders are the most common family of mental Illnesses, affecting 40M U.S. adultshttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Very Common

Anxiety disorders are the most common family of mental Illnesses, affecting 40M U.S. adultshttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Very Common

More time for cumulative damageAnxiety Dx: Snares Many Teens http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

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 socialexperiences with peers and others, and substance abuseAnxiety Dx: Snares Many Teens http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

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 socialexperiences with peers and others, and substance abuseAnxiety Dx: Snares Many Teens http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Under-Treatedhttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Under-Treatedhttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Anxiety Dx: Expensivehttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

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: Expensivehttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Major Depressive Disorder (MDD)http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

MDD: Signs

Students What are the key features of depression?


MDD: Signs


MDD: Diagn. Criteria


MDD: Commonhttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

MDD: Common


MDD: Common


Burden: MDD is the leading disorderDALY = disability-adjusted life-yearhttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Burden: MDD is the leading disorder

DALY = disability-adjusted life-yearI want to belabor this pointfor a moment

World-wide stats from the World Health Organization (WHO)



1 Euro = $1.09

1 Euro = $1.09

1 Euro = $1.09

1 Euro = $1.09http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Mood Disorders: Under-Treatedhttp://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml

Mood Disorders: Under-Treated

Bottom Line

N/NE confers substantial risk for emotional disorders and emotional disorders are a big deal

Whadya mean risk?Bottom Line

N/NE confers substantial risk for emotional disorders and emotional disorders are a big deal

Whadya mean risk?N/NE is

The strongest predictor of categorical emotional disorder diagnoses (Kotov et al., 2010)

The strongest predictor of continuous symptoms (self-report and clinical ratings) that cut across disorders

Especially strongly linked to general distress/negative affectivity (e.g., depressed mood, anxious mood, worry), which lies at the core of the emotional disorders

Remains predictive of anxiety and depression symptoms even after eliminating 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 N/NE is



Especially strongly linked to general distress/negative affectivity (e.g., depressed mood, anxious mood, worry), which lies at the core of the emotional disorders





Especially strongly linked to general distress/negative affectivity (e.g., depressed mood, anxious mood, worry), that lies at the core of the emotional disorders





Especially strongly linked to general distress/negative affectivity (e.g., depressed mood, anxious mood, worry), that lies at the core of the emotional disorders


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

Why????Risk

???

MDDMultiple DisordersWhy does N/NE confer risk for multiple disorders?RiskA more specific question we could ask is: Why does N/NE confer risk for multiple diagnoses? 64Section 3. Why is N/NE a Transdiagnostic Risk Factor ?

David Barlow (BU)Among the most prominent living anxiety researchers

Key member of the team that wrote DSM-IVBarlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic Cause

For convergent evidence, see Ormel et al CPR 2013ANXDEPN/NEBarlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic CauseA 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 multipleemotional disorders

They are not categoricallydifferent entities

ANXDEPN/NEFor convergent evidence, see Ormel et al CPR 2013Barlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic CauseA 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 multipleemotional disorders

Because they are not categoricallydifferent entities

ANXDEPN/NEInternalizing SpectrumOf Disorders(a.k.a. Emotional Dxes) For convergent evidence, see Ormel et al CPR 2013Barlow offers 6 lines of evidence#1: Disorders are not categorically distinctFactor analyses indicate broad spectra, not discrete diagnosesDump in the symptoms (diagnostic criteria) that are used by the DSM to define all of the emotional 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!#1: Disorders are not categorically distinctFactor analyses indicate broad spectra, not discrete diagnosesDump in the symptoms (diagnostic criteria) that are used by the DSM to define all of the emotional disorders



NO!YES!#1: Disorders are not categorically distinctFactor analyses indicate broad spectra, not discrete diagnosesDump in the symptoms (diagnostic criteria) that are used by the DSM to define all of the emotional disorders



NO!YES!What does a spectrum look like to a psychiatric statistician?#1: Disorders are not categorically distinct

#1: Disorders are not categorically distinct

0000#1: Disorders are not categorically distinct

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

Can re-represent each of the categorical diagnoses as scores on two correlated dimensions (Distress and Fear)

The scores do a better job predicting deleterious future outcomes than the diagnoses

Bottom Lines#1. DSM diagnoses are not real natural kinds, theyare clinically convenient short-hand descriptionsof symptom clusters

#2. Evidence suggests that the symptoms that define the disorders reflect 2 highly correlatedfactors (latent dimensions), which helps to explain why, for example, MDD and GAD Frequentlyco-occur




2 Bottom Lines#1. DSM diagnoses are not real natural kinds, theyare clinically convenient short-hand descriptionsof symptom clusters

#2. Evidence suggests that the symptoms that define the disorders reflect 2 highly correlatedfactors (Distress & Fear = Internalizing), which helps to explain why, for example, MDD and GAD often co-occur and why N/NE predicts both




2 Bottom Lines#1. DSM diagnoses are not real natural kinds, theyare clinically convenient short-hand descriptionsof symptom clusters (sound familiar?)





2 Bottom Lines#1. DSM diagnoses are not real natural kinds, theyare clinically convenient short-hand descriptionsof symptom clusters (sound familiar?)


Not just the symptoms that hang together#2: Emotional Dxes are Highly ComorbidConsistent with the factor analysis of symptoms,

Individuals diagnosed with one emotional disorder often meet diagnostic criteria for one or more other emotional disorders

Tend to hang together in nature

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

Which helps to explain why N/NE predicts multiple emotional disorders

#2: Emotional Dxes are Highly ComorbidConsistent with the factor analysis of symptoms,


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

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


Common mechanism(s) helps to explain why N/NE predicts multiple emotional disorders






Common mechanism(s) helps to explain why N/NE predicts multiple emotional disorders





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

#3. Things that Alter One DisorderTend to Alter the Others (and N/NE)in a Similar Way#3: Overlapping Treatment EffectsTreatments targeting one emotional disorder often improve other, non-targeted symptoms as well as N/NE

Cognitive-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, suggesting that The disorders reflect a limited number of underlying mechanismsOne of which appears to be N/NEHelps to explain why N/NE is a risk factor for multiple emotional disorders#3: Overlapping Treatment EffectsTreatments targeting one emotional disorder often improve other, non-targeted symptoms as well as N/NE



Treatment effects and T&P hang together, suggesting that The disorders reflect a limited number of underlying mechanismsWhich we can conceptualize as N/NE or a common causeHelps to explain why N/NE is a risk factor for multiple emotional disorders#3: Overlapping Treatment EffectsTreatments targeting one emotional disorder often improve other, non-targeted symptoms as well as N/NE



Treatment effects and T&P hang together, suggesting that The disorders reflect a limited number of underlying mechanismsWhich we can conceptualize as N/NE or a common causeHelps to explain why N/NE is a risk factor for multiple emotional disorders#3: Overlapping Treatment EffectsTreatments targeting one emotional disorder often improve other, non-targeted symptoms as well as N/NE



Treatment effects and T&P hang together, suggesting that The disorders reflect a limited number of underlying mechanismsWhich we can conceptualize as N/NE or a common causeHelps to explain why N/NE is a risk factor for multiple emotional disordersThe opposite effect is also true

Bad things increase depression, anxiety, and N/NE in tandem#4: Shared Environmental PathogensMirroring the treatment evidence, negative events that increase the risk for developing one emotional 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 emotional 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 multiple emotional disorders

#4: Shared Environmental PathogensMirroring the treatment evidence, negative events that increase the risk for developing one emotional disorder tend to increase the risk of developing the others



There is evidence that they also elevate N/NE












Bateson Can J Psychiatry 2011

Bateson Can J Psychiatry 2011






#5: Shared Genes (Heritability)The emotional disorders are somewhat heritable

N/NE is somewhat heritable

The variation in emotional disorders that is heritable is shared across multiple disorders AND N/NE

Familial aggregation and segregationFamilies (pedigrees) tend to have higher or lower levels of emotional disorders AND N/NEIndividuals within families with higher levels of one tend to have higher levels of the othersCommon inheritanceShared genetic underpinnings

Common genetic substrate would help to explain why N/NE is a risk factor for multiple emotional disorders#5: Shared Genes (Heritability)The emotional disorders are somewhat heritable


The variation in emotional disorders that is heritable is shared among multiple disorders AND N/NE

Familial aggregation and segregationFamilies (pedigrees) tend to have higher or lower levels of emotional disorders AND N/NEIndividuals within families with higher levels of one (e.g., anxiety) tend to have higher levels of the others (depression, N/NE)Common inheritanceShared genetic underpinnings

Common genetic substrate, one shared by multiple DXes and N/NE, would help to explain why N/NE is a risk factor for multiple emotional disorders#5: Shared Genes (Heritability)The emotional disorders are somewhat heritable


The variation in emotional disorders that is heritable is shared among multiple disorders AND N/NE (jargon term: genetically correlated)










Common genetic substrate, one shared by multiple DXes and N/NE, would help to explain why N/NE is a risk factor for multiple emotional disorders#6: Common Neural Circuit Across DXesThe emotional disorders (and N/NE) are consistently associated with heightened activation in a core brain circuit centered on the amygdala and anterior insula

Shared biological substratescan explain why N/NE is arisk factor for multiple emotional disorders

#6: Common Neural Circuit Across DXesThe emotional disorders (and N/NE) are consistently associated with heightened activation in a core brain circuit centered on the amygdala and anterior insula




Across Anxiety Disorders#6: Common Neural Circuit Across DXesThe emotional disorders (and N/NE) are consistently associated with heightened activation in a core brain circuit centered on the amygdala and anterior insula


Depression, too!



Depression, too

Interim SummaryN/NE predicts the emotional disorders (non-specific risk)Symptoms hang together (internalizing spectrum)Disorders hang together (co-morbidity)1-3 suggest that the disorders and N/NE reflect a common cause(s)

Treatments cause parallel, non-specific decreasesEnvironmental pathogens like stress cause parallel, non-specific increases4-5 provide more mechanistic evidence that T&P (N/NE) and psychopathology (emotional disorders) reflect a common substrate

Shared heritability, suggesting shared genesShared brain circuitry6-7 begin to address the make-up of the common cause


















Shared heritability, suggesting shared genesShared brain circuitry6-7 begin to address the biological origins of the common cause

What explains who develops which disorder (diagnostic specificity)?117The development of a particular emotional disorder reflects1. Non-specific common cause: Elevated N/NE

2. Disorder specific, learned vulnerability

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

The development of a particular emotional disorder reflects1. Non-specific common cause: Elevated N/NE









Temperamental RiskSpecific Learning ExperienceIs N/NE a cause, a symptom, or simply the same as the emotional disorders?N is a Cause, Not a SymptomCMD = Common Mental Disorder; Ormel et al CPR 2013N is a Cause, Not a SymptomCMD = Common Mental Disorder; Ormel et al CPR 2013

YesYesYesYesYesN/NE precedes disorder onsetCommon Cause Does Not Mean The Same AsSome individuals with high levels of N/NE never meet diagnostic criteria for an emotional disorder

Not altogether clear what this means- e.g., able to cope with or regulate N/NE to maintain sufficient function (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 disorderCommon Cause Does Not Mean The Same AsSome individuals with high levels of N/NE never meet diagnostic criteria for an emotional disorder


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




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










- e.g., N/NE reflects a vulnerability (diathesis); by chance, some never experience sufficient stress or the like to trigger full-blown disorderTake Home PointsThere are substantial similarities and co-morbidity between the anxiety and depressive disorders. Spectra, not fundamentally different natural kinds

Manipulations that decrease (treatment) or increase (negative events) one Dx, tend to have similar effects on the others as well as N/NE suggesting a common substrate

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

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

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

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

6. All in all, this evidence suggests that individual differences in N/NE and Emotional Disorders are not fundamentally different, but instead reflect a common causeTake Home PointsThere are substantial similarities and co-morbidity between the anxiety and depressive disorders. Spectra, not fundamentally different natural kinds














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






















6. All in all, this evidence suggests that N/NE andEmotional Disorders are not fundamentally different, but instead reflect a common causeCritical Thinking Questions (Pick 2)Critical Thinking Questions (Pick 2)Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder e.g. Robin Williams

Briefly discuss the most important challenges or limitations of Barlows account and how future research could address them (see the extra slides for hints).

Choose your own adventure: We talked about many facets of mental illness and personality today. Write a nano-essay on whatever facet was most interesting to you (e.g., societal impact of mental illness, implications for public healthcare, etc.)Critical Thinking Questions (Pick 2)Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder e.g. Robin Williams

Briefly discuss the most important challenges or limitations of Barlows account and how future research could address them (see the extra slides for hints).

Choose your own adventure: We talked about many facets of mental illness and personality today. Write a nano-essay on whatever facet was most interesting to you (e.g., societal impact of mental illness, implications for public healthcare, etc.)Critical Thinking Questions (Pick 2)Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder e.g. Robin Williams

Briefly discuss the most important challenges or limitations of Barlows account and how future research could address them.

Choose your own adventure: We talked about many facets of mental illness and personality today. Write a nano-essay on whatever facet was most interesting to you (e.g., societal impact of mental illness, implications for public healthcare, stigma, etc.)Continued on next slideCritical Thinking Questions (Pick 2)4. Theres growing evidence that the microfauna in our intestines influence our state of mind. The gut-brain axis seems to be bidirectionalthe brain acts on gastrointestinal and immune functions that shape the guts microbial makeup, and gut microbes make neurotransmitters and metabolites that act on the brain.

e.g. Scientists colonized the intestines of one strain of mice with bacteria taken from the intestines of another mouse strain, the recipient animals would take on aspects of the donors personality. Naturally timid mice would become more exploratory, whereas more daring mice would become apprehensive and shy.

What do you think?

Briefly describe the potential implications of this work (e.g. for our understanding of T&P, for psychopathology, for the development of neutriceuticals (Probiotics for your Brain, etc.)

Schmidt Nature 2015; Cryan & Dinan Nature Rev Neuro 2012; Collins et al Nature Rev Microbio 2012Critical Thinking Questions (Pick 2)4. Theres growing evidence that the microfauna in our intestines influence our state of mind. The gut-brain axis seems to be bidirectionalthe brain acts on gastrointestinal and immune functions that shape the guts microbial makeup, and gut microbes make neurotransmitters and metabolites that act on the brain.

e.g. Scientists colonized the intestines of one strain of mice with bacteria taken from the intestines of another mouse strain, the recipient animals would take on aspects of the donors personality. Timid mice became exploratory, whereas daring mice became apprehensive and shy.

What do you think?

Briefly describe the potential implications of this work (e.g. for our understanding of T&P, for psychopathology, for the development of neutriceuticals (Probiotics for your Brain, etc.)

Schmidt Nature 2015; Cryan & Dinan Nature Rev Neuro 2012; Collins et al Nature Rev Microbio 2012Critical Thinking Questions (Pick 2)4. Theres growing evidence that the microfauna in our intestines influence our state of mind. The gut-brain axis seems to be bidirectionalthe brain acts on gastrointestinal and immune functions that shape the guts microbial makeup, and gut microbes make neurotransmitters and metabolites that act on the brain.

e.g. Scientists colonized the intestines of one strain of mice with bacteria taken from the intestines of another mouse strain, the recipient animals would take on aspects of the donors personality. Timid mice became exploratory, whereas daring mice became apprehensive and shy.

What do you think?

Briefly describe the potential implications of this work (e.g. for our understanding of T&P, for psychopathology, and for the development of neutriceuticals (Probiotics for your Brain, etc.))Schmidt Nature 2015; Cryan & Dinan Nature Rev Neuro 2012; Collins et al Nature Rev Microbio 2012

Critical Thinking Questions (Pick 2)5. The Anxiety & Depression Association of America (ADAA) distributes a number of compelling video clips and other kinds of information on what its like to live with an anxiety disorder:

Stossel Interview Re Anxiety http://www.adaa.org/about-adaa/press-room/multimedia/stossel

Glass People / Anxiety http://www.adaa.org/about-adaa/press-room/multimedia/glass-people

Myths & Misconceptions http://www.adaa.org/understanding-anxiety/myth-conceptions

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 interesting, informative, or counter-intuitive. Briefly comment on how you might make use of this information or other facts about mental illness that we covered in class in your own daily life (with friends, family members, or co-workers). Critical Thinking Questions (Pick 2)5. The Anxiety & Depression Association of America (ADAA) distributes a number of compelling video clips and other kinds of information on what its like to live with an anxiety disorder:

Stossel Interview Re Anxiety http://www.adaa.org/about-adaa/press-room/multimedia/stossel

Glass People / Anxiety http://www.adaa.org/about-adaa/press-room/multimedia/glass-people

Myths & Misconceptions http://www.adaa.org/understanding-anxiety/myth-conceptions

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 interesting, informative, or counter-intuitive. Briefly comment on how you might make use of this information or other facts about mental illness that we covered in class in your own daily life (with friends, family members, or co-workers). The End (No Review Questions)Things to Consider Tweaking forSpring 2014

N = Neuroticism; E = Extraversion; D = Disinhibition; C = ConscientiousnessDistress = GAD + MDD; Fear = Panic and PhobiasAlex these next few slides actually make the point that MDD and SAD are really really similar, which belongs in one of the earlier ppts

the fun-seeking data are kind of disturbingsuggest that MDD is more about PE than appetitive motivation

Regarding Weak MDD-E RelationsRegarding Weak MDD-E RelationsLow PE is supposed to be the facet that distinguishes depression from the anxiety disorders

Tripartite Model: Clark & Watson JAP 1991; Watson et al JAP 1995a, bHighN/NELowE/PERegarding Weak MDD-E/PE RelationsLow PE is supposed to be the facet that distinguishes depression from the anxiety disorders

Tripartite Model: Clark & Watson JAP 1991; Watson et al JAP 1995a, bHighN/NELowPERegarding Weak MDD-E RelationsWeak relations may reflect the use of a broadband measure of Extraversion, rather than a more specific measure of Positive EmotionalityRegarding Weak MDD-E RelationsWeak relations may reflect the use of a broadband measure of Extraversion, rather than a more specific measure of Positive Emotionality

Collected multiple measures of each facet of E/PE

Results revealed that

1) E/PE = 4 Facets = Sociability, PE, Exhibitionism/Dominance, and Fun-Seeking

2) Depression, but not anxiety, was strongly and selectively related to low PE

Extra SlidesNeed to understand the mechanisms that convey risk (N/NE Dx)* What exactly is that arrow??* What are the proximal mechanisms mediating the assoc. between T&P and Dx* Increased reactivity, biased attention, neg appraisals, stress generation, maladaptive coping, etc?

2. Another way to think about this is, We need to dissect N/NE into its constituents* Mood/Feelings, Cognition, Peripheral Physiol, Behavior, Learning* May be helpful to adopt an endophenotype-type simplication strategy

3. Adjudicating between causal models* Manipulations targeting N/NE would let you pick vulnerability vs. common cause* No studies have tested whether Tx-induced reductions in N/NE are separable from changes in Dx; if so, evidence favoring vulnerability

N/NE is a transdiagnostic risk factor. We also need to understand the mechanisms that determine diagnostic divergence.* e.g., why do some develop SAD vs. MDD vs. PD? * Can be environmental (severe childhood teasing vs. loss of loved one) orbiological (sensitivity to interoceptive cues)

Future ChallengesBarlow CPS 2013/in press; Caspi CPS 2013/in press; Ormel et al CPR 2013; Nolen-Hoeksema & Watkins PPS 2011Neuroticism / Negative Emotionality (N/NE)Israel et al JPSP 2014

Differences in N/NE in turn reflectA disorder-nonspecific biological vulnerability (e.g., hyper-reactive amygdala)

That promotes a disorder nonspecific psychological vulnerabilityShared, trans-diagnostic phenotype, common to N/NE and the DxesCharacterized by

More frequent/intense negative emotions

Reduced emotional clarity and acceptance of emotional experiences

Tendency to experience negative emotions as more unpleasant or to have heightened apprehension about the prospect of feeling distressed or anxious in the future (elevated anxiety sensitivity; anx about being anxious)

Another Hallmark of the Core PhenotypeAnother Hallmark of the Core PhenotypeTendency to rely on strategies aimed at reducing negative emotions that paradoxically serve to increase and maintain negative emotions

Attentional avoidance

Other Escape / Avoidance Strategies* overt situational avoidance (social anxiety disorder/SAD, specific phobias, PTSD, depression, agoraphobia, PD)

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

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

Shackman Psyc210 Module13 TPandMentalDisordersFocusNE

Documents

punishment nne

emotional disordersstudents

key features of nne

shared biology

multiple diagnoses

bible of psychiatric

nne aj shackman7

risk factor