nuts & bolts plan for today shorter meeting today – no clicker review lecture (lahey, barlow,...
TRANSCRIPT
Nuts & Bolts Plan for Today
Shorter meeting today– No clicker review
Lecture (Lahey, Barlow, and Ormel papers)– Emotional disorders: symptoms & burden– Informed citizens and taxpayers
Take-home critical thinking questions
PSYC 612:
How does T&P contribute to emotional disorders?
Part 1 of 3
Focus on N/NE
AJ Shackman15 October 2014
Take Care of Yourself & One Another
Today’s Conceptual Roadmap• What 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
Today’s Conceptual Roadmap• What 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
Today’s Conceptual Roadmap• What 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
Section 1: What is N/NE and how is it related to emotional disorders
Students: 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 Down
Caspi et al. ARP 2005; Barlow et al. CPS 2013
Emotion• susceptibility to negative moods
Appraisal• experience the world as distressing or threatening
Motivation• aversive / defensive; tendency to
work hard to avoid punishment
N/NE: Boiling It Down
Caspi et al. ARP 2005; Barlow et al. CPS 2013
Emotion• susceptibility to negative moods
Appraisal• experience the world as distressing or threatening
Motivation• aversive / defensive; tendency to
work hard to avoid punishment
N/NE: Boiling It Down
Emotion• susceptibility to negative moods
Appraisal• experience the world as distressing or threatening
Motivation• aversive / defensive; tendency to
work hard to avoid punishment
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 2013
Lumper!
Students: What is the significance?
Lahey Amer Psychol 2009
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
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
(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 Deal
Emotional Dx Are a Big Deal
- tremendous suffering
- tremendous economic burden
- aggravate other problems and disorders
Emotional Dx are a Big Deal
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
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 Disorders• Generalized Anxiety (GAD)) General• Panic About attacks• Post-Traumatic Stress (PTSD) About trauma cues • Social Anxiety / Social Phobia About social interactions• Other Specific Phobias e.g., dogs, spiders
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Signs
Family of Disorders• Generalized Anxiety (GAD)) General• Panic About attacks• Post-Traumatic Stress (PTSD) About trauma cues • Social Anxiety / Social Phobia About social interactions• Other Specific Phobias e.g., dogs, spiders
http://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. adults
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Very Common
Anxiety 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 abuse
Anxiety 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 abuse
Anxiety 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-Treated
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Under-Treated
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Expensive
http://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: Expensive
http://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?
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Signs
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Dx Criteria
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Common
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Common
http://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-year
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Mood Disorders: Under-Treated
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Mood Disorders: Under-Treated
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
and Emotional Disorders are a Big Deal
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)
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
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)
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
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), that 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)
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
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), that 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)
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
Why?
???Risk
???
MDD
Multiple Disorders
Why does N/NE confer risk for multiple disorders?
Risk
Section 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-IV
Barlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic Cause
For convergent evidence, see Ormel et al CPR 2013
Barlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic 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 multipleemotional disorders
They are not categoricallydifferent entities
ANX DEPN/NE
Internalizing SpectrumOf Disorders
(a.k.a. Emotional Dx’es)
For convergent evidence, see Ormel et al CPR 2013
Barlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic 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 multipleemotional disorders
Because they are not categoricallydifferent entities
ANX DEPN/NE
Internalizing SpectrumOf Disorders
(a.k.a. Emotional Dx’es)
For convergent evidence, see Ormel et al CPR 2013
Barlow offers 6 lines of evidence
#1: Disorders are not categorically distinctFactor analyses indicate broad spectra, not discrete diagnoses
• Dump 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 diagnoses
• Dump 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 distinct
#1: Disorders are not categorically distinct
0000
#1: Disorders are not categorically distinctThird 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
#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
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
#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
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
#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
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
Not just the symptoms that ‘hang together’
#2: Emotional Dx’es 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 Dx’es 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
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 manifestations of one or a limited number of aberrant mechanisms
• Common mechanism(s) helps to explain why N/NE predicts multiple emotional disorders
#2: Emotional Dx’es 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
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 manifestations of one or a limited number of aberrant mechanisms
• Common mechanism(s) helps to explain why N/NE predicts multiple emotional disorders
#2: Emotional Dx’es 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
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 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 mechanisms• One of which appears to be N/NE• Helps 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
• 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 mechanisms• Which we can conceptualize as N/NE or a common cause• Helps 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
• 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 mechanisms• Which we can conceptualize as N/NE or a common cause• Helps 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
• 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 mechanisms• Which we can conceptualize as N/NE or a common cause• Helps to explain why N/NE is a risk factor for multiple emotional disorders
The opposite effect is also true
Bad things increase depression, anxiety, and N/NE in tandem
#4: Shared Environmental ‘Pathogens’Mirroring 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 ‘Pathogens’Mirroring 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 evidence that they 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 ‘Pathogens’Mirroring 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 evidence that they 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 ‘Pathogens’Mirroring 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 evidence that they also elevate N/NE
This is consistent with a shared/common biological vulnerability and can explain why N/NE predicts multiple emotional disorders
#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 segregation• Families (pedigrees) tend to have higher or lower levels of emotional disorders
AND N/NE• Individuals within families with higher levels of one tend to have higher levels of
the others• Common inheritance• Shared 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
N/NE is somewhat heritable
The variation in emotional disorders that is heritable is shared among multiple disorders AND N/NE
Familial aggregation and segregation• Families (pedigrees) tend to have higher or lower levels of emotional 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 genetic underpinnings
Common genetic substrate, one shared by multiple DX’es 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
N/NE is somewhat heritable
The variation in emotional disorders that is heritable is shared among multiple disorders AND N/NE
Familial aggregation and segregation• Families (pedigrees) tend to have higher or lower levels of emotional 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 genetic underpinnings
Common genetic substrate, one shared by multiple DX’es 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
N/NE is somewhat heritable
The variation in emotional disorders that is heritable is shared among multiple disorders AND N/NE
Familial aggregation and segregation• Families (pedigrees) tend to have higher or lower levels of emotional 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 genetic underpinnings
Common genetic substrate, one shared by multiple DX’es 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
N/NE is somewhat heritable
The variation in emotional disorders that is heritable is shared among multiple disorders AND N/NE
Familial aggregation and segregation• Families (pedigrees) tend to have higher or lower levels of emotional 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 genetic underpinnings
Common genetic substrate, one shared by multiple DX’es and N/NE, would help to explain why N/NE is a risk factor for multiple emotional disorders
#6: Common Neural Circuit Across DX’esThe 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 DX’esThe 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 DX’esThe 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
Across Anxiety Disorders
#6: Common Neural Circuit Across DX’esThe 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
Depression, too
#6: Common Neural Circuit Across DX’esThe 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
Depression, too
Interim Summary1. N/NE predicts the emotional 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 decreases5. Environmental 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
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary1. N/NE predicts the emotional 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 decreases5. Environmental 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
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary1. N/NE predicts the emotional 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 decreases5. Environmental 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
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary1. N/NE predicts the emotional 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 decreases5. Environmental 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
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary1. N/NE predicts the emotional 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 decreases5. Environmental 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
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary1. N/NE predicts the emotional 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 decreases5. Environmental 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
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
What explains who develops which disorder
(diagnostic specificity)?
The development of a particular emotional disorder reflects…
1. 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 reflects…
1. 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 reflects…
1. 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 reflects…
1. Non-specific common cause: Elevated N/NE
2. Disorder specific, learned vulnerability
e.g., Why a specific phobia of dogs?
Is N/NE a cause, a symptom, or simply ‘the same as’ the emotional disorders?
N is a Cause, Not a Symptom
CMD = Common Mental Disorder; Ormel et al CPR 2013
N is a Cause, Not a Symptom
CMD = Common Mental Disorder; Ormel et al CPR 2013
Yes
Yes
Yes
Yes
Common Cause Does Not Mean ‘The Same As’
Some 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 disorder
Common Cause Does Not Mean ‘The Same As’
Some 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 disorder
Common Cause Does Not Mean ‘The Same As’
Some 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 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
Common Cause Does Not Mean ‘The Same As’
Some 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 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
Common Cause Does Not Mean ‘The Same As’
Some 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 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
Common Cause Does Not Mean ‘The Same As’
Some 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 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
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. 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
3. Elevated levels of N/NE are a common/shared feature of the emotional 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 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 cause
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. 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
3. Elevated levels of N/NE are a common/shared feature of the emotional 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 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 cause
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. 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
3. Elevated levels of N/NE are a common/shared feature of the emotional 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 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 cause
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. 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
3. Elevated levels of N/NE are a common/shared feature of the emotional 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 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 cause
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. 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
3. Elevated levels of N/NE are a common/shared feature of the emotional 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 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 cause
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. 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
3. Elevated levels of N/NE are a common/shared feature of the emotional 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 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 N/NE and Emotional Disorders are not fundamentally different, but instead reflect a common cause
Critical Thinking Questions (Pick 2)
Critical Thinking Questions (Pick 2)
1. Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder
2. Briefly discuss the most important challenges or limitations 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 interesting to you (e.g., societal impact of mental illness, implications for public healthcare, etc.)
Critical Thinking Questions (Pick 2)
1. Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder
2. Briefly discuss the most important challenges or limitations 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 interesting to you (e.g., societal impact of mental illness, implications for public healthcare, etc.)
Critical Thinking Questions (Pick 2)
1. Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder
2. Briefly discuss the most important challenges or limitations 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 interesting to you (e.g., societal impact of mental illness, implications for public healthcare, etc.)
The End
Things to Consider Tweaking forSpring 2014
N = Neuroticism; E = Extraversion; D = Disinhibition; C = ConscientiousnessDistress = GAD + MDD; Fear = Panic and Phobias
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 appetitive motivation
Regarding Weak MDD-E Relations
Regarding 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, b
HighN/NE
LowE/PE
Regarding 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, b
HighN/NE
LowPE
Regarding Weak MDD-E RelationsWeak relations may reflect the use of a broadband measure of Extraversion, rather than a more specific measure of Positive Emotionality
Regarding 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 Slides
1. Need 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
4. 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 Challenges
Barlow CPS 2013/in press; Caspi CPS 2013/in press; Ormel et al CPR 2013; Nolen-Hoeksema & Watkins PPS 2011
Neuroticism / Negative Emotionality (N/NE)
Israel et al JPSP 2014
Differences in N/NE in turn reflect- A disorder-nonspecific biological vulnerability (e.g., hyper-
reactive amygdala)
- That promotes a disorder nonspecific psychological vulnerability
Shared, trans-diagnostic phenotype, common to N/NE and the Dxes
Characterized 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 Phenotype
Another Hallmark of the Core Phenotype
Tendency 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)