Shackman Psyc210 Module14 TPandMentalDisordersFocusBI 041415

Nuts & Bolts Plan for Today

Lecture (Fox and Clauss/Blackford papers) Focus on the BI phenotype and its associa@on with mental health, especially social anxiety disorder (SAD)

Take-home cri@cal thinking ques@ons

PSYC 210:

How does N/NE contribute to emo@onal disorders?

Part 2 of 3

Focus on Behavioral Inhibi2on (BI)

and Social Anxiety Disorder

AJ Shackman 14 April 2015

Todays Conceptual Roadmap What is behavioral inhibi@on (BI)?

How is BI related to other models of T&P, such as N/NE or Grays BIS? Implica@ons for thinking about childhood temperament vs. adult personality?

Individual dierences in BI predict anxiety and other psychiatric disorders? Why? How? Is BI a viable intermediate phenotype?

Jerry Kagan (Harvard)

Nathan Fox (UMD)

Jenni Blackford (Vanderbilt) Danny Pine (NIMH)

What is BI?

Intui2ve Feel

NA Fox et al ARP 2005

Marked Individual Dierences in BI

h\p://www.abc.net.au/tv/life/video/LIFEAT1.htm

BI in Toddlers Passive Avoidance / Freezing Avoid unfamiliar events, objects (robot) and people (intruder)

When faced with such challenges, children with high levels of BI cease their play, become quiet, and withdraw to the proximity of their caregivers


What About Grown Ups?

Retrospec@vely Assessing BI in Adults

Reznick and colleagues RSRI Were you afraid of unfamiliar animals, such as those you encountered on the street or at someone elses home?

Did it upset you when your parents le9 you with a new, unfamiliar baby-si

How is BI related to other models and other kinds of data that we have discussed in class?

BI in Toddlers Passive Avoidance / Freezing

They remain vigilant (orient toward source of poten@al threat) May show high levels of distress (reac@ve) or show elevated levels of the stress hormone cor@sol Parallels with AT in monkeys (freezing/cor@sol) and BIS (passive avoidance) in adults

BI is a Facet of N/NE

Zentner et al. 2012; cf. Caspi et al 2005

Caspis Hierarchical Model of T&P

BI in Toddlers Parallels with BIS (passive avoidance) in adults and anxious temperament in monkeys

Oler, Fo

x, Sha

ckman

& Kalin, in press

How stable is BI?

Students What is your intui2on,

Do high-BI toddlers grow up to be high-BI adults?


BI Shows Modest Con@nuity Stability es@mates for BI typically fall in the low to moderate range E.g. 4.5 to 7 years of age (R = 0.24; ~6% variance) (Stevenson-Hinde & Shouldice, 1995)

~50% of infants in the High-BI group were classied as High at 2 years; only ~33% at 4 years; 2/3 changed (Fox et al. 2001)


BI Shows Modest Con@nuity Rela@vely high propor@on of children switch from inhibited to noninhibited classica@ons (e.g., Perez-Edgar & Fox, 2005; Kagan & Snidman, 1999)

Put simply, many to most kids grow out of extreme early-life BI As Kagan says, there is no need to be fatalis@c if you are the parent of a high-BI child; considerable plas@city and room for op@mism J


BI Shows Modest Con@nuity Suggests that the environment / nurture plays an important role in determining con@nuity (Rubin et al 2002) e.g., stress/adversity

e.g., derisive parengng associated with increased congnuity;


StudentsWhy isnt BI more stable?

Might this reect a mixture of Age-Appropriate Fears

vs. More Extreme Disposi2ons?

Blackford & Pine

Why isnt BI more stable?

Might this reect a mixture of adap2ve, age-appropriate fears

-and- Kids with more extreme disposi2ons?

Blackford & Pine

Start @ 2:25 hjps://www.youtube.com/watch?v=cyrduIwU7UM

Start @ 2:25 hjps://www.youtube.com/watch?v=cyrduIwU7UM

The preschool years are years of intense feelings, but most children arent yet able to use words well enough to express those feelings. Many things can be scary to them things that are real and imaginary and, like all of us, they carry their own inner dramas which color everything they see and do. So its natural that not all children develop the same fears, and that some children are more fearful than others

Students

Show of hands, how many of you had some kind of strong fear or anxiety

when you were liTle that you grew out of

(e.g., strangers, losing your parents,

geVng lost, monsters, etc.) Blackford & Pine

Students

Why might fear & anxiety be a norma2ve, adap2ve part of

early childhood?

Blackford & Pine

Blackford & Pine

Modest Con@nuity Reects Norma@ve Developmental Milestones

Fear and anxiety are adap@ve in the face of danger Intense fear and anxiety are a normal part of childhood

Most infants experience stranger anxiety @ ~8-12 months

Most toddlers experience separagon anxiety @ ~10-18 mo

Blackford & Pine

Modest Con@nuity Reects Heterogeneity

Fears are thought to be protec@ve, preven@ng the child from encountering harm during periods marked by the onset of walking and increased explora@on For most kids, the norma@ve fears vanish by 2-3 years


But for some kids, childhood is marked by the persistence of these fears and the development of new fears, which we would deem non-norma@ve or age-inappropriate (i.e., clinically signicant)


But for some kids, childhood is marked by the persistence of these fears and the development of new fears, which we would deem non-norma@ve or age-inappropriate (i.e., clinically signicant) Modest con@nuity of BI par@ally reects heterogeneity in the func@onal signicance of early-life anxiety and inhibi@on; for some kids, its a normal part of growing up; for others, a harbinger of life-long challenges


But for some kids, childhood is marked by the persistence of these fears and the development of new fears, which we would deem non-norma@ve or age-inappropriate (i.e., clinically signicant) Modest con@nuity of BI par@ally reects heterogeneity in the func@onal signicance of early-life anxiety and inhibi@on; for some kids, its a normal part of growing up; for others, a harbinger of life-long challenges It also reects the emergence/matura@on of emo@on regula@on

Given this heterogeneity

Were going to focus on the subset of children

who are characterized by stable AND high levels of BI

Stable, High BI Confers Risk Kids who consistently show heightened BI across repeated laboratory assessments are at risk for developing

Anxiety Disorders

Major Depressive Disorder (MDD)

Substance Use Disorders (SUDs)

Hirshfeld-Becker NDCAD 2010

Extreme behavioral inhibi@on (BI) confers liability for Social Anxiety Disorder (SAD)

What exactly is SAD?

Students?

MTV Perspec2ve

h\p://www.mtv.com/videos/true-life-i-have-social-anxiety/1706675/playlist.jhtml

NIMH Perspec2ve

Social Anxiety Disorder / Social Phobia

hjp://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml

BoTom Line: Convergence between the social re2cence of extreme BI and SAD

Students?

What might explain this trajectory?

That is, how does BI become adult dysfunc2on?

BI Inuences Social Skill Acquisi@on BI Promotes Problema@c Social Behaviors

Behaviorally inhibited children interact with others in less eecgve ways (e.g., nonassergve strategies during peer interacgons)

BI Predicts Worse Social Outcomes

More likely to have their requests refused

Leads to poorer quality peer relagonships Makes it more and more challenging for BI kids to

- learn social skills - forge strong social relagonships with new people (develop new social networks among peers, friends, schoolmates and ulgmately dorm-mates, colleagues, and co-workers)

These kinds of social exchange / social interac@on mechanisms may underlie the associa@on between BI and psychopathology

Extreme BI Aberrant Social Skills/Peer Relagons Psychopathology

BI Inuences Social Skill Acquisi@on BI Promotes Problema@c Social Behaviors

Behaviorally inhibited children interact with others in less eecgve ways (e.g., nonassergve strategies during peer interacgons)

BI Predicts Worse Social Outcomes

More likely to have their requests refused

Leads to poorer quality peer relagonships Makes it more and more challenging for BI kids to

- learn social skills and condence - forge strong social relagonships with new people (develop new social networks among peers, friends, schoolmates and ulgmately dorm-mates, colleagues, and co-workers)

These kinds of social exchange / social interac@on mechanisms may underlie the associa@on between BI and psychopathology

Extreme BI Aberrant Social Skills/Peer Relagons Psychopathology

BI Inuences Social Skill Acquisi@on Social Behaviors & Outcomes Over gme, the experience of social failure may teach BI children to interpret ambiguous social situagons as threatening and believe that poor social outcomes are a result of internal causes; socially anxious

BI Inuences Social Skill Acquisi@on Social Behaviors & Outcomes Over gme, the experience of social failure may teach BI children to interpret ambiguous social situagons as threatening and believe that poor social outcomes are a result of internal causes; socially anxious

The mastery of skills that are essenAal for success and the development of their underlying neural pathways follow hierarchical rules. Later a

Collec2vely, these data raise the possibility that BI represents an intermediate phenotype or even an endophentype for SAD

Quick Recap

2 Kinds of Intermediate Phenotypes

Miller & Rockstroh Ann Rev Clin Psychol 2013

Intermediate Phenotype: Nonheritable cause of the trait Stable, high levels of BI SAD

Endophenotype: Special Case

I.P. that is causal and heritable

Could BI be an Endophenotype for SAD?

2 Kinds of Intermediate Phenotypes


Intermediate Phenotype: Nonheritable cause of the trait Stable, high levels of BI SAD

Endophenotype: Special Case

I.P. that is causal and heritable

Could BI be an endophenotype for SAD?

Yes! Modest Heritability Heritability esgmates in toddlerhood range from .41.64 (DiLalla et al., 1994; Emde et al., 1992; Matheny, 1989; Robinson et al., 1992) BI is elevated among preschoolers of parents with panic disorder

Parents of kids with elevated BI themselves are more likely to have a diagnosable anxiety disorder (Rosenbaum et al., 1991)

Yes! Modest Heritability Heritability esgmates in toddlerhood range from .41.64 (DiLalla et al., 1994; Emde et al., 1992; Matheny, 1989; Robinson et al., 1992) BI is elevated among preschoolers of parents with panic disorder

Parents of kids with elevated BI themselves are more likely to have a diagnosable anxiety disorder (Rosenbaum et al., 1991)

Work to establish whether BI is causal is

on-going

(Childhood interven@on studies in Australia and Maryland)

Todays Take Home Points What is behavioral inhibi@on (BI)?


Individual dierences in BI predict anxiety and other psychiatric disorders? Why? How? Is BI a viable intermediate phenotype?

Todays Take Home Points What is behavioral inhibi@on (BI)?


Todays Take Home Points Do individual dierences in BI predict anxiety and other psychiatric disorders? Why? How? Is BI a viable intermediate phenotype?

Cri@cal Thinking Ques@ons (pick 2)


1. Briey describe: What are some loose ends with this simplied account? What are the most important challenges for future research?


2. Watch the complete episode of MTVs True Life: Social Anxiety Disorder (hjp://www.mtv.com/videos/true-life-i-have-social-anxiety/1706675/playlist.jhtml).

Briey describe how this popular media perspecgve on SAD jibes with the NIMHs perspecgve


2. Watch the complete episode of MTVs True Life: Social Anxiety Disorder (hjp://www.mtv.com/videos/true-life-i-have-social-anxiety/1706675/playlist.jhtml).

Briey describe: How this popular media perspecgve on SAD jibes with the NIMHs perspecgve (hjp://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml).


3. What are the implicagons of the material we discussed today for intervenAon? Should we screen and target high-risk children for intervengons aimed at reducing childhood BI and prevengng the subsequent development of psychopathology. Why or why not?

Cri@cal Thinking Ques@ons (pick 2) 4. Read this brief, highly entertaining NY Times Magazine argcle on pagents with Williams syndrome: hjp://www.nygmes.com/2007/07/08/magazine/08sociability-t.html?pagewanted=all&_r=0 A key focus of the story is on the interacgon of genegc predisposigons and the environment. Briey describe the implicagons of this conceptual perspecgve for understanding BI and SAD. How might stable, high levels of social regcence and anxiety interact early in life interact with the environment (e.g. relagonships with caregivers, teachers, and peers) in ways that increase the likelihood of developing psychopathology? (biologyenvironmentnew learning and new changes in biology)

Cri@cal Thinking Ques@ons (pick 2) 4. Read this brief, highly entertaining NY Times Magazine argcle on pagents with Williams syndrome: hjp://www.nygmes.com/2007/07/08/magazine/08sociability-t.html?pagewanted=all&_r=0 A key focus of the story is on the interacgon of genegc predisposigons and the environment. Briey describe the implicagons of this conceptual perspecgve for understanding BI and SAD. How might stable, high levels of social regcence and anxiety early in life interact with the environment (e.g. relagonships with caregivers, teachers, and peers) in ways that increase the likelihood of developing psychopathology? (biologyenvironmentnew learning and changes in biology)

Cri@cal Thinking Ques@ons (pick 2) 5. The Anxiety & Depression Associagon of America (ADAA) distributes a number of interesgng and informagve video clips on social anxiety disorder: Social Anxiety

hjp://www.adaa.org/about-adaa/press-room/mulgmedia/what-is-social-anxiety-disorder

Social Anxiety in Adults hjp://www.adaa.org/about-adaa/press-room/mulgmedia/adults-social-anxiety

Social Anxiety in Youth hjp://www.adaa.org/about-adaa/press-room/mulgmedia/children-teens-social-anxiety

Social Anxiety Symptoms hjp://www.adaa.org/%20about-adaa/press-room/mulgmedia/social-anxiety-symptoms

Watch any one of the video clips and briey comment on what you found most interesgng, informagve, or counter-intuigve.

Cri@cal Thinking Ques@ons (pick 2) 6. Craske and colleagues (2014) describe recent developments in cognigve-behavioral therapy for anxiety disorders. Available @ hjp://www.sciencedirect.com/science/argcle/pii/S0005796714000606 In the second half of the paper, they describe several case studies of individual pagents (e.g. Deandres experience with social phobia). Read one or more of the vignejes and comment on what you found most interesgng and, as relevant, how it relates to the material we discussed in class today.

Cri@cal Thinking Ques@ons (pick 2) 6. Craske and colleagues (2014) describe recent developments in cognigve-behavioral therapy for anxiety disorders. Available @ hjp://www.sciencedirect.com/science/argcle/pii/S0005796714000606 In the second half of the paper, they describe several case studies of individual pagents (e.g. Deandres experience with social phobia). Read one or more of the vigne

Time-Permijng Review Ques@ons

Which is true?

A. There is one anxiety disorder

B. There is a whole family of anxiety disorders

There

is one anxiety diso...

There

is a w

hole fam

ily o...

0%0%

The most common family of psychiatric disorders is

A. Anxiety B. Depression C. Schizophrenia D. Somatoform

Anxiety

Depre

ssion

Schizophren

ia

Somatoform

0% 0%0%0%

Anxiety disorders tend to onset

A. Late in life B. Mid life C. Early in life

Late in life

Mid life

Early in life

0% 0%0%

Depression tends to onset

A. Early in life B. Mid life C. Late in life

Early in life

Mid life

Late in life

0% 0%0%

The most burdensome disorder (disability, illnes, death) in the US is

A. Depression B. Heart Disease C. COPD D. Cancer E. Alzheimers

Depression

Heart Disease

COPD

Cancer

Alzheimers

0% 0% 0%0%0%

Elevated N/NE is a risk factor for

A. Anxiety disorders B. Depressive

disorders C. Both

Anxiety disord

ers

Depre

ssive disorde

rsBoth

0% 0%0%

Anxiety and depression symptoms

A. Form a coherent, factor (internalizing)

B. Are categorically disgnct

C. Should be thought of as natural kinds, discrete engges that exist in nature waigng to be discovered Form

a cohere

nt, facto

r (...

Are cate

gorically distinct

Should be thought of as ...

0% 0%0%

Anxiety and depression

A. Are highly co-morbid

B. Rarely co-occur in the same individual

Are highly co-morb

id

Rarely co-o

ccur in

the s...

0%0%

Treatments targegng one emogonal disorder

A. Ameliorate (decrease) the symptoms of other emogonal disorders

B. Decrease ragngs of N/NE

C. Both, suggesgng a common cause

Ameliora

te (de

crease

) the...

Decrease

ratings of N/NE

Both, suggesting a comm

..

0% 0%0%

Negagve life events & psychological pathogens such as stress tend to

A. Cause individuals to cross the diagnosgc boundary and experience a frank depressive disorder

B. Increase the risk of developing a diagnosable anxiety disorder

C. Increase N/NE D. All of the above

Cause individuals to cross...

Increa

se the

risk of devel...

Increa

se N/NE

All of the above

0% 0%0%0%

Anxiety disorders, depression, and N/NE

A. Reect completely separate genes

B. Are inherited together (shared inheritance), suggesgng a common genegc underpinning

Reflect comp

letely separ...

Are inherited

togethe

r (...

0%0%

Recent meta-analyses demonstrate that

A. A variety of anxiety disorders, like N/NE, are associated with heightened amygdala acgvagon to potengal threat

B. Depression, like N/NE, is associated with increased amygdala reacgvity to aversive cues

C. Both, providing evidence for a common biology

A variety

of anxiety disor...

Depre

ssion, like N/

NE, is ...

Both, providing evide

nce ...

0% 0%0%

Barlow argues that the development of a pargcular Dx (diagnosgc

specicity) reects A. N/NE and a

disorder-specic learned vulnerability (e.g., fear dogs)

B. N/NE and an innate vulnerability

C. N/NE and other non-specic risk factors

N/NE and a disorde

r-speci...

N/NE and an innate

vuln...

N/NE and o

ther non-speci...

0% 0%0%

N/NE is a

A. Cause of emogonal disorders

B. Symptom of emogonal disorders

C. Idengcal to or synonymous with the emogonal disorders

D. A symptom of too much anxiety

Cause o

f emo

tional disor...

Symp

tom of em

otional d...

Identical to or synonymo

..

A sympto

m of too

much ...

0% 0%0%0%

The End

Extra Slides

Social Anxiety Disorder / Social Phobia Strong fear of being judged by others and of being embarrassed, crigcized, or found out. Can be so strong that it gets in the way of going to work or school or doing other everyday things Everyone has felt anxious or embarrassed at one gme or another. For example, meegng new people or giving a public speech can make anyone nervous But people with social phobia worry about these and other things for weeks before they happen


Social Anxiety Disorder / Social Phobia Afraid of doing common things in front of other people

e.g., signing a check in front of a cashier at the grocery store eagng or drinking in front of other people

using a public restroom


Intermediate Phenotypes are a Bridge Symptoma@c Disorders (Phenotype)

Genome (Genotype)

Endophenotypes: 6 Criteria


6. Can be measured reliably

*

Social Anxiety Disorder / Social Phobia People with SAD know that they shouldn't be as afraid as they are, but have trouble regula@ng their fears Maladap@ve Ac@ve Avoidance Behaviors

May end up staying away from places or events (e.g., party or other gatherings) where they think they might have to do something that could embarrass them


Documents

Shackman Psyc210 Module14 TPandMentalDisordersFocusBI 041415