Shackman Psyc210 Module14 TPandMentalDisordersFocusBI

PowerPoint Presentation

Nuts & Bolts Plan for TodayLecture (Fox and Clauss/Blackford papers)Focus on the BI phenotype and its association with mental health, especially social anxiety disorder (SAD)

Take-home critical thinking questionsPSYC 210:

How does N/NE contribute to emotional disorders?

Part 2 of 3

Focus on Behavioral Inhibition (BI) and Social Anxiety Disorder

AJ Shackman14 April 2015Todays Conceptual RoadmapWhat is behavioral inhibition (BI)?

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

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

Todays Conceptual RoadmapWhat is behavioral inhibition (BI)?



Todays Conceptual RoadmapWhat is behavioral inhibition (BI)?



Jerry Kagan (Harvard)

Nathan Fox (UMD)

Jenni Blackford (Vanderbilt)

Danny Pine (NIMH)

What is BI?

Intuitive FeelNA Fox et al ARP 2005Marked Individual Differences in BI

http://www.abc.net.au/tv/life/video/LIFEAT1.htmBI in ToddlersPassive Avoidance / FreezingAvoid 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

NA Fox et al ARP 2005BI in ToddlersPassive Avoidance / FreezingAvoid 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

NA Fox et al ARP 2005What About Grown Ups?Retrospectively Assessing BI in AdultsReznick and colleagues RSRIWere 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 left you with a new, unfamiliar baby-sitter?

Did you ever pretend to be sick in order to avoid going to school or to other social events?

Did you enjoy meeting new children your age?

Retrospectively Assessing BI in AdultsReznick and colleagues RSRIWere you afraid of unfamiliar animals, such as those you encountered on the street or at someone elses home?




Retrospectively Assessing BI in AdultsReznick and colleagues RSRIWere you afraid of unfamiliar animals, such as those you encountered on the street or at someone elses home?




Students: Why would you want to assess BI via adult self-report? Retrospectively Assessing BI in AdultsReznick and colleagues RSRIWere you afraid of unfamiliar animals, such as those you encountered on the street or at someone elses home?




Usual Caveats About Self-Report Measures ApplyHow is BI related to other modelsand other kinds of data that we have discussed in class?BI in ToddlersPassive Avoidance / Freezing

They remain vigilant (orient toward source of potential threat)

May show high levels of distress (reactive) or show elevated levels of the stress hormone cortisol

Parallels with AT in monkeys (freezing/cortisol) and BIS (passive avoidance) in adults

BI is a Facet of N/NEZentner et al. 2012; cf. Caspi et al 2005

Caspis Hierarchical Model of T&PBI in ToddlersParallels with BIS (passive avoidance) in adults and anxious temperament in monkeys

Oler, Fox, Shackman & Kalin, in press










Oler, Fox, Shackman & Kalin, in pressHow stable is BI?

Students What is your intuition,

Do high-BI toddlers grow up to be high-BI adults?NA Fox et al ARP 2005BI Shows Modest ContinuityStability estimates for BI typically fall in the low to moderate rangeE.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 classified as High at 2 years; only ~33% at 4 years; 2/3 changed (Fox et al. 2001)NA Fox et al ARP 2005BI Shows Modest ContinuityStability estimates for BI typically fall in the low to moderate rangeE.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 classified as High at 2 years; only ~33% at 4 years; 2/3 changed (Fox et al. 2001)NA Fox et al ARP 2005BI Shows Modest ContinuityStability estimates for BI typically fall in the low to moderate rangeE.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 classified as High at 2 years; only ~33% at 4 years; 2/3 changed (Fox et al. 2001)NA Fox et al ARP 2005BI Shows Modest ContinuityRelatively high proportion of children switch from inhibited to noninhibited classifications (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 fatalistic if you are the parent of a high-BI child; considerable plasticity and room for optimism NA Fox et al ARP 2005BI Shows Modest ContinuityRelatively high proportion of children switch from inhibited to noninhibited classifications (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 fatalistic if you are the parent of a high-BI child; considerable plasticity and room for optimism NA Fox et al ARP 2005BI Shows Modest ContinuitySuggests that the environment / nurture plays an important role in determining continuity (Rubin et al 2002) e.g., stress/adversity

e.g., derisive parenting associated with increased continuity;NA Fox et al ARP 2005BI Shows Modest ContinuitySuggests that the environment / nurture plays an important role in determining continuity (Rubin et al 2002) e.g., stress/adversity

e.g., derisive parenting associated with increased continuity;NA Fox et al ARP 2005StudentsWhy isnt BI more stable?

Might this reflect a mixture of Age-Appropriate Fears vs.More Extreme Dispositions?

Blackford & PineWhy isnt BI more stable?

Might this reflect a mixture of adaptive, age-appropriate fears -and-Kids with more extreme dispositions?

Blackford & Pine

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

Start @ 2:25 https://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 othersStudents

Show of hands, how many of you had some kind of strong fear or anxiety when you were little that you grew out of

(e.g., strangers, losing your parents, getting lost, monsters, etc.)

Blackford & PineStudents

Why might fear & anxiety be a normative, adaptive part ofearly childhood?

Blackford & Pine

Blackford & PineModest Continuity ReflectsNormative Developmental MilestonesFear and anxiety are adaptive 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 separation anxiety @ ~10-18 mo









Blackford & PineModest Continuity Reflects HeterogeneityFears are thought to be protective, preventing the child from encountering harm during periods marked by the onset of walking and increased exploration

For most kids, the normative fears vanish by 2-3 years

Modest Continuity Reflects HeterogeneityFears are thought to be protective, preventing the child from encountering harm during periods marked by the onset of walking and increased exploration

For most kids, the normative fears vanish by 2-3 years

Modest Continuity Reflects HeterogeneityBut for some kids, childhood is marked by the persistence of these fears and the development of new fears, which we would deem non-normative or age-inappropriate (i.e., clinically significant)


Modest continuity of BI partially reflects heterogeneity in the functional significance of early-life anxiety and inhibition; for some kids, its a normal part of growing up; for others, a harbinger of life-long challenges


Modest continuity of BI partially reflects heterogeneity in the functional significance of early-life anxiety and inhibition; for some kids, its a normal part of growing up; for others, a harbinger of life-long challenges

It also reflects the emergence/maturation of emotion regulation

Given this heterogeneity

Were going to focus on the subset of childrenwho are characterized by stable AND high levels of BIStable, High BI Confers RiskKids 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 2010Stable, High BI Confers RiskKids 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 2010Extreme behavioral inhibition (BI) confers liability for Social Anxiety Disorder (SAD)

In humans 58What exactly is SAD?

Students?MTV Perspectivehttp://www.mtv.com/videos/true-life-i-have-social-anxiety/1706675/playlist.jhtml

NIMH PerspectiveSocial Anxiety Disorder / Social Phobiahttp://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml

Social Anxiety Disorder / Social Phobiahttp://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml







Bottom Line:

Convergence between the social reticence of extreme BI and SAD

Students?

What might explain this trajectory?

That is, how does BI become adult dysfunction?

BI Influences Social Skill AcquisitionBI Promotes Problematic Social BehaviorsBehaviorally inhibited children interact with others in less effective ways (e.g., nonassertive strategies during peer interactions)

BI Predicts Worse Social OutcomesMore likely to have their requests refused

Leads to poorer quality peer relationships

Makes it more and more challenging for BI kids to - learn social skills- forge strong social relationships with new people (develop new social networks among peers, friends, schoolmates and ultimately dorm-mates, colleagues, and co-workers)

These kinds of social exchange / social interaction mechanisms may underlie the association between BI and psychopathology

Extreme BI Aberrant Social Skills/Peer Relations Psychopathology
















Makes it more and more challenging for BI kids to - learn social skills and confidence- forge strong social relationships with new people (develop new social networks among peers, friends, schoolmates and ultimately dorm-mates, colleagues, and co-workers)






Makes it more and more challenging for BI kids to - learn social skills and confidence- forge strong social relationships with new people (develop new social networks among peers, friends, schoolmates and ultimately dorm-mates, colleagues, and co-workers)



BI Influences Social Skill AcquisitionSocial Behaviors & OutcomesOver time, the experience of social failure may teach BI children to interpret ambiguous social situations as threatening and believe that poor social outcomes are a result of internal causes; socially anxious

BI Influences Social Skill AcquisitionSocial Behaviors & OutcomesOver time, the experience of social failure may teach BI children to interpret ambiguous social situations as threatening and believe that poor social outcomes are a result of internal causes; socially anxious

The mastery of skills that are essential for success and the development of their underlying neural pathwaysfollow hierarchical rules. Later attainments buildon foundations that are laid down earlier.

(i) early learning confers value on acquired skills, which leads to self-reinforcing motivation to learn more, and (ii) early mastery of a range of cognitive, social, and emotional competencies makes learning at later ages more efficient and therefore easier and more likely to continue.

A child who falls behind may never catch up.

Heckman Science 2006

Collectively, these data raise the possibility that BI represents an intermediate phenotype or even an endophentype for SAD Quick Recap2 Kinds of Intermediate PhenotypesMiller & Rockstroh Ann Rev Clin Psychol 2013Intermediate Phenotype: Nonheritable cause of the traitStable, high levels of BI SAD

Endophenotype: Special CaseI.P. that is causal and heritable

Could BI be an Endophenotype for SAD?

2 Kinds of Intermediate PhenotypesMiller & Rockstroh Ann Rev Clin Psychol 2013Intermediate Phenotype: Nonheritable cause of the traitStable, high levels of BI SAD








Could BI be an endophenotype for SAD?

Yes! Modest HeritabilityHeritability estimates 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 intervention studies in Australiaand Maryland)Todays Take Home PointsWhat is behavioral inhibition (BI)?



Todays Take Home PointsWhat is behavioral inhibition (BI)?



Todays Take Home PointsWhat is behavioral inhibition (BI)?


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




Critical Thinking Questions (pick 2)Critical Thinking Questions (pick 2)Briefly describe: What are some loose ends with this simplified account? What are the most important challenges for future research?Critical Thinking Questions (pick 2)Watch the complete episode of MTVs True Life: Social Anxiety Disorder (http://www.mtv.com/videos/true-life-i-have-social-anxiety/1706675/playlist.jhtml).

Briefly describe how this popular media perspective on SAD jibes with the NIMHs perspectiveCritical Thinking Questions (pick 2)Watch the complete episode of MTVs True Life: Social Anxiety Disorder (http://www.mtv.com/videos/true-life-i-have-social-anxiety/1706675/playlist.jhtml).

Briefly describe:How this popular media perspective on SAD jibes with the NIMHs perspective (http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml).Critical Thinking Questions (pick 2)3. What are the implications of the material we discussed today for intervention?

Should we screen and target high-risk children for interventions aimed at reducing childhood BI and preventing the subsequent development of psychopathology.

Why or why not?Critical Thinking Questions (pick 2)4. Read this brief, highly entertaining NY Times Magazine article on patients with Williams syndrome:

http://www.nytimes.com/2007/07/08/magazine/08sociability-t.html?pagewanted=all&_r=0

A key focus of the story is on the interaction of genetic predispositions and the environment.

Briefly describe the implications of this conceptual perspective for understanding BI and SAD.

How might stable, high levels of social reticence and anxiety interact early in life interact with the environment (e.g. relationships with caregivers, teachers, and peers) in ways that increase the likelihood of developing psychopathology?

(biologyenvironmentnew learning and new changes in biology)Critical Thinking Questions (pick 2)4. Read this brief, highly entertaining NY Times Magazine article on patients with Williams syndrome:




How might stable, high levels of social reticence and anxiety interact early in life interact with the environment (e.g. relationships with caregivers, teachers, and peers) in ways that increase the likelihood of developing psychopathology?

(biologyenvironmentnew learning and new changes in biology)Critical Thinking Questions (pick 2)4. Read this brief, highly entertaining NY Times Magazine article on patients with Williams syndrome:




How might stable, high levels of social reticence and anxiety early in life interact with the environment (e.g. relationships with caregivers, teachers, and peers) in ways that increase the likelihood of developing psychopathology?

(biologyenvironmentnew learning and changes in biology)Critical Thinking Questions (pick 2)5. The Anxiety & Depression Association of America (ADAA) distributes a number of interesting and informative video clips on social anxiety disorder:

Social Anxiety http://www.adaa.org/about-adaa/press-room/multimedia/what-is-social-anxiety-disorder

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

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

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

Watch any one of the video clips and briefly comment on what you found most interesting, informative, or counter-intuitive. Critical Thinking Questions (pick 2)5. The Anxiety & Depression Association of America (ADAA) distributes a number of interesting and informative video clips on social anxiety disorder:

Social Anxiety http://www.adaa.org/about-adaa/press-room/multimedia/what-is-social-anxiety-disorder

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

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

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

Watch any one of the video clips and briefly comment on what you found most interesting, informative, or counter-intuitive. Critical Thinking Questions (pick 2)6. Craske and colleagues (2014) describe recent developments in cognitive-behavioral therapy for anxiety disorders.

Available @ http://www.sciencedirect.com/science/article/pii/S0005796714000606

In the second half of the paper, they describe several case studies of individual patients (e.g. Deandres experience with social phobia).

Read one or more of the vignettes and comment on what you found most interesting and, as relevant, how it relates to the material we discussed in class today. Critical Thinking Questions (pick 2)6. Craske and colleagues (2014) describe recent developments in cognitive-behavioral therapy for anxiety disorders.



Read one or more of the vignettes and comment on what you found most interesting and, as relevant, how it relates to the material we discussed in class today. Critical Thinking Questions (pick 2)6. Craske and colleagues (2014) describe recent developments in cognitive-behavioral therapy for anxiety disorders.



Read one or more of the vignettes and comment on what you found most interesting and, as relevant, how it relates to the material we discussed in class today. Time-PermittingReview QuestionsWhich is true?There is one anxiety disorderThere is a whole family of anxiety disorders

The most common family of psychiatric disorders isAnxietyDepressionSchizophreniaSomatoform

Anxiety disorders tend to onsetLate in lifeMid lifeEarly in life

Depression tends to onsetEarly in lifeMid lifeLate in life

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

Elevated N/NE is a risk factor forAnxiety disordersDepressive disordersBoth

Anxiety and depression symptomsForm a coherent, factor (internalizing)Are categorically distinctShould be thought of as natural kinds, discrete entities that exist in nature waiting to be discovered

Anxiety and depressionAre highly co-morbidRarely co-occur in the same individual

Treatments targeting one emotional disorderAmeliorate (decrease) the symptoms of other emotional disordersDecrease ratings of N/NEBoth, suggesting a common cause

Negative life events & psychological pathogens such as stress tend toCause individuals to cross the diagnostic boundary and experience a frank depressive disorderIncrease the risk of developing a diagnosable anxiety disorderIncrease N/NEAll of the above

Anxiety disorders, depression, and N/NEReflect completely separate genesAre inherited together (shared inheritance), suggesting a common genetic underpinning

Recent meta-analyses demonstrate thatA variety of anxiety disorders, like N/NE, are associated with heightened amygdala activation to potential threatDepression, like N/NE, is associated with increased amygdala reactivity to aversive cuesBoth, providing evidence for a common biology

Barlow argues that the development of a particular Dx (diagnostic specificity) reflectsN/NE and a disorder-specific learned vulnerability (e.g., fear dogs)N/NE and an innate vulnerabilityN/NE and other non-specific risk factors

N/NE is a Cause of emotional disordersSymptom of emotional disordersIdentical to or synonymous with the emotional disordersA symptom of too much anxiety

The EndExtra SlidesSocial Anxiety Disorder / Social PhobiaStrong fear of being judged by others and of being embarrassed, criticized, 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 time or another. For example, meeting 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

http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtmlSocial Anxiety Disorder / Social PhobiaAfraid of doing common things in front of other people

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

using a public restroom

http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtmlIntermediate Phenotypes are a Bridge

Symptomatic Disorders (Phenotype)Genome (Genotype)Endophenotypes: 6 CriteriaMiller & Rockstroh Ann Rev Clin Psychol 2013

6. Can be measured reliably*Social Anxiety Disorder / Social PhobiaPeople with SAD know that they shouldn't be as afraid as they are, but have trouble regulating their fears

Maladaptive Active Avoidance BehaviorsMay 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 themhttp://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtmlSocial Anxiety Disorder / Social PhobiaPeople with SAD know that they shouldn't be as afraid as they are, but have trouble regulating their fears

Maladaptive Active Avoidance BehaviorsMay 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 themhttp://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml

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Shackman Psyc210 Module14 TPandMentalDisordersFocusBI