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 Shackman
15 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
Emotion
• susceptibility to negative moods
Appraisal
• experience the world as distressing or threatening
Motivation
• aversive / defensive; tendency to
work hard to avoid punishment
Caspi et al. ARP 2005; Barlow et al. CPS 2013
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
Caspi et al. ARP 2005; Barlow et al. CPS 2013
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
Lumper!
Like Caspi, David Barlow emphasizes the
similarities between different models and
measures 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
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
Section 2: Crash course in emotional
disorders
(I do not expect you to retain the specifics
of the next few slides, just the gist)
Emotional Dx are a Big Deal
Emotional Dx are a Big Deal
Emotional Dx Are a Big Deal
- tremendous suffering
- tremendous economic burden
- aggravate other problems and disorders
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))
• Panic
• Post-Traumatic Stress (PTSD)
• Social Anxiety / Social Phobia
• Other Specific Phobias
General
About attacks
About trauma cues
About social interactions
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))
• Panic
• Post-Traumatic Stress (PTSD)
• Social Anxiety / Social Phobia
• Other Specific Phobias
General
About attacks
About trauma cues
About social interactions
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
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: Snares Many Teens
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Snares Many Teens
Anxiety disorders affect
1 in 4 teens
Teens with untreated anxiety
disorders are at higher risk for
performing poorly in school,
missing out on important social
experiences with peers and
others, and substance abuse
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Snares Many Teens
Anxiety disorders affect
1 in 4 teens
Teens with untreated anxiety
disorders are at higher risk for
performing poorly in school,
missing out on important social
experiences with peers and
others, and substance abuse
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
Anxiety Dx: Expensive
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
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Major Depressive Disorder (MDD)
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
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Bottom Line: N/NE Confers
Substantial Risk for Emotional Disorders
and Emotional Disorders are a Big Deal
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
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
Bottom Line: N/NE Confers
Substantial Risk for Emotional Disorders
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
Bottom Line: N/NE Confers
Substantial Risk for Emotional Disorders
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)
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
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)
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
Why?
???
Risk
Why does N/NE confer risk for multiple disorders?
Multiple Disorders
???
Risk
MDD
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 multiple
emotional disorders
They are not categorically
different entities
For convergent evidence, see Ormel et al CPR 2013
ANX
N/NE
DEP
Internalizing Spectrum
Of Disorders
(a.k.a. Emotional Dx’es)
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 multiple
emotional disorders
Because they are not categorically
different entities
For convergent evidence, see Ormel et al CPR 2013
ANX
N/NE
DEP
Internalizing Spectrum
Of Disorders
(a.k.a. Emotional Dx’es)
Barlow offers 6 lines of evidence
#1: Disorders are not categorically distinct
Factor 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
Factor 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 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, they
are clinically convenient short-hand descriptions
of symptom clusters
#2. Evidence suggests that the symptoms that
define the disorders reflect 2 highly correlated
factors (‘latent’ dimensions), which helps to
explain why, for example, MDD and GAD
Frequentlyco-occur
#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, they
are clinically convenient short-hand descriptions
of symptom clusters
#2. Evidence suggests that the symptoms that
define the disorders reflect 2 highly correlated
factors (Distress & Fear = Internalizing), which
helps to explain why, for example, MDD and GAD
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, they
are clinically convenient short-hand descriptions
of symptom clusters
#2. Evidence suggests that the symptoms that
define the disorders reflect 2 highly correlated
factors (Distress & Fear = Internalizing), which
helps to explain why, for example, MDD and GAD
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, they
are clinically convenient short-hand descriptions
of symptom clusters
#2. Evidence suggests that the symptoms that
define the disorders reflect 2 highly correlated
factors (Distress & Fear = Internalizing), which
helps to explain why, for example, MDD and GAD
often co-occur and why N/NE predicts both
Not just the symptoms that
‘hang together’
#2: Emotional Dx’es are Highly Comorbid
Consistent 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 Comorbid
Consistent 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 Comorbid
Consistent 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 Comorbid
Consistent 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 Disorder
Tend to Alter the Others
(and N/NE)
in a Similar Way
#3: Overlapping Treatment Effects
Treatments 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 Effects
Treatments 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 Effects
Treatments 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 Effects
Treatments 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’es
The 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 substrates
can explain why N/NE is a
risk factor for multiple
emotional disorders
#6: Common Neural Circuit Across DX’es
The 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 substrates
can explain why N/NE is a
risk factor for multiple
emotional disorders
#6: Common Neural Circuit Across DX’es
The 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 substrates
can explain why N/NE is a
risk factor for multiple
emotional disorders
Across Anxiety Disorders
#6: Common Neural Circuit Across DX’es
The 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 substrates
can explain why N/NE is a
risk factor for multiple
emotional disorders
Depression, too
#6: Common Neural Circuit Across DX’es
The 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 substrates
can explain why N/NE is a
risk factor for multiple
emotional disorders
Depression, too
Interim Summary
1. 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 decreases
5. Environmental pathogens like stress cause parallel, non-specific
increases
4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes
7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary
1. 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 decreases
5. Environmental pathogens like stress cause parallel, non-specific
increases
4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes
7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary
1. 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 decreases
5. Environmental pathogens like stress cause parallel, non-specific
increases
4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes
7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary
1. 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 decreases
5. Environmental pathogens like stress cause parallel, non-specific
increases
4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes
7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary
1. 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 decreases
5. Environmental pathogens like stress cause parallel, non-specific
increases
4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes
7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary
1. 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 decreases
5. Environmental pathogens like stress cause parallel, non-specific
increases
4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes
7. 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
Yes
Yes
Yes
Yes
CMD = Common Mental Disorder; Ormel et al CPR 2013
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 fullblown 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 fullblown 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 fullblown 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 fullblown 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 fullblown 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 fullblown disorder
Take Home Points
1.
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 Points
1.
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 Points
1.
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 Points
1.
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 Points
1.
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 Points
1.
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 nanoessay 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 nanoessay 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 nanoessay 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 for
Spring 2014
N = Neuroticism; E = Extraversion; D = Disinhibition; C = Conscientiousness
Distress = 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 Relations
Low PE is supposed to be the facet that distinguishes
depression from the anxiety disorders
Low
E/PE
High
N/NE
Tripartite Model: Clark & Watson JAP 1991; Watson et al JAP 1995a, b
Regarding Weak MDD-E/PE Relations
Low PE is supposed to be the facet that distinguishes
depression from the anxiety disorders
Low
PE
High
N/NE
Tripartite Model: Clark & Watson JAP 1991; Watson et al JAP 1995a, b
Regarding Weak MDD-E Relations
Weak relations may reflect the use of a broadband
measure of Extraversion, rather than a more specific
measure of Positive Emotionality
Regarding Weak MDD-E Relations
Weak 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
Future Challenges
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) or
biological (sensitivity to interoceptive cues)
013/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., hyperreactive 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)