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Note: Clicker Qs @ end Slide 2 Nuts & Bolts Plan for Today Lecture Focus on the BI phenotype and its association with mental health, especially social anxiety disorder (SAD) Take-home critical thinking questions Slide 3 PSYC 612: How does N/NE contribute to emotional disorders? Part 2 of 3 Focus on Behavioral Inhibition (BI) and Social Anxiety Disorder AJ Shackman 15 October 2014 Slide 4 Todays Conceptual Roadmap What 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? Slide 5 Todays Conceptual Roadmap What 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? Slide 6 Todays Conceptual Roadmap What 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? Slide 7 Jerry Kagan (Harvard) Slide 8 Nathan Fox (UMD) Jenni Blackford (Vanderbilt)Danny Pine (NIMH) Slide 9 What is BI? Intuitive Feel NA Fox et al ARP 2005 Slide 10 Marked Individual Differences in BI http://www.abc.net.au/tv/life/video/LIFEAT1.htm Slide 11 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 NA Fox et al ARP 2005 Slide 12 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 NA Fox et al ARP 2005 Slide 13 What About Grown Ups? Slide 14 Retrospectively 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 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? Slide 15 Retrospectively 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 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? Slide 16 Retrospectively 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 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? Students: Why would you want to assess BI in this way? (Clue: Longitudinal Studies) Slide 17 Retrospectively 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 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? Usual Caveats About Self- Report Measures Apply Slide 18 How is BI Related to Other Models and Other Kinds of Data That We Have Discussed in Class? Slide 19 BI in Toddlers Passive 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 Slide 20 BI in Toddlers Parallels with AT in monkeys (freezing/cortisol) and BIS (passive avoidance) in adults Slide 21 BI in Toddlers Sustained emotional reaction: Do not recover or return to baseline very quickly Per Richie Davidson Slide 22 BI in Toddlers Right >> Left frontal EEG asymmetry Parallels with work in anxious, inhibited adults and monkeys Slide 23 BI is a Facet of N/NE Zentner et al. 2012; cf. Caspi et al 2005 Caspis Hierarchical Model of T&P Slide 24 How stable is BI? Students What is your intuition, Do High-BI Toddlers Grow Up to be High-BI Adults? NA Fox et al ARP 2005 Slide 25 BI Shows Modest Continuity Stability estimates 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 classified as High at 2 years; only ~33% at 4 years; 2/3 changed (Fox et al. 2001) NA Fox et al ARP 2005 Slide 26 BI Shows Modest Continuity Stability estimates 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 classified as High at 2 years; only ~33% at 4 years; 2/3 changed (Fox et al. 2001) NA Fox et al ARP 2005 Slide 27 BI Shows Modest Continuity Stability estimates 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 classified as High at 2 years; only ~33% at 4 years; 2/3 changed (Fox et al. 2001) NA Fox et al ARP 2005 Slide 28 BI Shows Modest Continuity Relatively 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 2005 Slide 29 BI Shows Modest Continuity Relatively 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 2005 Slide 30 BI Shows Modest Continuity Suggests 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 2005 Slide 31 BI Shows Modest Continuity Suggests 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 2005 Slide 32 StudentsWhy Isnt BI More Stable? Might this reflect a mixture of Age-Appropriate Fears vs. More Extreme Dispositions? Blackford & Pine Slide 33 StudentsWhy Isnt BI More Stable? Might this reflect a mixture of Age-Appropriate Fears vs. More Extreme Dispositions? Blackford & Pine Slide 34 Students 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 & Pine Slide 35 Students Why Might Fear & Anxiety Be a Normative, Adaptive Part of Early Childhood? Blackford & Pine Slide 36 Slide 37 Modest Continuity Reflects Normative Developmental Milestones Fear 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 & Pine Slide 38 Modest Continuity Reflects Normative Developmental Milestones Fear 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 & Pine Slide 39 Modest Continuity Reflects Normative Developmental Milestones Fear 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 & Pine Slide 40 Modest Continuity Reflects Heterogeneity Fears 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 Slide 41 Modest Continuity Reflects Heterogeneity Fears 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 Slide 42 Modest Continuity Reflects Heterogeneity But 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) Slide 43 Modest Continuity Reflects Heterogeneity But 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, normal part of growing up; for others, harbinger of life-long challenges Slide 44 Modest Continuity Reflects Heterogeneity But 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, normal part of growing up; for others, harbinger of life-long challenges It also reflects the emergence/maturation of emotion regulation Slide 45 Given this heterogeneity Were going to focus on the subset of children who are characterized by stable AND high levels of BI Slide 46 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 Slide 47 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 Slide 48 Extreme behavioral inhibition (BI) confers liability for Social Anxiety Disorder (SAD) Slide 49 What exactly is SAD? Students? Slide 50 MTV Perspective Slide 51 http://www.mtv.com/videos/true-life-i-have-social-anxiety/1706675/playlist.jhtml Slide 52 NIMH Perspective Slide 53 Social Anxiety Disorder / Social Phobia http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 54 Social Anxiety Disorder / Social Phobia http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 55 Social Anxiety Disorder / Social Phobia http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 56 Social Anxiety Disorder / Social Phobia http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 57 Social Anxiety Disorder / Social Phobia http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 58 Social Anxiety Disorder / Social Phobia http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 59 Social Anxiety Disorder / Social Phobia http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 60 Social Anxiety Disorder / Social Phobia http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 61 Bottom Line: Convergence between the social reticence of extreme BI and SAD Slide 62 Students? What might explain this trajectory? That is, how does BI become adult dysfunction? Slide 63 BI Influences Social Skill Acquisition BI Promotes Problematic Social Behaviors Behaviorally inhibited children interact with others in less effective ways (e.g., nonassertive strategies during peer interactions) BI Predicts Worse Social Outcomes More 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 Slide 64 BI Influences Social Skill Acquisition BI Promotes Problematic Social Behaviors Behaviorally inhibited children interact with others in less effective ways (e.g., nonassertive strategies during peer interactions) BI Predicts Worse Social Outcomes More 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 Slide 65 BI Influences Social Skill Acquisition BI Promotes Problematic Social Behaviors Behaviorally inhibited children interact with others in less effective ways (e.g., nonassertive strategies during peer interactions) BI Predicts Worse Social Outcomes More 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 Slide 66 BI Influences Social Skill Acquisition BI Promotes Problematic Social Behaviors Behaviorally inhibited children interact with others in less effective ways (e.g., nonassertive strategies during peer interactions) BI Predicts Worse Social Outcomes More 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 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) These kinds of social exchange / social interaction mechanisms may underlie the association between BI and psychopathology Extreme BI Aberrant Social Skills/Peer Relations Psychopathology Slide 67 BI Influences Social Skill Acquisition BI Promotes Problematic Social Behaviors Behaviorally inhibited children interact with others in less effective ways (e.g., nonassertive strategies during peer interactions) BI Predicts Worse Social Outcomes More 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 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) These kinds of social exchange / social interaction mechanisms may underlie the association between BI and psychopathology Extreme BI Aberrant Social Skills/Peer Relations Psychopathology Slide 68 BI Influences Social Skill Acquisition Social Behaviors & Outcomes Over 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 Slide 69 Collectively, these data raise the possibility that BI represents an intermediate phenotype or even an endophentype for SAD Slide 70 Quick Recap Slide 71 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? Slide 72 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? Slide 73 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? Slide 74 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? Slide 75 Yes! Modest Heritability Heritability 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) Slide 76 Yes! Modest Heritability Heritability 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) Slide 77 Yes! Modest Heritability Heritability 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 Study in Australia) Slide 78 Todays Take Home Points What 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? Slide 79 Todays Take Home Points What 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? Slide 80 Todays Take Home Points What 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? Slide 81 Critical Thinking Questions (pick 2) Slide 82 1.What are some loose ends with this simplified account? What are the most important challenges for future research? Slide 83 Critical Thinking Questions (pick 2) 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).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 Slide 84 Critical Thinking Questions (pick 2) 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).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).http://www.nimh.nih.gov/health/topics/social- phobia-social-anxiety-disorder/index.shtml Slide 85 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? Slide 86 Which is true? A.There is one anxiety disorder B.There is a whole family of anxiety disorders Slide 87 The most common family of psychiatric disorders is A.Anxiety B.Depression C.Schizophrenia D.Somatoform Slide 88 Anxiety disorders tend to onset A.Late in life B.Mid life C.Early in life Slide 89 Depression tends to onset A.Early in life B.Mid life C.Late in life Slide 90 The most burdensome disorder (disability, illnes, death) in the US is A.Depression B.Heart Disease C.COPD D.Cancer E.Alzheimers Slide 91 Elevated N/NE is a risk factor for A.Anxiety disorders B.Depressive disorders C.Both Slide 92 Anxiety and depression symptoms A.Form a coherent, factor (internalizing) B.Are categorically distinct C.Should be thought of as natural kinds, discrete entities that exist in nature waiting to be discovered Slide 93 Anxiety and depression A.Are highly co- morbid B.Rarely co-occur in the same individual Slide 94 Treatments targeting one emotional disorder A.Ameliorate (decrease) the symptoms of other emotional disorders B.Decrease ratings of N/NE C.Both, suggesting a common cause Slide 95 Negative life events & psychological pathogens such as stress tend to A.Cause individuals to cross the diagnostic 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 Slide 96 Anxiety disorders, depression, and N/NE A.Reflect completely separate genes B.Are inherited together (shared inheritance), suggesting a common genetic underpinning Slide 97 Recent meta-analyses demonstrate that A.A variety of anxiety disorders, like N/NE, are associated with heightened amygdala activation to potential threat B.Depression, like N/NE, is associated with increased amygdala reactivity to aversive cues C.Both, providing evidence for a common biology Slide 98 Barlow argues that the development of a particular Dx (diagnostic specificity) reflects A.N/NE and a disorder-specific learned vulnerability (e.g., fear dogs) B.N/NE and an innate vulnerability C.N/NE and other non-specific risk factors Slide 99 N/NE is a A.Cause of emotional disorders B.Symptom of emotional disorders C.Identical to or synonymous with the emotional disorders D.A symptom of too much anxiety Slide 100 The End Slide 101 Extra Slides Slide 102 Social Anxiety Disorder / Social Phobia Strong 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.shtml Slide 103 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 eating or drinking in front of other people using a public restroom http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 104 Intermediate Phenotypes are a Bridge Symptomatic Disorders (Phenotype) Genome (Genotype) Slide 105 Endophenotypes: 6 Criteria Miller & Rockstroh Ann Rev Clin Psychol 2013 6. Can be measured reliably * Slide 106 Social Anxiety Disorder / Social Phobia People with SAD know that they shouldn't be as afraid as they are, but have trouble regulating their fears Maladaptive Active 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 http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml Slide 107 Social Anxiety Disorder / Social Phobia People with SAD know that they shouldn't be as afraid as they are, but have trouble regulating their fears Maladaptive Active 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 http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml