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Transcript of Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and...
![Page 1: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/1.jpg)
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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
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PSYC 612:
How does T&P contribute to emotional disorders?
Part 1 of 3
Focus on N/NE
AJ Shackman15 October 2014
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Take Care of Yourself & One Another
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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
![Page 6: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/6.jpg)
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
![Page 7: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/7.jpg)
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
![Page 8: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/8.jpg)
Section 1: What is N/NE and how is it related to emotional disorders
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Students: What are key features of N/NE?
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Neuroticism / Negative Emotionality (N/NE)
Caspi et al. ARP 2005; Barlow et al. CPS 2013
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N/NE: Boiling It Down
Caspi et al. ARP 2005; Barlow et al. CPS 2013
Emotion• susceptibility to negative moods
Appraisal• experience the world as distressing or threatening
Motivation• aversive / defensive; tendency to
work hard to avoid punishment
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N/NE: Boiling It Down
Caspi et al. ARP 2005; Barlow et al. CPS 2013
Emotion• susceptibility to negative moods
Appraisal• experience the world as distressing or threatening
Motivation• aversive / defensive; tendency to
work hard to avoid punishment
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N/NE: Boiling It Down
Emotion• susceptibility to negative moods
Appraisal• experience the world as distressing or threatening
Motivation• aversive / defensive; tendency to
work hard to avoid punishment
Like Caspi, David Barlow emphasizes the similarities between different models andmeasures of Negative Emotionality (NE)
• Neuroticism • Behavioral Inhibition System (BIS)• (Childhood) Behavioral Inhibition (BI)• Negative Affectivity (NA)• Trait Anxiety (STAI)• Harm Avoidance (HA) Caspi et al. ARP 2005; Barlow et al. CPS 2013
Lumper!
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Students: What is the significance?
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Lahey Amer Psychol 2009
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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
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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
![Page 18: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/18.jpg)
(I do not expect you to retain the specifics of the next few slides, just the gist)
Section 2: Crash course in emotional disorders
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Emotional Dx are a Big Deal
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Emotional Dx Are a Big Deal
- tremendous suffering
- tremendous economic burden
- aggravate other problems and disorders
Emotional Dx are a Big Deal
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Signs
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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?
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Signs
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Signs
Family of Disorders• Generalized Anxiety (GAD)) General• Panic About attacks• Post-Traumatic Stress (PTSD) About trauma cues • Social Anxiety / Social Phobia About social interactions• Other Specific Phobias e.g., dogs, spiders
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Signs
Family of Disorders• Generalized Anxiety (GAD)) General• Panic About attacks• Post-Traumatic Stress (PTSD) About trauma cues • Social Anxiety / Social Phobia About social interactions• Other Specific Phobias e.g., dogs, spiders
![Page 26: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/26.jpg)
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Very Common
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Anxiety disorders are the most common family of mental Illnesses, affecting 40M U.S. adults
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Anxiety Dx: Very Common
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Anxiety Dx: Snares Many Teens
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
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Anxiety disorders affect 1 in 4 teens
Teens with untreated anxiety disorders are at higher risk for performing poorly in school, missing out on important socialexperiences with peers and others, and substance abuse
Anxiety Dx: Snares Many Teens
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
![Page 30: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/30.jpg)
Anxiety disorders affect 1 in 4 teens
Teens with untreated anxiety disorders are at higher risk for performing poorly in school, missing out on important socialexperiences with peers and others, and substance abuse
Anxiety Dx: Snares Many Teens
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
![Page 31: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/31.jpg)
Anxiety Dx: Under-Treated
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
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Anxiety Dx: Under-Treated
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
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Anxiety Dx: Expensive
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
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Cost the U.S. >$42B/yr, one-third of the country's $148 billion total mental health bill
All in all, ~10% of Medicaid funding pays for mental health care and ~20% of state/local health programs pay for mental health care
Anxiety Dx: Expensive
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
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Major Depressive Disorder (MDD)
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Signs
Students – What are the key features of depression?
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Signs
![Page 38: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/38.jpg)
http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Dx Criteria
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Common
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
MDD: Common
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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
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Mood Disorders: Under-Treated
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http://www.adaa.org/about-adaa/press-room/facts-statistics & http://www.nimh.nih.gov/Statistics/index.shtml
Mood Disorders: Under-Treated
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Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
and Emotional Disorders are a Big Deal
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N/NE is …
• The strongest predictor of categorical emotional disorder diagnoses (Kotov et al., 2010)
• The strongest predictor of continuous symptoms (self-report and clinical ratings) that cut across disorders
• Especially strongly linked to general distress/negative affectivity (e.g., depressed mood, anxious mood, worry), which lies at the core of the emotional disorders
• Remains predictive of anxiety and depression symptoms even after eliminating overlapping content (Uliaszek et al., 2009)• I feel depressed (DSM) vs. I feel blue (N/NE)
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
![Page 46: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/46.jpg)
N/NE is …
• The strongest predictor of categorical emotional disorder diagnoses (Kotov et al., 2010)
• The strongest predictor of continuous symptoms (self-report and clinical ratings) that cut across disorders
• Especially strongly linked to general distress/negative affectivity (e.g., depressed mood, anxious mood, worry), which lies at the core of the emotional disorders
• Remains predictive of anxiety and depression symptoms even after eliminating overlapping content (Uliaszek et al., 2009)• I feel depressed (DSM) vs. I feel blue (N/NE)
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
![Page 47: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/47.jpg)
N/NE is …
• The strongest predictor of categorical emotional disorder diagnoses (Kotov et al., 2010)
• The strongest predictor of continuous symptoms (self-report and clinical ratings) that cut across disorders
• Especially strongly linked to general distress/negative affectivity (e.g., depressed mood, anxious mood, worry), that lies at the core of the emotional disorders
• Remains predictive of anxiety and depression symptoms even after eliminating overlapping content (Uliaszek et al., 2009)• I feel depressed (DSM) vs. I feel blue (N/NE)
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
![Page 48: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/48.jpg)
N/NE is …
• The strongest predictor of categorical emotional disorder diagnoses (Kotov et al., 2010)
• The strongest predictor of continuous symptoms (self-report and clinical ratings) that cut across disorders
• Especially strongly linked to general distress/negative affectivity (e.g., depressed mood, anxious mood, worry), that lies at the core of the emotional disorders
• Remains predictive of anxiety and depression symptoms even after eliminating overlapping content (Uliaszek et al., 2009)• I feel depressed (DSM) vs. I feel blue (N/NE)
Bottom Line: N/NE Confers Substantial Risk for Emotional Disorders
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
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Why?
???Risk
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???
MDD
Multiple Disorders
Why does N/NE confer risk for multiple disorders?
Risk
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Section 3. Why is N/NE a ‘Transdiagnostic Risk Factor’ ?
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David Barlow (BU)
Among the most prominent living anxiety researchers
Key member of the team that wrote DSM-IV
![Page 53: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/53.jpg)
Barlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic Cause
For convergent evidence, see Ormel et al CPR 2013
![Page 54: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/54.jpg)
Barlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic Cause
A common cause gives rise to features that are shared hallmarks of anxiety, depression, and N/NE
This would explain why N/NE confers liability for multipleemotional disorders
They are not categoricallydifferent entities
ANX DEPN/NE
Internalizing SpectrumOf Disorders
(a.k.a. Emotional Dx’es)
For convergent evidence, see Ormel et al CPR 2013
![Page 55: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/55.jpg)
Barlow Argues that N/NE and Emotion Disorders Reflect a Common Transdiagnostic Cause
A common cause gives rise to features that are shared hallmarks of anxiety, depression, and N/NE
This would explain why N/NE confers liability for multipleemotional disorders
Because they are not categoricallydifferent entities
ANX DEPN/NE
Internalizing SpectrumOf Disorders
(a.k.a. Emotional Dx’es)
For convergent evidence, see Ormel et al CPR 2013
![Page 56: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/56.jpg)
Barlow offers 6 lines of evidence
![Page 57: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/57.jpg)
#1: Disorders are not categorically distinctFactor analyses indicate broad spectra, not discrete diagnoses
• Dump in the symptoms (‘diagnostic criteria’) that are used by the DSM to define all of the emotional disorders
• Do you get factors corresponding to the DSM diagnoses? • E.g., MDD vs. GAD vs. PTSD etc.
• No! You get broad spectra of ‘internalizing’ symptoms
NO! YES!
![Page 58: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/58.jpg)
#1: Disorders are not categorically distinctFactor analyses indicate broad spectra, not discrete diagnoses
• Dump in the symptoms (‘diagnostic criteria’) that are used by the DSM to define all of the emotional disorders
• Do you get factors corresponding to the DSM diagnoses? • E.g., MDD vs. GAD vs. PTSD etc.
• No! You get broad spectra of ‘internalizing’ symptoms
NO! YES!
![Page 59: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/59.jpg)
#1: Disorders are not categorically distinct
![Page 60: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/60.jpg)
#1: Disorders are not categorically distinct
0000
![Page 61: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/61.jpg)
#1: Disorders are not categorically distinctThird and last example
![Page 62: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/62.jpg)
#1: Disorders are not categorically distinct
Can re-represent each of the categorical diagnoses as “scores” on two correlated dimensions (Distress and Fear)
The “scores” do a better job predicting deleterious future outcomes than the diagnoses
Bottom Lines#1. DSM diagnoses are not real natural kinds, theyare clinically convenient short-hand descriptionsof symptom clusters
#2. Evidence suggests that the symptoms that define the disorders reflect 2 highly correlatedfactors (‘latent’ dimensions), which helps to explain why, for example, MDD and GAD Frequentlyco-occur
![Page 63: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/63.jpg)
#1: Disorders are not categorically distinct
Can re-represent each of the categorical diagnoses as “scores” on two correlated dimensions (Distress and Fear)
The “scores” do a better job predicting deleterious future outcomes than the diagnoses
2 Bottom Lines#1. DSM diagnoses are not real natural kinds, theyare clinically convenient short-hand descriptionsof symptom clusters
#2. Evidence suggests that the symptoms that define the disorders reflect 2 highly correlatedfactors (Distress & Fear = Internalizing), which helps to explain why, for example, MDD and GAD often co-occur and why N/NE predicts both
![Page 64: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/64.jpg)
#1: Disorders are not categorically distinct
Can re-represent each of the categorical diagnoses as “scores” on two correlated dimensions (Distress and Fear)
The “scores” do a better job predicting deleterious future outcomes than the diagnoses
2 Bottom Lines#1. DSM diagnoses are not real natural kinds, theyare clinically convenient short-hand descriptionsof symptom clusters
#2. Evidence suggests that the symptoms that define the disorders reflect 2 highly correlatedfactors (Distress & Fear = Internalizing), which helps to explain why, for example, MDD and GAD often co-occur and why N/NE predicts both
![Page 65: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/65.jpg)
#1: Disorders are not categorically distinct
Can re-represent each of the categorical diagnoses as “scores” on two correlated dimensions (Distress and Fear)
The “scores” do a better job predicting deleterious future outcomes than the diagnoses
2 Bottom Lines#1. DSM diagnoses are not real natural kinds, theyare clinically convenient short-hand descriptionsof symptom clusters
#2. Evidence suggests that the symptoms that define the disorders reflect 2 highly correlatedfactors (Distress & Fear = Internalizing), which helps to explain why, for example, MDD and GAD often co-occur and why N/NE predicts both
![Page 66: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/66.jpg)
Not just the symptoms that ‘hang together’
![Page 67: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/67.jpg)
#2: Emotional Dx’es are Highly ComorbidConsistent with the factor analysis of symptoms,
• Individuals diagnosed with one emotional disorder often meet diagnostic criteria for one or more other emotional disorders
• Tend to hang together in nature
• Suggests that they reflect different manifestations of one or a limited number of aberrant mechanisms
• Which helps to explain why N/NE predicts multiple emotional disorders
![Page 68: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/68.jpg)
#2: Emotional Dx’es are Highly ComorbidConsistent with the factor analysis of symptoms,
• Individuals diagnosed with one emotional disorder often meet diagnostic criteria for one or more other emotional disorders
e.g., Nearly 50% of those Dx’ed with depression are also diagnosed with an anxiety disorder
• Like the symptoms, the disorders tend to hang together in the clinic
• Suggests that they reflect different manifestations of one or a limited number of aberrant mechanisms
• Common mechanism(s) helps to explain why N/NE predicts multiple emotional disorders
![Page 69: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/69.jpg)
#2: Emotional Dx’es are Highly ComorbidConsistent with the factor analysis of symptoms,
• Individuals diagnosed with one emotional disorder often meet diagnostic criteria for one or more other emotional disorders
e.g., Nearly 50% of those Dx’ed with depression are also diagnosed with an anxiety disorder
• Like the symptoms, the disorders tend to hang together in the clinic
• Suggests that they reflect different manifestations of one or a limited number of aberrant mechanisms
• Common mechanism(s) helps to explain why N/NE predicts multiple emotional disorders
![Page 70: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/70.jpg)
#2: Emotional Dx’es are Highly ComorbidConsistent with the factor analysis of symptoms,
• Individuals diagnosed with one emotional disorder often meet diagnostic criteria for one or more other emotional disorders
e.g., Nearly 50% of those Dx’ed with depression are also diagnosed with an anxiety disorder
• Like the symptoms, the disorders tend to hang together in the clinic
• Suggests that they reflect different manifestations of one or a limited number of aberrant mechanisms. Common mechanism(s) helps to explain why N/NE predicts multiple emotional disorders
![Page 71: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/71.jpg)
#3. Things that Alter One DisorderTend to Alter the Others
(and N/NE)in a Similar Way
![Page 72: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/72.jpg)
#3: Overlapping Treatment EffectsTreatments targeting one emotional disorder often improve other, non-targeted symptoms as well as N/NE
• Cognitive-behavioral therapy for generalized anxiety disorder can produce improvements in depressive symptoms
• Pharmacological treatments for MDD reduce N/NE
• Treatment effects and T&P hang together, suggesting that • The disorders reflect a limited number of underlying mechanisms• One of which appears to be N/NE• Helps to explain why N/NE is a risk factor for multiple emotional disorders
![Page 73: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/73.jpg)
#3: Overlapping Treatment EffectsTreatments targeting one emotional disorder often improve other, non-targeted symptoms as well as N/NE
• Cognitive-behavioral therapy for generalized anxiety disorder can produce improvements in depressive symptoms
• Pharmacological treatments for MDD reduce N/NE
• Treatment effects and T&P hang together, suggesting that • The disorders reflect a limited number of underlying mechanisms• Which we can conceptualize as N/NE or a common cause• Helps to explain why N/NE is a risk factor for multiple emotional disorders
![Page 74: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/74.jpg)
#3: Overlapping Treatment EffectsTreatments targeting one emotional disorder often improve other, non-targeted symptoms as well as N/NE
• Cognitive-behavioral therapy for generalized anxiety disorder can produce improvements in depressive symptoms
• Pharmacological treatments for MDD reduce N/NE
• Treatment effects and T&P hang together, suggesting that • The disorders reflect a limited number of underlying mechanisms• Which we can conceptualize as N/NE or a common cause• Helps to explain why N/NE is a risk factor for multiple emotional disorders
![Page 75: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/75.jpg)
#3: Overlapping Treatment EffectsTreatments targeting one emotional disorder often improve other, non-targeted symptoms as well as N/NE
• Cognitive-behavioral therapy for generalized anxiety disorder can produce improvements in depressive symptoms
• Pharmacological treatments for MDD reduce N/NE
• Treatment effects and T&P hang together, suggesting that • The disorders reflect a limited number of underlying mechanisms• Which we can conceptualize as N/NE or a common cause• Helps to explain why N/NE is a risk factor for multiple emotional disorders
![Page 76: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/76.jpg)
The opposite effect is also true
Bad things increase depression, anxiety, and N/NE in tandem
![Page 77: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/77.jpg)
#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
![Page 78: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/78.jpg)
#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
![Page 79: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/79.jpg)
#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
![Page 80: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/80.jpg)
#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
![Page 81: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/81.jpg)
#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
![Page 82: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/82.jpg)
#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
![Page 83: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/83.jpg)
#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
![Page 84: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/84.jpg)
#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
![Page 85: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/85.jpg)
#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
![Page 86: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/86.jpg)
#6: Common Neural Circuit Across DX’esThe emotional disorders (and N/NE) are consistently associated with heightened activation in a core brain circuit centered on the amygdala and anterior insula
Shared biological substratescan explain why N/NE is arisk factor for multiple emotional disorders
![Page 87: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/87.jpg)
#6: Common Neural Circuit Across DX’esThe emotional disorders (and N/NE) are consistently associated with heightened activation in a core brain circuit centered on the amygdala and anterior insula
Shared biological substratescan explain why N/NE is arisk factor for multiple emotional disorders
![Page 88: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/88.jpg)
#6: Common Neural Circuit Across DX’esThe emotional disorders (and N/NE) are consistently associated with heightened activation in a core brain circuit centered on the amygdala and anterior insula
Shared biological substratescan explain why N/NE is arisk factor for multiple emotional disorders
Across Anxiety Disorders
![Page 89: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/89.jpg)
#6: Common Neural Circuit Across DX’esThe emotional disorders (and N/NE) are consistently associated with heightened activation in a core brain circuit centered on the amygdala and anterior insula
Shared biological substratescan explain why N/NE is arisk factor for multiple emotional disorders
Depression, too
![Page 90: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/90.jpg)
#6: Common Neural Circuit Across DX’esThe emotional disorders (and N/NE) are consistently associated with heightened activation in a core brain circuit centered on the amygdala and anterior insula
Shared biological substratescan explain why N/NE is arisk factor for multiple emotional disorders
Depression, too
![Page 91: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/91.jpg)
Interim Summary1. N/NE predicts the emotional disorders
(non-specific risk)2. Symptoms hang together (internalizing spectrum)3. Disorders hang together (co-morbidity)
1-3 suggest that the disorders and N/NE reflect a common cause(s)
4. Treatments cause parallel, non-specific decreases5. Environmental pathogens like stress cause parallel, non-specific
increases4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
![Page 92: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/92.jpg)
Interim Summary1. N/NE predicts the emotional disorders
(non-specific risk)2. Symptoms hang together (internalizing spectrum)3. Disorders hang together (co-morbidity)
1-3 suggest that the disorders and N/NE reflect a common cause(s)
4. Treatments cause parallel, non-specific decreases5. Environmental pathogens like stress cause parallel, non-specific
increases4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
![Page 93: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/93.jpg)
Interim Summary1. N/NE predicts the emotional disorders
(non-specific risk)2. Symptoms hang together (internalizing spectrum)3. Disorders hang together (co-morbidity)
1-3 suggest that the disorders and N/NE reflect a common cause(s)
4. Treatments cause parallel, non-specific decreases5. Environmental pathogens like stress cause parallel, non-specific
increases4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
![Page 94: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/94.jpg)
Interim Summary1. N/NE predicts the emotional disorders
(non-specific risk)2. Symptoms hang together (internalizing spectrum)3. Disorders hang together (co-morbidity)
1-3 suggest that the disorders and N/NE reflect a common cause(s)
4. Treatments cause parallel, non-specific decreases5. Environmental pathogens like stress cause parallel, non-specific
increases4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
![Page 95: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/95.jpg)
Interim Summary1. N/NE predicts the emotional disorders
(non-specific risk)2. Symptoms hang together (internalizing spectrum)3. Disorders hang together (co-morbidity)
1-3 suggest that the disorders and N/NE reflect a common cause(s)
4. Treatments cause parallel, non-specific decreases5. Environmental pathogens like stress cause parallel, non-specific
increases4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
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Interim Summary1. N/NE predicts the emotional disorders
(non-specific risk)2. Symptoms hang together (internalizing spectrum)3. Disorders hang together (co-morbidity)
1-3 suggest that the disorders and N/NE reflect a common cause(s)
4. Treatments cause parallel, non-specific decreases5. Environmental pathogens like stress cause parallel, non-specific
increases4-5 provide more mechanistic evidence that T&P (N/NE) and
psychopathology (emotional disorders) reflect a common substrate
6. Shared heritability, suggesting shared genes7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
![Page 97: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/97.jpg)
What explains who develops which disorder
(diagnostic specificity)?
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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?
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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?
![Page 100: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/100.jpg)
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?
![Page 101: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/101.jpg)
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?
![Page 102: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/102.jpg)
Is N/NE a cause, a symptom, or simply ‘the same as’ the emotional disorders?
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N is a Cause, Not a Symptom
CMD = Common Mental Disorder; Ormel et al CPR 2013
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N is a Cause, Not a Symptom
CMD = Common Mental Disorder; Ormel et al CPR 2013
Yes
Yes
Yes
Yes
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Common Cause Does Not Mean ‘The Same As’
Some individuals with high levels of N/NE never meet diagnostic criteria for an emotional disorder
Not altogether clear what this means- e.g., able to cope with or regulate N/NE to maintain sufficient
function (hence do not meet DSM criteria)? Perhaps Dx requires N/NE AND poor coping skills
- e.g., disorder requires N/NE + another
- e.g., lower intensity of N/NE (threshold effect)
- e.g., N/NE reflects a vulnerability (‘diathesis’); by chance, some never experience sufficient stress or the like to trigger full- blown disorder
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Common Cause Does Not Mean ‘The Same As’
Some individuals with high levels of N/NE never meet diagnostic criteria for an emotional disorder
Not altogether clear what this means- e.g., able to cope with or regulate N/NE to maintain sufficient
function (hence do not meet DSM criteria)? Perhaps Dx requires N/NE AND poor coping skills
- e.g., disorder requires N/NE + another
- e.g., lower intensity of N/NE (threshold effect)
- e.g., N/NE reflects a vulnerability (‘diathesis’); by chance, some never experience sufficient stress or the like to trigger full- blown disorder
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Common Cause Does Not Mean ‘The Same As’
Some individuals with high levels of N/NE never meet diagnostic criteria for an emotional disorder
Not altogether clear what this means- e.g., able to cope with or regulate N/NE to maintain sufficient
function (hence do not meet DSM criteria)? Perhaps Dx requires N/NE AND poor coping skills
- e.g., disorder requires N/NE + another cause, such as stress
- e.g., lower intensity of N/NE (threshold effect)
- e.g., N/NE reflects a vulnerability (‘diathesis’); by chance, some never experience sufficient stress or the like to trigger full- blown disorder
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Common Cause Does Not Mean ‘The Same As’
Some individuals with high levels of N/NE never meet diagnostic criteria for an emotional disorder
Not altogether clear what this means- e.g., able to cope with or regulate N/NE to maintain sufficient
function (hence do not meet DSM criteria)? Perhaps Dx requires N/NE AND poor coping skills
- e.g., disorder requires N/NE + another cause, such as stress
- e.g., lower intensity of N/NE (threshold effect)
- e.g., N/NE reflects a vulnerability (‘diathesis’); by chance, some never experience sufficient stress or the like to trigger full- blown disorder
![Page 109: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/109.jpg)
Common Cause Does Not Mean ‘The Same As’
Some individuals with high levels of N/NE never meet diagnostic criteria for an emotional disorder
Not altogether clear what this means- e.g., able to cope with or regulate N/NE to maintain sufficient
function (hence do not meet DSM criteria)? Perhaps Dx requires N/NE AND poor coping skills
- e.g., disorder requires N/NE + another cause, such as stress
- e.g., lower intensity of N/NE (threshold effect)
- e.g., N/NE reflects a vulnerability (‘diathesis’); by chance, some never experience sufficient stress or the like to trigger full- blown disorder
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Common Cause Does Not Mean ‘The Same As’
Some individuals with high levels of N/NE never meet diagnostic criteria for an emotional disorder
Not altogether clear what this means- e.g., able to cope with or regulate N/NE to maintain sufficient
function (hence do not meet DSM criteria)? Perhaps Dx requires N/NE AND poor coping skills
- e.g., disorder requires N/NE + another cause, such as stress
- e.g., lower intensity of N/NE (threshold effect)
- e.g., N/NE reflects a vulnerability (‘diathesis’); by chance, some never experience sufficient stress or the like to trigger full- blown disorder
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Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. Manipulations that decrease (treatment) or increase (negative events) one Dx, tend to have similar effects on the others as well as N/NE suggesting a common substrate
3. Elevated levels of N/NE are a common/shared feature of the emotional disorders (anxiety, depression)
4. This shared phenotype (symptoms or traits) reflects a common biological substrate (genes, brain circuits)
5. Specificity: Why do some individuals develop particular disorders, such as specific phobia of dogs?
This reflects learning and experience (exposure to aggressive dog) interacting with the core vulnerability (e.g., hyper-reactive amygdala)
6. All in all, this evidence suggests that individual differences in N/NE and Emotional Disorders are not fundamentally different, but instead reflect a common cause
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Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. Manipulations that decrease (treatment) or increase (negative events) one Dx, tend to have similar effects on the others as well as N/NE suggesting a common substrate
3. Elevated levels of N/NE are a common/shared feature of the emotional disorders (anxiety, depression)
4. This shared phenotype (symptoms or traits) reflects a common biological substrate (genes, brain circuits)
5. Specificity: Why do some individuals develop particular disorders, such as specific phobia of dogs?
This reflects learning and experience (exposure to aggressive dog) interacting with the core vulnerability (e.g., hyper-reactive amygdala)
6. All in all, this evidence suggests that individual differences in N/NE and Emotional Disorders are not fundamentally different, but instead reflect a common cause
![Page 113: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/113.jpg)
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. Manipulations that decrease (treatment) or increase (negative events) one Dx, tend to have similar effects on the others as well as N/NE suggesting a common substrate
3. Elevated levels of N/NE are a common/shared feature of the emotional disorders (anxiety, depression)
4. This shared phenotype (symptoms or traits) reflects a common biological substrate (genes, brain circuits)
5. Specificity: Why do some individuals develop particular disorders, such as specific phobia of dogs?
This reflects learning and experience (exposure to aggressive dog) interacting with the core vulnerability (e.g., hyper-reactive amygdala)
6. All in all, this evidence suggests that individual differences in N/NE and Emotional Disorders are not fundamentally different, but instead reflect a common cause
![Page 114: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/114.jpg)
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. Manipulations that decrease (treatment) or increase (negative events) one Dx, tend to have similar effects on the others as well as N/NE suggesting a common substrate
3. Elevated levels of N/NE are a common/shared feature of the emotional disorders (anxiety, depression)
4. This shared phenotype (symptoms or traits) reflects a common biological substrate (genes, brain circuits)
5. Specificity: Why do some individuals develop particular disorders, such as specific phobia of dogs?
This reflects learning and experience (exposure to aggressive dog) interacting with the core vulnerability (e.g., hyper-reactive amygdala)
6. All in all, this evidence suggests that individual differences in N/NE and Emotional Disorders are not fundamentally different, but instead reflect a common cause
![Page 115: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/115.jpg)
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. Manipulations that decrease (treatment) or increase (negative events) one Dx, tend to have similar effects on the others as well as N/NE suggesting a common substrate
3. Elevated levels of N/NE are a common/shared feature of the emotional disorders (anxiety, depression)
4. This shared phenotype (symptoms or traits) reflects a common biological substrate (genes, brain circuits)
5. Specificity: Why do some individuals develop particular disorders, such as specific phobia of dogs?
This reflects learning and experience (exposure to aggressive dog) interacting with the core vulnerability (e.g., hyper-reactive amygdala)
6. All in all, this evidence suggests that individual differences in N/NE and Emotional Disorders are not fundamentally different, but instead reflect a common cause
![Page 116: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/116.jpg)
Take Home Points1. There are substantial similarities and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally different natural kinds
2. Manipulations that decrease (treatment) or increase (negative events) one Dx, tend to have similar effects on the others as well as N/NE suggesting a common substrate
3. Elevated levels of N/NE are a common/shared feature of the emotional disorders (anxiety, depression)
4. This shared phenotype (symptoms or traits) reflects a common biological substrate (genes, brain circuits)
5. Specificity: Why do some individuals develop particular disorders, such as specific phobia of dogs?
This reflects learning and experience (exposure to aggressive dog) interacting with the core vulnerability (e.g., hyper-reactive amygdala)
6. All in all, this evidence suggests that N/NE and Emotional Disorders are not fundamentally different, but instead reflect a common cause
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Critical Thinking Questions (Pick 2)
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Critical Thinking Questions (Pick 2)
1. Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder
2. Briefly discuss the most important challenges or limitations of Barlow’s account and how future research could address them (see the extra slides for hints).
3. Choose your own adventure: We talked about many facets of mental illness and personality today. Write a nano-essay on whatever facet was most interesting to you (e.g., societal impact of mental illness, implications for public healthcare, etc.)
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Critical Thinking Questions (Pick 2)
1. Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder
2. Briefly discuss the most important challenges or limitations of Barlow’s account and how future research could address them (see the extra slides for hints).
3. Choose your own adventure: We talked about many facets of mental illness and personality today. Write a nano-essay on whatever facet was most interesting to you (e.g., societal impact of mental illness, implications for public healthcare, etc.)
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Critical Thinking Questions (Pick 2)
1. Briefly discuss the implications of what we discussed today for a loved one or celebrity (living or dead) suffering from an emotional disorder
2. Briefly discuss the most important challenges or limitations of Barlow’s account and how future research could address them (see the extra slides for hints).
3. Choose your own adventure: We talked about many facets of mental illness and personality today. Write a nano-essay on whatever facet was most interesting to you (e.g., societal impact of mental illness, implications for public healthcare, etc.)
![Page 121: Nuts & Bolts Plan for Today Shorter meeting today – No clicker review Lecture (Lahey, Barlow, and Ormel papers) – Emotional disorders: symptoms & burden.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649e165503460f94b007b0/html5/thumbnails/121.jpg)
The End
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Things to Consider Tweaking forSpring 2014
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N = Neuroticism; E = Extraversion; D = Disinhibition; C = ConscientiousnessDistress = GAD + MDD; Fear = Panic and Phobias
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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
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Regarding Weak MDD-E Relations
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Regarding Weak MDD-E RelationsLow PE is supposed to be the facet that distinguishes depression from the anxiety disorders
Tripartite Model: Clark & Watson JAP 1991; Watson et al JAP 1995a, b
HighN/NE
LowE/PE
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Regarding Weak MDD-E/PE RelationsLow PE is supposed to be the facet that distinguishes depression from the anxiety disorders
Tripartite Model: Clark & Watson JAP 1991; Watson et al JAP 1995a, b
HighN/NE
LowPE
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Regarding Weak MDD-E RelationsWeak relations may reflect the use of a broadband measure of Extraversion, rather than a more specific measure of Positive Emotionality
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Regarding Weak MDD-E RelationsWeak relations may reflect the use of a broadband measure of Extraversion, rather than a more specific measure of Positive Emotionality
Collected multiple measures of each facet of E/PE
Results revealed that
1) E/PE = 4 Facets = Sociability, PE, Exhibitionism/Dominance, and Fun-Seeking
2) Depression, but not anxiety, was strongly and selectively related to low PE
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Extra Slides
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1. Need to understand the mechanisms that convey risk (N/NE Dx)* What exactly is that arrow??* What are the proximal mechanisms mediating the assoc. between T&P and Dx* Increased reactivity, biased attention, neg appraisals, stress generation,
maladaptive coping, etc?
2. Another way to think about this is, We need to dissect N/NE into its constituents* Mood/Feelings, Cognition, Peripheral Physiol, Behavior, Learning* May be helpful to adopt an endophenotype-type simplication strategy
3. Adjudicating between causal models* Manipulations targeting N/NE would let you pick vulnerability vs. common cause* No studies have tested whether Tx-induced reductions in N/NE are separable
from changes in Dx; if so, evidence favoring vulnerability
4. N/NE is a transdiagnostic risk factor. We also need to understand the mechanisms that determine diagnostic divergence.
* e.g., why do some develop SAD vs. MDD vs. PD? * Can be environmental (severe childhood teasing vs. loss of loved one) orbiological (sensitivity to interoceptive cues)
Future Challenges
Barlow CPS 2013/in press; Caspi CPS 2013/in press; Ormel et al CPR 2013; Nolen-Hoeksema & Watkins PPS 2011
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Neuroticism / Negative Emotionality (N/NE)
Israel et al JPSP 2014
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Differences in N/NE in turn reflect- A disorder-nonspecific biological vulnerability (e.g., hyper-
reactive amygdala)
- That promotes a disorder nonspecific psychological vulnerability
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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)
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Another Hallmark of the Core Phenotype
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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)