Shackman Psyc210 Module14 TPandMentalDisordersFocusBI 041415

Nuts
& Bolts Plan for Today

Lecture (Fox and Clauss/Blackford papers)
Focus on the BI phenotype and its associa@on
with mental health, especially social anxiety
disorder (SAD)
Take-home cri@cal thinking ques@ons
PSYC 210:

How does N/NE contribute to

emo@onal disorders?

Part 2 of 3

Focus on Behavioral Inhibi2on (BI)
and Social Anxiety
D
isorder

AJ Shackman
14 April 2015
Todays Conceptual Roadmap

What is behavioral inhibi@on (BI)?
How is BI related to other models of T&P, such as
N/NE or Grays BIS? Implica@ons for thinking
about childhood temperament vs. adult
personality?
Individual dierences in BI predict anxiety and
other psychiatric disorders? Why? How? Is BI a
viable intermediate phenotype?

personality?

personality?
Jerry Kagan (Harvard)
Nathan Fox (UMD)
Danny Pine (NIMH)
Jenni Blackford (Vanderbilt)
What is BI?

Intui2ve Feel
NA Fox et al ARP 2005
Marked Individual Dierences in BI
h\p://www.abc.net.au/tv/life/video/LIFEAT1.htm
BI in Toddlers

Passive Avoidance / Freezing
Avoid unfamiliar events, objects (robot) and people
(intruder)
When faced with such challenges, children with high
levels of BI cease their play, become quiet, and
withdraw to the proximity of their caregivers
BI in Toddlers

Avoid unfamiliar events, objects (robot) and people
(intruder)
When faced with such challenges, children with high
levels of BI cease their play, become quiet, and
withdraw to the proximity of their caregivers
What About Grown Ups?
Retrospec@vely Assessing BI in Adults

Reznick and colleagues RSRI

Were you afraid of unfamiliar animals, such as those you
encountered on the street or at someone elses home?
Did it upset you when your parents le9 you with a new,
unfamiliar baby-si<er?
Did you ever pretend to be sick in order to avoid going to
school or to other social events?
Did you enjoy meeAng new children your age?




Did it upset
you when W
your
parents
e9 you with a new,
Students:
hy w
ould ylou
want to assess BI
via adult self-report?



Usual Caveats
About Self-
Report Measures
Apply
school or to other social
events?
How is BI related to other models

and other kinds of data that we have
discussed in class?
BI in Toddlers

They remain vigilant (orient toward source of poten@al threat)

May show high levels of distress (reac@ve) or show elevated levels of the
stress hormone cor@sol

Parallels with AT in monkeys (freezing/cor@sol) and BIS (passive avoidance)
in adults
BI is a Facet of N/NE
Caspis Hierarchical Model of T&P
Zentner et al. 2012; cf. Caspi et al 2005
BI in Toddlers

Parallels with BIS (passive avoidance) in adults and anxious temperament in
monkeys
Oler, Fox, Shackman & Kalin, in press
How stable is BI?

Students What is your intui2on,

Do high-BI toddlers grow up
to be high-BI adults?
BI Shows Modest Con@nuity

Stability es@mates for BI typically fall in the low to
moderate range
E.g. 4.5 to 7 years of age (R = 0.24; ~6% variance)
(Stevenson-Hinde & Shouldice, 1995)
~50% of infants in the High-BI group were classied as
High at 2 years; only ~33% at 4 years; 2/3 changed (Fox
et al. 2001)

moderate range
et al. 2001)

moderate range
et al. 2001)

Rela@vely high propor@on of children switch from
inhibited to noninhibited classica@ons (e.g., Perez-
Edgar & Fox, 2005; Kagan & Snidman, 1999)
Put simply, many to most kids grow out of extreme
early-life BI

As Kagan says, there is no need to be fatalis@c if you
are the parent of a high-BI child; considerable
plas@city and room for op@mism J

Rela@vely high propor@on of children switch from
inhibited to noninhibited classica@ons (e.g., Perez-
Edgar & Fox, 2005; Kagan & Snidman, 1999)
Put simply, many to most kids grow out of extreme
early-life BI

As Kagan says, there is no need to be fatalis@c if you
are the parent of a high-BI child; considerable
plas@city and room for op@mism J

Suggests that the environment / nurture plays an
important role in determining con@nuity (Rubin et al
2002)
e.g., stress/adversity
e.g., derisive parengng associated with increased
congnuity;

Suggests that the environment / nurture plays an
important role in determining con@nuity (Rubin et al
2002)
e.g., stress/adversity
e.g., derisive parengng associated with increased
congnuity;
StudentsWhy isnt BI more stable?

Might this reect a mixture of
Age-Appropriate Fears
vs.
More Extreme Disposi2ons?
Blackford & Pine
Why isnt BI more stable?

Might this reect a mixture of
adap2ve, age-appropriate fears
-and-
Kids with more extreme disposi2ons?
Blackford & Pine
Start @ 2:25 hjps://www.youtube.com/watch?v=cyrduIwU7UM
The preschool years are years of intense

feelings, but most children arent yet able to
use words well enough to express those
feelings. Many things can be scary to them
things that are real and imaginary and, like
all of us, they carry their own inner dramas
which color everything they see and do. So its
natural that not all children develop the same
fears, and that some children are more fearful
than others
Start @ 2:25 hjps://www.youtube.com/watch?v=cyrduIwU7UM
Students

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

(e.g., strangers, losing your parents,
geVng lost, monsters, etc.)
Blackford & Pine
Students

Why might fear & anxiety be a
norma2ve, adap2ve part of
early childhood?
Blackford & Pine
Blackford & Pine
Modest Con@nuity Reects

Norma@ve Developmental Milestones

Fear and anxiety are adap@ve in the face of danger

Intense fear and anxiety are a normal part of
childhood

Most infants experience stranger anxiety @ ~8-12 months
Most toddlers experience separagon anxiety @ ~10-18 mo
Blackford & Pine



childhood

Blackford & Pine



childhood

Blackford & Pine
Modest Con@nuity
Reects Heterogeneity

Fears are thought to be protec@ve, preven@ng the child from
encountering harm during periods marked by the onset of
walking and increased explora@on

For most kids, the norma@ve fears vanish by 2-3 years
Modest Con@nuity

Fears are thought to be protec@ve, preven@ng the child from
encountering harm during periods marked by the onset of
walking and increased explora@on

For most kids, the norma@ve fears vanish by 2-3 years
Modest Con@nuity

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

Modest Con@nuity

signicant)

Modest con@nuity of BI par@ally reects heterogeneity in the
func@onal signicance of early-life anxiety and inhibi@on; for
some kids, its a normal part of growing up; for others, a
harbinger of life-long challenges

Modest Con@nuity

signicant)

Modest con@nuity of BI par@ally reects heterogeneity in the
func@onal signicance of early-life anxiety and inhibi@on; for
some kids, its a normal part of growing up; for others, a
harbinger of life-long challenges

It also reects the emergence/matura@on of emo@on regula@on

Given this heterogeneity

Were going to focus on
the subset of children
who are characterized by
stable AND high levels of BI
Stable, High BI Confers Risk

Kids who consistently show heightened BI across repeated
laboratory assessments are at risk for developing

Anxiety Disorders
Major Depressive Disorder (MDD)
Substance Use Disorders (SUDs)
Hirshfeld-Becker NDCAD 2010
Stable, High BI Confers Risk

Kids who consistently show heightened BI across repeated
laboratory assessments are at risk for developing

Anxiety Disorders
Major Depressive Disorder (MDD)
Substance Use Disorders (SUDs)
Hirshfeld-Becker NDCAD 2010
Extreme behavioral inhibi@on (BI) confers

liability for Social Anxiety Disorder (SAD)
What exactly is SAD?

Students?
MTV Perspec2ve
h\p://www.mtv.com/videos/true-life-i-have-social-anxiety/1706675/playlist.jhtml
NIMH Perspec2ve
Social Anxiety Disorder / Social Phobia
hjp://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml
BoTom Line:

Convergence between the social
re2cence of extreme BI and SAD
Students?

What might explain this trajectory?

That is, how does BI become adult dysfunc2on?
BI Inuences Social Skill Acquisi@on

BI Promotes Problema@c Social Behaviors
Behaviorally inhibited children interact with others in less eecgve ways (e.g., nonassergve
strategies during peer interacgons)

BI Predicts Worse Social Outcomes
More likely to have their requests refused

Leads to poorer quality peer relagonships

Makes it more and more challenging for BI kids to
- learn social skills
- forge strong social relagonships with new people (develop new social networks among
peers, friends, schoolmates and ulgmately dorm-mates, colleagues, and co-workers)
These kinds of social exchange / social interac@on mechanisms may underlie the
associa@on between BI and psychopathology
Extreme BI Aberrant Social Skills/Peer Relagons Psychopathology












- learn social skills and condence




- learn social skills and condence

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

BI Inuences
Social Skill Acquisi@on

The mastery of skills that are essenAal for success and
the development of their underlying neural pathways
follow hierarchical rules. Later a<ainments build
on foundaAons that are laid down earlier.

(i) early learning confers value on acquired skills, which
leads to self-reinforcing moAvaAon to learn more, and
(ii) early mastery of a range of cogniAve, social, and
emoAonal competencies makes learning at later ages
more ecient and therefore easier and more likely to
conAnue.

A child who falls behind may never catch up.

Heckman Science 2006

Social Behaviors & Outcomes

Over gme, the experience of social failure may teach
BI children to interpret ambiguous social situagons
as threatening and believe that poor social outcomes
are a result of internal causes; socially anxious
Collec2vely, these data raise the

possibility that BI represents an
intermediate phenotype or even an
endophentype for SAD
Quick Recap
2 Kinds of Intermediate Phenotypes

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?

Miller & Rockstroh Ann Rev Clin Psychol 2013











Could BI be an endophenotype for SAD?

Yes! Modest Heritability

Heritability esgmates in toddlerhood range from .41.64 (DiLalla
et al., 1994; Emde et al., 1992; Matheny, 1989; Robinson et al.,
1992)

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

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

to eM
stablish
et al., 1994; Emde et aWork
l., 1992;
atheny, 1989; Robinson et al.,
whether BI is causal is
1992)
on-going

BI is elevated among
preschoolers
of parents with panic disorder
(Childhood
interven@on
studies in Australia
and Maryland)
Parents of kids with elevated
BI themselves are more likely to
Todays Take Home Points

personality?

personality?

personality?

Do individual dierences in BI predict anxiety and



Cri@cal Thinking Ques@ons (pick 2)

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

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

2. Watch the complete episode of MTVs True
Life: Social Anxiety Disorder (
hjp://www.mtv.com/videos/true-life-i-have-
social-anxiety/1706675/playlist.jhtml).
Briey describe:
How this popular media perspecgve on SAD jibes
with the NIMHs perspecgve (
hjp://www.nimh.nih.gov/health/topics/social-
phobia-social-anxiety-disorder/index.shtml).

3. What are the implicagons of the material we
discussed today for intervenAon?

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

Why or why not?

4. Read this brief, highly entertaining NY Times Magazine argcle on pagents with
Williams syndrome:

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

A key focus of the story is on the interacgon of genegc predisposigons and the
environment.

Briey describe the implicagons of this conceptual perspecgve for understanding
BI and SAD.

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

(biologyenvironmentnew learning and new changes in biology)

Williams syndrome:

pagewanted=all&_r=0

environment.

BI and SAD.

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

(biologyenvironmentnew learning and new changes in biology)

Williams syndrome:

pagewanted=all&_r=0

environment.

BI and SAD.

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

(biologyenvironmentnew learning and changes in biology)
5. The Anxiety & Depression Associagon of America (ADAA) distributes a

number of interesgng and informagve video clips on social anxiety disorder:

Social Anxiety
hjp://www.adaa.org/about-adaa/press-room/mulgmedia/what-is-
social-anxiety-disorder
Social Anxiety in Adults
hjp://www.adaa.org/about-adaa/press-room/mulgmedia/adults-social-
anxiety
Social Anxiety in Youth
hjp://www.adaa.org/about-adaa/press-room/mulgmedia/children-
teens-social-anxiety
Social Anxiety Symptoms
hjp://www.adaa.org/%20about-adaa/press-room/mulgmedia/social-
anxiety-symptoms
5. The Anxiety & Depression Associagon of America (ADAA) distributes a

number of interesgng and informagve video clips on social anxiety disorder:

Social Anxiety
hjp://www.adaa.org/about-adaa/press-room/mulgmedia/what-is-
social-anxiety-disorder
Social Anxiety in Adults
hjp://www.adaa.org/about-adaa/press-room/mulgmedia/adults-social-
anxiety
Social Anxiety in Youth
hjp://www.adaa.org/about-adaa/press-room/mulgmedia/children-
teens-social-anxiety
Social Anxiety Symptoms
hjp://www.adaa.org/%20about-adaa/press-room/mulgmedia/social-
anxiety-symptoms
6. Craske and colleagues (2014) describe recent developments

in cognigve-behavioral therapy for anxiety disorders.

Available @
hjp://www.sciencedirect.com/science/argcle/pii/
S0005796714000606

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

Read one or more of the vignejes and comment on what you
found most interesgng and, as relevant, how it relates to the
material we discussed in class today.


Available @
S0005796714000606


Read one or more of the vignejes and comment on what you
found most interesgng and, as relevant, how it relates to the


Available @
S0005796714000606


Read one or more of the vigne<es and comment on what you
found most interesAng and, as relevant, how it relates to the
Time-Permijng
Review Ques@ons
Which is true?
A. There is one anxiety
disorder
B. There is a whole
family of anxiety
disorders
0%
ily
le
fa
m
ho
a w
er
e i
s
Th
Th
er
e i
s
on
e
a
nx
ie
ty
d
iso
...
o
...
0%
The most common family of

psychiatric disorders is
A. Anxiety
B. Depression
C. Schizophrenia
D. Somatoform
So
m
at
Sc
h
izo
ph
re
ni
io
n
0%
of
or
m
0%
a
0%
De
pr
es
s
An
xie
ty
0%
Anxiety disorders tend to onset

A. Late in life
B. Mid life
C. Early in life
0%
Ea
rly

id

in
li
lif
e
fe

0%
M
La
t
in
lif
e
0%
Depression tends to onset

A. Early in life
B. Mid life
C. Late in life
0%
lif
e
in
e
La
t
id

fe
in
li
rly

Ea
0%
lif
e
0%
The most burdensome disorder

(disability, illnes, death) in the US is
A. Depression
B. Heart Disease
C. COPD
D. Cancer
E. Alzheimers
ei
m
er
s
0%
Al
zh
er
0%
Ca
nc
0%
CO
PD
0%
ise
as
He
ar
t D
De
pr
es
s
io
n
0%
Elevated N/NE is a risk factor for

A. Anxiety disorders
B. Depressive
disorders
C. Both
0%
Bo
t
rd
er
s
0%
ive
d
iso
De
pr
es
s
An
xie
ty
d
i
so
rd
er
s
0%
Anxiety and depression symptoms
0%
t o
e t
h
ou
gh
go
ric
a
Sh
o
ul
d
b
te
Ar
e
ca
f a
lly
d
i st
s .
..
in
r (
...
ct
o
, f
a
co
he
re
nt
0%
ct
0%
Fo
rm
a
A. Form a coherent,
factor (internalizing)
B. Are categorically
disgnct
C. Should be thought of
as natural kinds,
discrete engges that
exist in nature
waigng to be
discovered
Anxiety and depression

A. Are highly co-
morbid
B. Rarely co-occur in
the same individual
0%
th
e
s..
.
co
-o
cc
ur
in
Ra
re
ly
Ar
e
h
igh
ly
co
-m
or
bi
0%
Treatments targegng one emogonal

disorder
in
g a
tin
gs
Bo
t
h,
su
gg
es
t
se
ra
De
cr
ea
0%
m
..
e.
..
se
) t
h
(d
ec
re
a
e
ra
t
Am
el
io
0%
o
f N
/N
E
0%
co
m
A. Ameliorate
(decrease) the
symptoms of other
emogonal disorders
B. Decrease ragngs of
N/NE
C. Both, suggesgng a
common cause
Negagve life events & psychological

pathogens such as stress tend to
e t
h
In
cr
ea
s
e
in
di
vi
ov
e
0%
he
ab
of
t
e N
/N
E
0%
Al
l
o
f d
ev
el
...
0%
In
cr
ea
s
du
a
e r
isk
ls
to
cr
os
s..
.
0%
Ca
us
A. Cause individuals to
cross the diagnosgc
boundary and
experience a frank
depressive disorder
B. Increase the risk of
developing a
diagnosable anxiety
disorder
C. Increase N/NE
D. All of the above
Anxiety disorders, depression, and N/

NE
A. Reect completely
separate genes
B. Are inherited
together (shared
inheritance),
suggesgng a
common genegc
underpinning
to
ge
th
ly
Ar
e
in
he
rit
e
et
e
om
pl
Re
f le
ct
c
0%
er
(.
..
se
pa
r..
.
0%
Recent meta-analyses demonstrate

that
g e
vid
...
h,
p
ro
vid
Bo
t
0%
en
ce
..
.
0%
ke
N
/N
E,
is

io
n,
li
De
pr
es
s
A
va
rie
ty
o
f a
n
xie
ty
d
i
so
r..
.
0%
in
A. A variety of anxiety
disorders, like N/NE, are
associated with
heightened amygdala
acgvagon to potengal
threat
B. Depression, like N/NE, is
associated with increased
amygdala reacgvity to
aversive cues
C. Both, providing evidence
for a common biology
Barlow argues that the development

of a pargcular Dx (diagnosgc
specicity) reects
0%
na
he
r n
o
te
vu
ln
...
n-
sp
ec
i..
.
0%
N/
NE
a
nd
o
t
in
an
nd
N/
NE
a
nd
di
so
rd
er
-sp
ec
i. .
.
0%
N/
NE
a
A. N/NE and a
disorder-specic
learned vulnerability
(e.g., fear dogs)
B. N/NE and an innate
vulnerability
C. N/NE and other
non-specic risk
factors
N/NE is a
l d
na
ot
io
Sy
m
pt
f e
m
e
o
0%
0%
0%
iso
om
r..
.
o
f e
m
ot
Id
en
io
na
tic
l d
al
to
...
o
r s
A
yn
sy
on
m
ym
pt
om
o.
.
o
f t
oo
m
uc
h
...
0%
Ca
us
A. Cause of emogonal
disorders
B. Symptom of
emogonal disorders
C. Idengcal to or
synonymous with the
emogonal disorders
D. A symptom of too
much anxiety
The End
Extra Slides

Strong fear of being judged by others and of being
embarrassed, crigcized, or found out.

Can be so strong that it gets in the way of going to work
or school or doing other everyday things

Everyone has felt anxious or embarrassed at one gme
or another. For example, meegng new people or giving
a public speech can make anyone nervous

But people with social phobia worry about these and
other things for weeks before they happen


Afraid of doing common things in front of other
people

e.g., signing a check in front of a cashier at the
grocery store

eagng or drinking in front of other people

using a public restroom

Intermediate Phenotypes are a Bridge

Symptoma@c Disorders (Phenotype)
Genome (Genotype)
Endophenotypes: 6 Criteria
6. Can be measured reliably

People with SAD know that they shouldn't be as
afraid as they are, but have trouble regula@ng their
fears

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

People with SAD know that they shouldn't be as
afraid as they are, but have trouble regula@ng their
fears

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

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Nuts

& Bolts Plan for Today

Take-home cri@cal thinking ques@ons

How does N/NE contribute to

Todays Conceptual Roadmap

Todays Conceptual Roadmap

Todays Conceptual Roadmap

Jerry Kagan (Harvard)

Nathan Fox (UMD)

Danny Pine (NIMH)

Jenni Blackford (Vanderbilt)

NA Fox et al ARP 2005

Marked Individual Dierences in BI

NA Fox et al ARP 2005

NA Fox et al ARP 2005

What About Grown Ups?

Retrospec@vely Assessing BI in Adults

Reznick and colleagues RSRI

Retrospec@vely Assessing BI in Adults

Reznick and colleagues RSRI

Retrospec@vely Assessing BI in Adults

Reznick and colleagues RSRI

Did you ever pretend to be sick in order to avoid going to

Retrospec@vely Assessing BI in Adults

Reznick and colleagues RSRI

How is BI related to other models

Caspis Hierarchical Model of T&P

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

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

Oler, Fox, Shackman & Kalin, in press

How stable is BI?

BI Shows Modest Con@nuity

NA Fox et al ARP 2005

BI Shows Modest Con@nuity

NA Fox et al ARP 2005

BI Shows Modest Con@nuity

NA Fox et al ARP 2005

BI Shows Modest Con@nuity

BI Shows Modest Con@nuity

BI Shows Modest Con@nuity

NA Fox et al ARP 2005

BI Shows Modest Con@nuity

NA Fox et al ARP 2005

StudentsWhy isnt BI more stable?

Why isnt BI more stable?

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

The preschool years are years of intense

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

Blackford & Pine

Blackford & Pine

Modest Con@nuity Reects

Blackford & Pine

Modest Con@nuity Reects

Blackford & Pine