Shackman Psyc210 Module14 TPandMentalDisordersFocusBI

Nuts & Bolts Plan for
Today
Lecture (Fox and Clauss/Blackford
papers)
Focus on the BI phenotype and its
association with mental health,
especially social anxiety disorder
(SAD)
Take-home critical thinking

questions
PSYC 210:
How does N/NE contribute to emotional disorders?
Part 2 of 3
Focus on Behavioral Inhibition (BI) and Social Anxiety Disorder
AJ Shackman
14 April 2015
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?

phenotype?

phenotype?
erry Kagan (Harvard)
Nathan Fox (UMD)
Danny Pine (NIMH)
Jenni Blackford (Vanderbilt
What is BI?
Intuitive Feel
NA Fox et al ARP 200
Marked Individual Differences in

BI
http://
www.abc.net.au/tv/life/video/LIFEAT1.
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?
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?
Adults
someone elses home?
Adults
someone elses home?
Students: Why
would you want to
assess BI
via adult selfreport?
Adults
someone elses home?
Usual
Caveats
About
Did it upset
you whenSelfyour parents left you with a
Report
Measures
Did you ever
pretend to be sick in order to avoid
going to schoolApply
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 potential
threat)
May show high levels of distress (reactive) or show
elevated levels of the stress hormone cortisol
Parallels with AT in monkeys (freezing/cortisol) and BIS
(passive avoidance) in adults
BI is a Facet of N/NE
Caspis Hierarchical Model of T&P
Zentner et al. 2012; cf. Caspi et al 20
BI in Toddlers
Parallels with BIS (passive avoidance) in adults and

anxious temperament in monkeys
r, Fox, Shackman & Kalin, in press
How stable is BI?

Students What is your intuition,
Do high-BI toddlers grow up
to be high-BI adults?
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)

1995)

1995)

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 highBI child; considerable plasticity and room
for optimism

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 highBI child; considerable plasticity and room
for optimism

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;

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;
StudentsWhy isnt BI more stable?

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

Might this reflect a mixture of adaptive, age-appropriate fears
-andKids with more extreme dispositions?
Blackford & Pine
Start @ 2:25 https://www.youtube.com/watch?
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 https://www.youtube.com/watch?
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
Students
Why might fear & anxiety be a normative, adaptive part of

early childhood?
Blackford & Pine
Blackford & Pine
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

face of danger
part of childhood
months
mo
Blackford & Pine

face of danger
part of childhood
months
mo
Blackford & Pine
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 23 years
Modest Continuity
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 23 years
Modest Continuity
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
persistence of these fears and the
development of new fears, which we would
deem non-normative or age-inappropriate (i.e.,
clinically significant)
Modest continuity of BI partially reflects
heterogeneity in the functional significance of
early-life anxiety and inhibition; for some kids,
its a normal part of growing up; for others, a
harbinger of life-long challenges
Modest Continuity
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 earlylife anxiety and inhibition; for some kids, its a
normal part of growing up; for others, a harbinger of
life-long challenges
It also reflects the emergence/maturation of emotion
regulation
Given this heterogeneity

Were going to focus on
the subset of children
who are characterized by
stable AND high levels of BI
able, 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 201
able, 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 201
confers
liability for Social Anxiety
Disorder (SAD)
What exactly is SAD?

Students?
MTV Perspective
http://www.mtv.com/videos/true-life-i-have-social-
NIMH Perspective
Social Anxiety Disorder / Social

Phobia
http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-

Phobia

Phobia

Phobia

Phobia

Phobia

Phobia

Phobia
Bottom Line:
Convergence between the social reticence of extreme BI and
SAD
Students?
What might explain this trajectory?
That is, how does BI become adult
dysfunction?
BI Influences Social Skill 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








- learn social skills and confidence



- learn social skills and confidence


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

mastery of skills that
essential for
SocialTheBehaviors
&areOutcomes
success and the development of their
underlying
neural
pathways
Over time,
the
experience
of social failure
follow hierarchical rules. Later attainments
may teach
BI children to interpret
build
on foundations that are laid down earlier.
ambiguous
social situations as threatening
(i) early learning confers value on acquired
and believe
that poor social outcomes are
skills, which leads to self-reinforcing
motivation
to learn more,
and (ii) early
a result
of internal
causes;
socially anxious
mastery of a range of cognitive, social, and
emotional competencies makes learning at
later ages more efficient and therefore easier
and more likely to continue.
A child who falls behind may never catch up.
Heckman Science 2006
Collectively, these data raise the possibility that BI

represents an intermediate phenotype or even an
endophentype for SAD
Quick 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 20


SAD?


SAD?

Could BI be an endophenotype for

SAD?
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)

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

Work to
Heritability estimates
in establish
toddlerhood range from .
is
41.64 (DiLalla etwhether
al., 1994;BIEmde
et al., 1992;
is on-going
Matheny, 1989;causal
Robinson
et al., 1992)
(Childhood
BI is elevated among
preschoolers of parents with
intervention
panic disorder
studies in
Australia
andelevated
Maryland)
Parents of kids with
BI themselves are more

Todays Take Home Points

phenotype?

phenotype?

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?

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



Critical Thinking Questions (pick

2)

2)
1. Briefly describe: What are some
loose ends with this simplified
account? What are the most
important challenges for future
research?

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

2)
2. Watch the complete episode of MTVs
True Life: Social Anxiety Disorder (http://
www.mtv.com/videos/true-life-i-have-soci
al-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-so
cial-anxiety-disorder/index.shtml
).

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?

2)
4. Read this brief, highly entertaining NY Times Magazine article on patients
with Williams syndrome:
http
://www.nytimes.com/2007/07/08/magazine/08sociability-t.html?pagewanted=al
l&_
r=0
A key focus of the story is on the interaction of genetic predispositions and the
environment.
Briefly describe the implications of this conceptual perspective for
understanding BI and SAD.
How might stable, high levels of social reticence and anxiety interact early in
life interact with the environment (e.g. relationships with caregivers, teachers,
and peers) in ways that increase the likelihood of developing psychopathology?
(biologyenvironmentnew learning and new changes in biology)

2)
http
l&_
r=0
environment.
How might stable, high levels of social reticence and anxiety interact early in
life interact with the environment (e.g. relationships with caregivers, teachers,
and peers) in ways that increase the likelihood of developing psychopathology?
(biologyenvironmentnew learning and new changes in biology)

2)
http
l&_
r=0
environment.
How might stable, high levels of social reticence and anxiety early in life
interact with the environment (e.g. relationships with caregivers, teachers, and
peers) in ways that increase the likelihood of developing psychopathology?
(biologyenvironmentnew learning and changes in biology)

2)
5. The Anxiety & Depression Association of America (ADAA) distributes a
number of interesting and informative video clips on social anxiety
disorder:
Social Anxiety http://
www.adaa.org/about-adaa/press-room/multimedia/what-is-social-anxiety-d
isorder
Social Anxiety in Adults http://
www.adaa.org/about-adaa/press-room/multimedia/adults-social-anxiety
Social Anxiety in Youth http://
www.adaa.org/about-adaa/press-room/multimedia/children-teens-social-a
nxiety
Social Anxiety Symptoms http://www.adaa.org/%
20about-adaa/press-room/multimedia/social-anxiety-symptoms
Watch any one of the video clips and briefly comment on what you found

2)
5. The Anxiety & Depression Association of America (ADAA) distributes a
number of interesting and informative video clips on social anxiety
disorder:
Social Anxiety http://
www.adaa.org/about-adaa/press-room/multimedia/what-is-social-anxiety-d
isorder
Social Anxiety in Adults http://
www.adaa.org/about-adaa/press-room/multimedia/adults-social-anxiety
Social Anxiety in Youth http://
www.adaa.org/about-adaa/press-room/multimedia/children-teens-social-a
nxiety
Social Anxiety Symptoms http://www.adaa.org/%
20about-adaa/press-room/multimedia/social-anxiety-symptoms
Watch any one of the video clips and briefly comment on what you found

2)
6. Craske and colleagues (2014) describe recent

developments in cognitive-behavioral therapy for anxiety
disorders.
Available @
http://
www.sciencedirect.com/science/article/pii/S00057967140006
06
In the second half of the paper, they describe several case
studies of individual patients (e.g. Deandres experience
with social phobia).
Read one or more of the vignettes and comment on what you
found most interesting and, as relevant, how it relates to the

2)

disorders.
Available @
http://
06

2)

disorders.
Available @
http://
06
Time-Permitting
Review Questions
Which is true?
A. There is one
anxiety disorder
B. There is a whole
family of
anxiety
disorders
The most common family of

psychiatric disorders is
A. Anxiety
B. Depression
C. Schizophrenia
D. Somatoform
Anxiety disorders tend to onset

A. Late in life
B. Mid life
C. Early in life
Depression tends to onset

A. Early in life
B. Mid life
C. Late in life
The most burdensome disorder

(disability, illnes, death) in the US is
A. Depression
B. Heart Disease
C. COPD
D. Cancer
E. Alzheimers
Elevated N/NE is a risk

factor for
A. Anxiety
disorders
B. Depressive
disorders
C. Both
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
Anxiety and depression

A. Are highly comorbid
B. Rarely co-occur
in the same
individual
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
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
Anxiety disorders, depression, and

N/NE
A. Reflect
completely
separate genes
B. Are inherited
together
(shared
inheritance),
suggesting a
common genetic
underpinning
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
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
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
The End
Extra Slides

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

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
Intermediate Phenotypes are a

Bridge
mptomatic Disorders (Phenotype)
Genome (Genotype)
Endophenotypes: 6 Criteria
6. Can be measured reliably

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

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

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Nuts & Bolts Plan for

Take-home critical thinking

Todays Conceptual Roadmap

Todays Conceptual Roadmap

Todays Conceptual Roadmap

erry Kagan (Harvard)

Nathan Fox (UMD)

Danny Pine (NIMH)

Jenni Blackford (Vanderbilt

NA Fox et al ARP 200

Marked Individual Differences in

NA Fox et al ARP 200

NA Fox et al ARP 200

What About Grown Ups?

How is BI related to other models

Caspis Hierarchical Model of T&P

Zentner et al. 2012; cf. Caspi et al 20

Parallels with BIS (passive avoidance) in adults and

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

r, Fox, Shackman & Kalin, in press

How stable is BI?

NA Fox et al ARP 200

BI Shows Modest Continuity

NA Fox et al ARP 200

BI Shows Modest Continuity

NA Fox et al ARP 200

BI Shows Modest Continuity

NA Fox et al ARP 200

BI Shows Modest Continuity

NA Fox et al ARP 200

BI Shows Modest Continuity

NA Fox et al ARP 200

BI Shows Modest Continuity

NA Fox et al ARP 200

BI Shows Modest Continuity

NA Fox et al ARP 200

StudentsWhy isnt BI more stable?

Blackford & Pine

Why isnt BI more stable?

Blackford & Pine

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

The preschool years are years of

Blackford & Pine

Why might fear & anxiety be a normative, adaptive part of

Blackford & Pine

Blackford & Pine

Modest Continuity Reflects

Blackford & Pine

Modest Continuity Reflects

Blackford & Pine

Modest Continuity Reflects

Blackford & Pine

Given this heterogeneity

able, High BI Confers Risk

Hirshfeld-Becker NDCAD 201