Shackman Psyc210 Module13 TPandMentalDisordersFocusNE 040715

Nuts
& Bolts Plan for Today

Exam
Grades uploaded to Canvas in the next 48 hours

Item #51 will be dropped
Reminder: 4-point extra credit opportunity (see syllabus
for details)

Lecture: Lahey, Barlow, and [opMonal] Ormel papers
EmoMonal disorders: symptoms & burden
Informed ciMzens and taxpayers
Take-home criMcal thinking quesMons

No class on Thursday (SAS meeMng in SF / ADAA meeMng
in Miami)
PSYC 210:

How does T&P contribute to
emoMonal disorders?

Part 1 of 3

Focus on N/NE

AJ Shackman
7 April 2015
Take Care of Yourself & One Another
Todays Conceptual Roadmap

What are the emoMonal disorders? Why are they a
big deal?
Why is N/NE a risk factor for mulMple diagnoses?
What does this mean for our understanding of the
emo6onal disorders?
For the DSM (the Bible of psychiatric diagnoses)?
What is the common denominator shared by N/NE

and the emoMonal disorders?
Shared biology?
Other kinds of core features

big deal?
emo6onal disorders?

Shared biology?

big deal?
emo6onal disorders?

Shared biology?

big deal?
emo6onal disorders?

Shared biology?

big deal?
emo6onal disorders?

Shared biology?
Other kinds of core features?
SecMon 1: What is N/NE and how is it

related to emoMonal disorders
Students: What are key features of N/NE?
NeuroMcism / NegaMve EmoMonality (N/NE)
Caspi et al. ARP 2005; Barlow et al. CPS 2013
N/NE: Boiling It Down

EmoMon
suscepAbility to negaAve moods

Appraisal
experience the world as distressing or threatening

MoMvaMon
aversive / defensive; tendency to
work hard to avoid punishment


EmoMon

Appraisal

MoMvaMon


EmoMon

Appraisal

MoMvaMon


EmoMon

Appraisal

MoMvaMon
Lumper!

Like Caspi, David Barlow emphasizes the
similariMes between dierent models and
measures of NegaMve EmoMonality (NE)
NeuroAcism
Behavioral InhibiAon System (BIS)
(Childhood) Behavioral InhibiAon (BI)
NegaAve AecAvity (NA)
Trait Anxiety (STAI)
Harm Avoidance (HA)
Students: What is the signicance?

Lahey Amer Psychol 2009
For comparison purposes, a Cohens

d of 1.04 is equivalent to

R = .46 (21% shared variance)

For comparison purposes, a Cohens

d of 1.04 is equivalent to

R = .46 (21% shared variance)

~1 SD dierence

SecMon 2: Crash course in emoMonal

disorders

(I do not expect you to retain the specics
of the next few slides, just the gist)
EmoMonal Dx are a Big Deal
EmoMonal Dx are a Big Deal

Emo6onal Dx Are a Big Deal

- tremendous suering

- tremendous economic burden

- aggravate other problems and disorders

Anxiety Dx: Signs
hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml
Anxiety Dx: Signs
Students What are the key features

of the anxiety disorders?
Anxiety Dx: Signs
Anxiety Dx: Signs
Family of Disorders
Generalized Anxiety (GAD))
Panic

Post-TraumaAc Stress (PTSD)
Social Anxiety / Social Phobia
Other Specic Phobias
General
About aJacks
About trauma cues
About social interacLons
e.g., dogs, spiders

Anxiety Dx: Signs
Family of Disorders
Generalized Anxiety (GAD))
Panic

Post-TraumaAc Stress (PTSD)
Social Anxiety / Social Phobia
Other Specic Phobias
General
About aJacks
About trauma cues
About social interacLons
e.g., dogs, spiders

Anxiety Dx: Very Common

Anxiety disorders are the most
common family of mental
Illnesses, aecAng 40M U.S.
adults

Anxiety disorders are the most
common family of mental
Illnesses, aecAng 40M U.S.
adults
More Lme for cumulaLve damage

Anxiety Dx: Snares Many Teens

Anxiety disorders aect
1 in 4 teens

Teens with untreated anxiety
disorders are at higher risk for
performing poorly in school,
missing out on important social
experiences with peers and
others, and substance abuse

Anxiety disorders aect
1 in 4 teens

Teens with untreated anxiety
disorders are at higher risk for
performing poorly in school,
missing out on important social
experiences with peers and
others, and substance abuse
Anxiety Dx: Under-Treated
Anxiety Dx: Under-Treated
Anxiety Dx: Expensive
Anxiety Dx: Expensive

Cost the U.S. >$42B/yr,
one-third of the
country's $148 billion
total mental health bill

All in all, ~10% of Medicaid funding pays for mental
health care and ~20% of state/local health programs
pay for mental health care
Major Depressive Disorder (MDD)
MDD: Signs
Students What are the key features

of depression?
MDD: Signs
MDD: Diagn. Criteria
MDD: Common
MDD: Common
MDD: Common
Burden: MDD is the leading disorder
DALY = disability-adjusted life-year

Burden: MDD is the leading disorder
DALY = disability-adjusted life-year

I want to belabor this point

for a moment
World-wide stats from the World Health OrganizaAon (WHO)
1 Euro = $1.09
1 Euro = $1.09
1 Euro = $1.09
1 Euro = $1.09
Mood Disorders: Under-Treated
Mood Disorders: Under-Treated
Boeom Line

N/NE confers
substan6al risk for emo6onal disorders
and emo6onal disorders are a big deal

Whadya mean risk?
Boeom Line

N/NE confers
substan6al risk for emo6onal disorders
and emo6onal disorders are a big deal

Whadya mean risk?
N/NE is

The strongest predictor of categorical emoAonal disorder diagnoses
(Kotov et al., 2010)
The strongest predictor of conLnuous symptoms (self-report and clinical
raAngs) that cut across disorders
Especially strongly linked to general distress/negaAve aecAvity (e.g.,
depressed mood, anxious mood, worry), which lies at the core of the
emoAonal disorders
Remains predicAve of anxiety and depression symptoms even aler
eliminaAng overlapping content (Uliaszek et al., 2009)

I feel depressed (DSM) vs. I feel blue (N/NE)
Lahey Amer Psychol 2009; cf. Kotov et al Psych Bull 2010; Watson &Naragon-Gainey CPS 2014
N/NE is

depressed mood, anxious mood, worry), which lies at the core of the
emoAonal disorders

N/NE is

depressed mood, anxious mood, worry), that lies at the core of the
emoAonal disorders

N/NE is

depressed mood, anxious mood, worry), that lies at the core of the
emoAonal disorders

Why?
???
Risk
Why does N/NE confer risk for mulMple disorders?

MulMple Disorders
???
Risk
MDD
SecMon 3. Why is N/NE a TransdiagnosMc

Risk Factor ?
David Barlow (BU)
Among the most prominent living anxiety researchers

Key member of the team that wrote DSM-IV
Barlow Argues that N/NE and

EmoMon Disorders Reect a Common
TransdiagnosMc Cause
ANX
For convergent evidence, see Ormel et al CPR 2013
N/NE
DEP

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 mulAple
emoAonal disorders

They are not categorically
dierent enAAes
ANX
N/NE
DEP

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 mulAple
emoAonal disorders

Because they are not categorically
dierent enAAes
ANX
N/NE
DEP
Internalizing Spectrum
Of Disorders
(a.k.a. EmoMonal Dxes)
Barlow oers 6 lines of evidence
#1: Disorders are not categorically disMnct

Factor analyses indicate broad spectra, not discrete diagnoses
Dump in the symptoms (diagnosMc criteria) that are used by the DSM to
dene all of the emoMonal 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!

NO!
YES!

NO!
YES!
What does a spectrum look like to a

psychiatric sta6s6cian?
0000

Third and last example
Can re-represent each of the categorical

diagnoses as scores on two correlated
dimensions (Distress and Fear)

The scores do a beeer job predicMng
deleterious future outcomes than the diagnoses

Boeom Lines
#1. DSM diagnoses are not real natural kinds, they
are clinically convenient short-hand descripMons
of symptom clusters

#2. Evidence suggests that the symptoms that
dene the disorders reect 2 highly correlated
factors (latent dimensions), which helps to
explain why, for example, MDD and GAD
Frequentlyco-occur




2 Boeom Lines
of symptom clusters

factors (Distress & Fear = Internalizing), which
helps to explain why, for example, MDD and GAD
open co-occur and why N/NE predicts both




2 Boeom Lines
of symptom clusters (sound familiar?)





2 Boeom Lines
of symptom clusters (sound familiar?)


Not just the symptoms that

hang together
#2: EmoMonal Dxes are Highly Comorbid

Consistent with the factor analysis of symptoms,

Individuals diagnosed with one emoAonal disorder olen meet
diagnosAc criteria for one or more other emoAonal disorders
Tend to hang together in nature
Suggests that they reect dierent manifestaAons of one or a limited
number of aberrant mechanisms
Which helps to explain why N/NE predicts mulAple emoAonal
disorders


e.g., Nearly 50% of those Dxed with depression are also diagnosed
with an anxiety disorder
Like the symptoms, the disorders tend to hang together in the clinic
Common mechanism(s) helps to explain why N/NE predicts mulAple
emoAonal disorders


Common mechanism(s) helps to explain why N/NE predicts mulAple
emoAonal disorders


number of aberrant mechanisms. Common mechanism(s) helps to
explain why N/NE predicts mulAple emoAonal disorders
#3. Things that Alter One Disorder

Tend to Alter the Others
(and N/NE)
in a Similar Way
#3: Overlapping Treatment Eects

Treatments targeMng one emoMonal disorder open improve other,
non-targeted symptoms as well as N/NE

CogniAve-behavioral therapy for generalized anxiety disorder can
produce improvements in depressive symptoms
Pharmacological treatments for MDD reduce N/NE
Treatment eects and T&P hang together, suggesAng that
The disorders reect 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 mulAple emoAonal disorders


Which we can conceptualize as N/NE or a common cause




The opposite eect is also true

Bad things increase depression,
anxiety, and N/NE in tandem
#4: Shared Environmental Pathogens

Mirroring the treatment evidence, negaMve events that increase the
risk for developing one emoMonal disorder tend to increase the risk of
developing the others

E.g., stress, early adversity, conict, unemployment, abuse/
maltreatment
All increase the risk of developing a diagnosable emoAonal
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 mulMple emoMonal disorders



maltreatment
disorder

There is evidence that they also elevate N/NE




maltreatment
disorder





maltreatment
disorder



Bateson Can J Psychiatry 2011
Bateson Can J Psychiatry 2011


maltreatment
disorder



#5: Shared Genes (Heritability)
The emoMonal disorders are somewhat heritable

N/NE is somewhat heritable

The variaMon in emoMonal disorders that is heritable is shared across

mulMple disorders AND N/NE

Familial aggregaMon and segregaMon

Families (pedigrees) tend to have higher or lower levels of emoAonal disorders
AND N/NE
Individuals within families with higher levels of one tend to have higher levels of
the others
Common inheritance
Shared geneAc underpinnings

Common geneMc substrate would help to explain why N/NE is a risk factor
for mulMple emoMonal disorders


The variaMon in emoMonal disorders that is heritable is shared among

mulMple disorders AND N/NE


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

Common geneMc substrate, one shared by mulMple DXes and N/NE, would
help to explain why N/NE is a risk factor for mulMple emoMonal disorders



mulMple disorders AND N/NE (jargon term: geneMcally correlated)


AND N/NE
Common inheritance






AND N/NE
Common inheritance






AND N/NE
Common inheritance

#6: Common Neural Circuit Across DXes

The emoMonal disorders (and N/NE) are consistently associated with
heightened acMvaMon in a core brain circuit centered on the
amygdala and anterior insula

Shared biological substrates
can explain why N/NE is a
risk factor for mulMple
emoMonal disorders



emoMonal disorders



emoMonal disorders

Across Anxiety Disorders



emoMonal disorders

Depression, too!



emoMonal disorders

Depression, too

Interim Summary
1. N/NE predicts the emoMonal disorders

(non-specic risk)
2. Symptoms hang together (internalizing spectrum)
3. Disorders hang together (co-morbidity)
1-3 suggest that the disorders and N/NE reect a common cause(s)

4. Treatments cause parallel, non-specic decreases
5. Environmental pathogens like stress cause parallel, non-specic
increases
4-5 provide more mechanis6c evidence that T&P (N/NE) and
psychopathology (emo6onal disorders) reect a common substrate

6. Shared heritability, suggesMng shared genes
7. Shared brain circuitry
6-7 begin to address the make-up of the common cause
Interim Summary

(non-specic risk)

increases

Interim Summary

(non-specic risk)

increases

Interim Summary

(non-specic risk)

increases

Interim Summary

(non-specic risk)

increases

Interim Summary

(non-specic risk)

increases

Interim Summary

(non-specic risk)

increases

6-7 begin to address the biological origins of the common cause
What explains who develops

which disorder
(diagnos6c specicity)?
The development of a parMcular

emoMonal disorder reects
1. Non-specic common cause: Elevated N/NE

2. Disorder specic, learned vulnerability

e.g., Why a specic phobia of dogs?













Temperamental Risk
Specic Learning Experience
Is N/NE a cause, a symptom, or simply

the same as the emo6onal
disorders?
N is a Cause, Not a Symptom
CMD = Common Mental Disorder; Ormel et al CPR 2013
N is a Cause, Not a Symptom

Yes
Yes
N/NE precedes disorder onset
Yes
Yes
Yes
CMD = Common Mental Disorder; Ormel et al CPR 2013
Common Cause Does Not Mean

The Same As
Some individuals with high levels of N/NE never meet diagnosAc criteria
for an emoAonal disorder

Not altogether clear what this means
- e.g., able to cope with or regulate N/NE to maintain sucient
funcAon (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 eect)

- e.g., N/NE reects a vulnerability (diathesis); by chance,
some never experience sucient stress or the like to trigger full-
blown disorder

The Same As


- e.g., disorder requires N/NE + another


blown disorder

The Same As


- e.g., disorder requires N/NE + another cause, such as stress


blown disorder

The Same As




blown disorder

The Same As




blown disorder
Take Home Points
1.
There are substanMal similariMes and co-morbidity between the anxiety and
depressive disorders. Spectra, not fundamentally dierent natural kinds
2.
ManipulaMons that decrease (treatment) or increase (negaMve events) one Dx,

tend to have similar eects on the others as well as N/NE suggesMng a
common substrate
3.
Elevated levels of N/NE are a common/shared feature of the emoMonal

disorders (anxiety, depression)
4.
This shared phenotype (symptoms or traits) reects a common biological

substrate (genes, brain circuits)
5.
Specicity: Why do some individuals develop parMcular disorders, such as

specic phobia of dogs?
This reects learning and experience (exposure to aggressive dog)
interacMng with the core vulnerability (e.g., hyper-reacMve amygdala)

6. All in all, this evidence suggests that individual dierences in N/NE and
EmoMonal Disorders are not fundamentally dierent, but instead reect a
common cause
Take Home Points
1.
2.

common substrate
3.

4.

5.


common cause
Take Home Points
1.
2.

common substrate
3.

4.

5.


common cause
Take Home Points
1.
2.

common substrate
3.

disorders (anxiety, depression). EmoMonal disorders are a Really Big Deal
4.

5.


common cause
Take Home Points
1.
2.

common substrate
3.

4.

5.


common cause
Take Home Points
1.
2.

common substrate
3.

4.

5.


common cause
Take Home Points
1.
2.

common substrate
3.

4.

5.


6. All in all, this evidence suggests that N/NE and EmoMonal Disorders are not
fundamentally dierent, but instead reect a common cause
CriMcal Thinking QuesMons (Pick 2)

1. Briey discuss the implicaAons of what we discussed
today for a loved one or celebrity (living or dead) suering
from an emoAonal disorder e.g. Robin Williams
2. Briey discuss the most important challenges or
limitaAons of Barlows 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 interesAng to you
(e.g., societal impact of mental illness, implicaAons for
public healthcare, etc.)

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 interesAng to you
(e.g., societal impact of mental illness, implicaAons for
public healthcare, etc.)

could address them.
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 interesAng to you (e.g.,
societal impact of mental illness, implicaAons for public
healthcare, sAgma, etc.)
ConLnued on next slide

4. Theres growing evidence that the microfauna in our
intesAnes inuence our state of mind. The gut-brain
axis seems to be bidirecAonalthe brain acts on
gastrointesAnal and immune funcAons that shape the
guts microbial makeup, and gut microbes make
neurotransmiSers and metabolites that act on the
brain.

e.g. ScienAsts colonized the intesAnes of one strain of
mice with bacteria taken from the intesAnes of another
mouse strain, the recipient animals would take on
aspects of the donors personality. Naturally Amid mice
would become more exploratory, whereas more daring
mice would become apprehensive and shy.

What do you think?

Briey describe the potenAal implicaAons of this work
(e.g. for our understanding of T&P, for
psychopathology, for the development of
neutriceuAcals (ProbioAcs for your Brain, etc.)
Schmidt Nature 2015; Cryan & Dinan Nature Rev Neuro 2012; Collins et al Nature Rev Microbio 2012

brain.

aspects of the donors personality. Timid mice became
exploratory, whereas daring mice became
apprehensive and shy.

What do you think?

psychopathology, for the development of
neutriceuAcals (ProbioAcs for your Brain, etc.)

brain.

aspects of the donors personality. Timid mice became
exploratory, whereas daring mice became
apprehensive and shy.

What do you think?

psychopathology, and for the development of
neutriceuAcals (ProbioAcs for your Brain, etc.))

5. The Anxiety & Depression AssociaAon of America (ADAA) distributes a number of compelling video
clips and other kinds of informaAon on what its like to live with an anxiety disorder:

Stossel Interview Re Anxiety hSp://www.adaa.org/about-adaa/press-room/mulAmedia/stossel
Glass People / Anxiety hSp://www.adaa.org/about-adaa/press-room/mulAmedia/glass-people

Myths & MisconcepAons hSp://www.adaa.org/understanding-anxiety/myth-concepAons
What do you think?

Watch one of the video clips or read the M&M webpage and then briey comment on what you found most
interesAng, informaAve, or counter-intuiAve. Briey comment on how you might make use of this
informaAon or other facts about mental illness that we covered in class in your own daily life (with friends,
family members, or co-workers).

5. The Anxiety & Depression AssociaAon of America (ADAA) distributes a number of compelling video
clips and other kinds of informaAon on what its like to live with an anxiety disorder:

Stossel Interview Re Anxiety hSp://www.adaa.org/about-adaa/press-room/mulAmedia/stossel
Glass People / Anxiety hSp://www.adaa.org/about-adaa/press-room/mulAmedia/glass-people

Myths & MisconcepAons hSp://www.adaa.org/understanding-anxiety/myth-concepAons
What do you think?

Watch one of the video clips or read the M&M webpage and then briey comment on what you found most
interesAng, informaAve, or counter-intuiAve. Briey comment on how you might make use of this
informaAon or other facts about mental illness that we covered in class in your own daily life (with friends,
family members, or co-workers).
The End (No Review QuesMons)
Things to Consider Tweaking for

Spring 2014
N = NeuroAcism; E = Extraversion; D = DisinhibiAon; C = ConscienAousness

Distress = GAD + MDD; Fear = Panic and Phobias
Alex these next few slides actually

make the point that MDD and SAD are
really really similar, which belongs in
one of the earlier ppts

the fun-seeking data are kind of
disturbingsuggest that MDD is more
about PE than appeAAve moAvaAon

Regarding Weak MDD-E RelaMons

Low PE is supposed to be the facet that
disMnguishes depression from the anxiety disorders
Low
E/PE
High
N/NE
TriparMte Model: Clark & Watson JAP 1991; Watson et al JAP 1995a, b
Regarding Weak MDD-E/PE RelaMons

Low PE is supposed to be the facet that
disMnguishes depression from the anxiety disorders
Low
PE
High
N/NE
TriparMte Model: Clark & Watson JAP 1991; Watson et al JAP 1995a, b

Weak relaMons may reect the use of a broadband
measure of Extraversion, rather than a more specic
measure of PosiMve EmoMonality

Weak relaMons may reect the use of a broadband
measure of Extraversion, rather than a more specic
measure of PosiMve EmoMonality
Collected mulMple measures of each facet of E/PE

Results revealed that

1) E/PE = 4 Facets = Sociability, PE, ExhibiAonism/Dominance, and Fun-Seeking

2) Depression, but not anxiety, was strongly and selecAvely related to low PE
Extra Slides
Future Challenges
1. Need to understand the mechanisms that convey risk (N/NE Dx)

* What exactly is that arrow??
* What are the proximal mechanisms mediaAng the assoc. between T&P and Dx
* Increased reacAvity, biased aSenAon, neg appraisals, stress generaAon,

maladapAve coping, etc?

2. Another way to think about this is, We need to dissect N/NE into its consMtuents
* Mood/Feelings, CogniAon, Peripheral Physiol, Behavior, Learning
* May be helpful to adopt an endophenotype-type simplicaAon strategy

3. AdjudicaMng between causal models
* ManipulaAons targeAng N/NE would let you pick vulnerability vs. common cause
* No studies have tested whether Tx-induced reducAons in N/NE are separable

from changes in Dx; if so, evidence favoring vulnerability

4. N/NE is a transdiagnosMc risk factor. We also need to understand the mechanisms that
determine diagnosMc divergence.
* e.g., why do some develop SAD vs. MDD vs. PD?
* Can be environmental (severe childhood teasing vs. loss of loved one) or
biological (sensiAvity to interocepAve cues)
013/in press; Caspi CPS 2013/in press; Ormel et al CPR 2013; Nolen-Hoeksema & Watkins PPS 2011
NeuroMcism / NegaMve EmoMonality (N/NE)
Israel et al JPSP 2014
Dierences in N/NE in turn reect

- A disorder-nonspecic biological vulnerability (e.g., hyper-
reacAve amygdala)
- That promotes a disorder nonspecic psychological vulnerability
Shared, trans-diagnosMc phenotype,

common to N/NE and the Dxes
Characterized by

More frequent/intense negaAve emoAons
Reduced emoAonal clarity and acceptance of emoAonal
experiences
Tendency to experience negaAve emoAons as more
unpleasant or to have heightened apprehension about the
prospect of feeling distressed or anxious in the future
(elevated anxiety sensiAvity; anx about being anxious)

Another Hallmark of the Core Phenotype
Another Hallmark of the Core Phenotype

Tendency to rely on strategies aimed at reducing negaMve emoMons
that paradoxically serve to increase and maintain negaMve emoMons

ASenAonal avoidance

Other Escape / Avoidance Strategies
* overt situaAonal avoidance (social anxiety disorder/SAD,

specic phobias, PTSD, depression, agoraphobia, PD)

* worrisome thoughts / ruminaAons / compulsions that serve to
avoid or control distress (GAD, OCD, MDD)

* Avoid eye contact, stand further from others, safety behaviors
(SAD, PD)

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Nuts

& Bolts Plan for Today

Grades uploaded to Canvas in the next 48 hours

Take-home criMcal thinking quesMons

Take Care of Yourself & One Another

Todays Conceptual Roadmap

What is the common denominator shared by N/NE

Todays Conceptual Roadmap

What is the common denominator shared by N/NE

Todays Conceptual Roadmap

What is the common denominator shared by N/NE

Todays Conceptual Roadmap

What is the common denominator shared by N/NE

Todays Conceptual Roadmap

What is the common denominator shared by N/NE

SecMon 1: What is N/NE and how is it

Students: What are key features of N/NE?

NeuroMcism / NegaMve EmoMonality (N/NE)

Caspi et al. ARP 2005; Barlow et al. CPS 2013

N/NE: Boiling It Down

Caspi et al. ARP 2005; Barlow et al. CPS 2013

N/NE: Boiling It Down

Caspi et al. ARP 2005; Barlow et al. CPS 2013

N/NE: Boiling It Down

Caspi et al. ARP 2005; Barlow et al. CPS 2013

N/NE: Boiling It Down

Students: What is the signicance?

For comparison purposes, a Cohens

For comparison purposes, a Cohens

SecMon 2: Crash course in emoMonal

EmoMonal Dx are a Big Deal

EmoMonal Dx are a Big Deal

Anxiety Dx: Signs

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Signs

Students What are the key features

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Signs

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Signs

Anxiety Dx: Signs

Anxiety Dx: Very Common

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Very Common

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Very Common

More Lme for cumulaLve damage

Anxiety Dx: Snares Many Teens

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Snares Many Teens

Anxiety Dx: Snares Many Teens

Anxiety Dx: Under-Treated

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Under-Treated

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Expensive

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

Anxiety Dx: Expensive

Major Depressive Disorder (MDD)

Students What are the key features

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml

MDD: Diagn. Criteria

hSp://www.adaa.org/about-adaa/press-room/facts-staAsAcs & hSp://www.nimh.nih.gov/StaAsAcs/index.shtml