Lecture 9

Chapter 14: Emotion in Clinical Psychology

VIGNASH THARMARATNAM
Diagnosis in Clinical Psychology
 In early days of clin. psych., few categories for
disorders existed
 Would classify people as either having:
 A) Psychosis: a severe mental disorder in which thought
and emotions are so impaired that contact is lost with
external reality
 Considered in past as more neurological problem
 B) Neurosis: a relatively mild mental illness that is not
caused by organic disease, involving symptoms of
stress but not a radical loss of touch with reality
 Excessive and irrational anxiety or obsession
 Considered in past as more psychological problem
Diagnosis in Clinical Psychology
 Over time precise diagnoses emerged
because:
 1. Insurance companies were more likely
to pay for treatment for labelled
diagnosed disorder than just talking with
therapist
 2. Therapists wanted to be seen more like
medical doctors
Likea doctor, by giving a specific diagnosis,
they can know what treatments to administer
Diagnosis in Clinical Psychology

 Developed Diagnostic and Statistical

Manual of Mental Disorders (DSM),
now 5th edition
Created system for every
therapist/researcher to define
diagnoses the same way
Not exactly successful with doing this
in practice
Diagnosis in Clinical Psychology
 Inconsistencies in use of DSM, due the
variety of symptoms possible
 E.g.
ADHD has 9 inattention symptoms and 9
hyperactivity/impulsive behaviours
 Child
only has to exhibit at least 6 of these
symptoms
 Therefore2 children with same diagnosis may not
have a single symptom in common
 E.g.Panic disorders include >23 000 possible
combinations of symptoms, and PTSD
diagnosis has >636 000 possible
combinations (Galatzer-Levy & Bryant, 2013)
Diagnosis in Clinical Psychology

 Other medical diagnoses that can

identify a direct cause of illness (e.g.
pathogen, damage to specific
organ, lab tests to see changes in
blood composition) in addition to
evaluating symptoms
Psychiatric disorder can only rely
on evaluating symptoms, rarely
understands underlying cause, no
lab tests available
Diagnosis in Clinical Psychology
 Often symptoms between disorders overlap,
making it hard to interpret symptoms
 E.g. Someone may meet simultaneously the criteria
for of depression, anxiety, substance abuse (Caspi et
al., 2014)
 Genetic factors also do not help distinguish
between disorders, since genes/proteins that
predict one disorder often linked to others
(Geschwind & Flint, 2015)
 Even if diagnosis is made precisely, often will
not clearly point to the best treatment for an
individual
Diagnosis in Clinical Psychology
 Somewhat arbitrary what is considered “normal”
vs. “abnormal”
 Condition is considered a diagnosable
disorder if it causes significant distress or
impairment in someone’s life
 E.g. two people could have the same fear of flying
 If one has to frequently fly for work -> disorder
 If one never has to fly for work -> normal behaviour
 E.g.
high alcohol consumption would not be
considered a disorder if it doesn’t impair one’s
employment, financial welfare, family life, or health
Diagnosis in Clinical Psychology
 Researcher find it hard to isolate groups as
with/without a disorder
 E.g. healthy people may have mild
degree of depression, but not enough
for a diagnosis
 Depressed people may have other
comorbidities (e.g. anxiety, substance
abuse)
If took people that only had depression,
would limit the generalizability of the
findings
Major Depressive Disorder

 MajorDepressive Episode: either a

depressed mood of a loss of interest
and pleasure, persisting almost every
day for at least 2 weeks
Can also include feelings of
worthlessness, agitation/inactivity, too
much/little sleep, increased/decreased
appetite, impaired concentration
(American Psychiatric Association,
2013)
Major Depressive Disorder
 Therapists can diagnose by:
 1. Talking with client, evaluate symptoms to
determine diagnosis
 2. Ask client to fill questionnaire to diagnose
disorder, can compare scores pre/post
treatment more objectively
MMPI – Minnesota Multiphasic Personality
Inventory (Butcher et al., 2003)
Beck Depression Inventory (Beck et al., 1988)
Hamilton Depression Rating Scale (Hamilton,
1960)
Major Depressive Disorder
 Although depression feels indefinite,
typically will resolve
 Afterweeks, months, even a year or more,
eventually person begins to feel better, even
without treatment
 Could be single depressive episode, or several
 Onaverage, subsequent episodes are briefer but
more frequent
 Most
people can trace back first episode to stressful
event (Slavich & Irwin, 2014)
 Later
episodes may become more spontaneous,
without obvious trigger
Major Depressive Disorder

Because of depression’s
episodic nature, hard to
determine whether treatment
alleviated symptoms or if it went
away on its own
Need to either compare
treatment against either control,
or another treatment
Major Depressive Disorder
 Brumfiel (2013) examined behaviour of
Japanese families after the earthquake that
destroyed the Fukushima nuclear power plant
 Many families forced to flee home, initially people
were energized and determined to cope with disaster
 Over time as they were unable to return to normal
lives, many became severely depressed
 Similar
to resistance and exhaustion phases in stress
responses
 Peoplebecome especially vulnerable to
depression from stress during exhaustion
Major Depressive Disorder
 Multiple Types of Depression
 Anxious depression: anxiety as well as depression symptoms
 Melancholic depression: severe depression, marked by lack
of pleasure in anything
 Psychotic depression: includes thought disorder similar to that
observed in schizophrenia
 Atypical depression: marked by increased appetite and
increased sleep
 In contrast to most cases of depression, where people usually
lose appetite and have insomnia
 People experience brief periods of enjoyment in response to
positive events
 Often times placing people into these categories
doesn’t help narrow down treatment, too much
variability in individual symptom profiles
Major Depressive Disorder
 Early hypothesis was that depression was
due to a lack of either norepinephrine or
serotonin
 Early antidepressants increased the
availability of serotonin, sometimes
dopamine too at synapses (i.e. tricyclic
antidepressants)
 Main problem with hypothesis was time
course of drugs
 Drugs
can enhance the activity at synapses within
minutes/hours, but behavioural benefits generally do
not emerge until at least 2 weeks later
Major Depressive Disorder

 Revisedhypothesis was that the

bombardment of synapses with NTs
reduces the number of receptors at
synapses to alleviate symptoms
 Problem with revised hypothesis is that
antidepressant drugs are ineffective for
many people, especially those with
mild/moderate depression (Kirsch, 2010)
 These drugs affect the synapses just as
much for people who do not respond
beneficially to them
Major Depressive Disorder
 Most researchers have given up on finding a
distinction between norepinephrine and
serotonin type depression to target treatment
 Most researchers now try to relate depressed
to altered neural circuits in the brain (Mulinari,
2012)
 E.g.
many studies indicate that depression is
associated with decreased production of new
neurons + synapses in hippocampus, impairing
learning (Miller & Hen, 2015)
 Anti-depressants, psychotherapy, or other
treatments that alleviate depression also
increase plasticity of hippocampus
Major Depressive Disorder
 DSM-5 makes a distinction between
major depression and dysthymia:
condition in which some feels sad
almost constantly for years at a
time
 Similarto melancholic depression but
different in that:
Emphasis on sad mood rather than
lack of pleasure
Instead of lasting months, will last
years
Major Depressive Disorder
 Causes of Depression
 Most people recover from major stressors without
entering diagnosable depression
 Stressful
events create greater reactions in
people predisposed to depression
 E.g.Nolen-Hoeksema & Morrow (1991) had
college students fill our personality questionnaire
that after a major earthquake in California
 Although virtually all students felt sad/depressed
shortly after damage, those already mildly
depressed before earthquake became more
severely depressed and remained depressed longer
Major Depressive Disorder
 Genetic factors contribute to
depression
 When an adopted child develops
depression (after reaching adulthood),
depression is generally more common
among their biological parents than
their adoptive parents (Wender et al.,
1986)
 Comparisons of identical (monozygotic)
and fraternal (dizygotic) twins show a
moderate genetic influence (Wilde et
al., 2014)
Major Depressive Disorder

 Researchers have struggled to find

any particular gene with a significant
effect on depression (Major
Depressive Disorder Working Group,
2013)
 Most only have small effects, hard to
replicate findings, genes often increase
the risk of several disorders, not just
depression (Geschwind & Flint, 2015)
Major Depressive Disorder
 Major depression runs in the same families as
those with other disorders (Dawson and Grant,
1998; Fu et al., 2002; Hudson et al, 2003; Javaras
et al., 2008; Kendler et al, 1995)
 Alcohol/drug dependence
 Antisocial personality disorders
 Bulimia
 Panic disorders
 Migraine headaches
 Attention deficit disorders
 Binge eating
Major Depressive Disorder
 One study found that within Chinese women
in China suffering from multiple episodes of
severe depression, two genes increased the
likelihood of depression by 15% (CONVERGE
Consortium, 2015)
 Results
were rare outside China, cannot be
generalized
 Suggeststhat different genes may
promote depression by different biological
mechanisms in different groups of people
Major Depressive Disorder

 Childrenthat have been

subjected to emotional abuse,
neglect, or sexual abuse have an
increased risk of depression later in
life (Mandelli, Petrelli, & Serretti,
2015)
Hardto separate influences of
abuse/neglect from effects of
poverty or other family life influences
Major Depressive Disorder

 Kendler,
Kuhn, and Prescott (2004) had
1404 female adult twins (one reporting
sexual abuse, one not) report levels of
depression
 Found that both twins had higher risk of
depression, highlighting
environmental/familial factors increasing
risk
 Only the abused twin had higher rate of
depression, showing trauma further
exacerbating symptoms
Major Depressive Disorder

Emotions underlying
depression is also based on
the appraisals one makes
about depression (Lazarus,
1991)
If you habitually feel depressed,
you will more often believe you
are helpless/hopeless and vice-
versa
Major Depressive Disorder

 Learned helplessness: failure to try to

improve one’s current situation,
resulting from lack of control in a prior
situation
 Seligman & Maier (1967) had dogs
harnessed in place on a floor that would
produce electric shock a few seconds
after a sound tone
 Half
the dogs learned to press a panel to avoid
shock after tone
 Other half could do nothing to avoid shock
Major Depressive Disorder

Dogs were later placed in

new structure where they
could avoid shock by jumping
over hurdle to other side of
room
Previously shock avoidance trained
dogs learnt new paradigm, helpless
dogs did not – acted as if shock was
unavoidable
Major Depressive Disorder
 Learned helplessness related to depression in
that:
 Variations
of learned helplessness procedures
have been used in many animal species to
produce animal models of depression
 Can measure behavioural responses, autonomic
responses, and brain activity related to depression
 Learned helplessness has been proposed as
an explanation for human depression
 Simple
hypothesis that having repeated defeats
makes someone naturally feel helpless, quit trying,
and become depressed
Major Depressive Disorder
 Revised version of theory is that a total lack of
success in some situation may or may not lead
to feelings of depression, depending on how
someone interprets the outcome (i.e. what
attributions they make) (Abramson, Seligman &
Teasdale, 1978)
 3 types of attribution
 Internal vs. External – attributing blame to internal
vs. external causes
 Stable vs. Unstable – evaluating the attribution as
permanent vs. temporary
 Specific vs Global – considering an attribution as
applying to specific circumstances vs. relating to
many/all situations
Major Depressive Disorder
 Attributions vary based on success/failure
 Attributions of successes usually follow facts
 E.g. attributing doing well on a test to studying hard, or the
test being easy
 Attributions of failures follow one’s explanatory style:
way of making attributions for their failures, especially
when explanation is not obvious
 Explanatory style for failures tends to be consistent across
situations over a long period of time, even decades (Burns
& Seligman, 1989)
 Can have optimistic style – e.g. blaming failure on lack of
effort, implying you have the skills to succeed
 Can have pessimistic style – e.g. blaming failure on lack of
ability, implying failure is internal, stable, and global
Major Depressive Disorder
 Depressed people often have dysfunctional
attitudes, with unrealistic beliefs about what they
must become/accomplish to be satisfied
 Beck (1973,1987) found that depressed people see
themselves as failing even when doing reasonably
well (e.g. getting depressed over getting an A,
someone not smiling at them makes them flawed)
 Perfectionism common amongst depressed people,
but correlation does not demonstrate cause and
effect
 Depressionmay cause dysfunctional attitudes or vice-
versa, or maybe third variables causes both (Burns &
Spangler, 2001)
Major Depressive Disorder
 Although depression linked to negative affect, the
more prominent feature is lack of enjoyment
 Psychologists disagree as to whether this is lack of pleasure
or lack of motivation (Pizzagalli, 2014)
 Peters et al. (2003) had participants respond to a beeper
reminding them at unpredictable times each day to report
current activity + mood
 People with depression report a normal number of sad events,
but differed from other people by reporting very few happy
events
 Rottenberg et al. (2005) had participants watch short films
intended to evoke either happy/sad/neutral moods
 People with depression reported little enjoyment of the happy
film, feeling equally bad no matter what they were watching
Major Depressive Disorder
 Sloan, Strauss and Wisner (2001) had
depressed + nondepressed women view
series of pictures and reported their
emotional responses while researchers
observed their expressions
 Both women reacted about equally to sad
pictures, but depressed people showed
significantly less response to pleasant pictures
 Participants also asked to rate how well 12
pleasant +12 unpleasant words applied to
themselves
 Then asked to recall the 24 words
 Both groups recalled about the same number
of unpleasant words, but depressed women
recalled fewer of the pleasant words
Major Depressive Disorder
 Henriques and Davidson (2000) had depressed and
nondepressed patients view words on computer screen,
then complete second task as distraction
 Then asked participants on another set of trials to identify
which words now presented had been on the original list
 Two types of trials:
 Asked to respond as accurately as possible, with no rewards
given
 Asked to respond as accurately as possible, 10 cents per correct
answer, no punishment for error
 Logically best thing to do over time when rewarded without
punishment is to say yes even when in doubt
 Nondepressed people would change strategy over time to do
this, but not depressed people
Major Depressive Disorder

 Since depression is associated with insensitivity to reward,

would be expected to also be associated with dopamine
circuit dysfunction, but results are mixed
 Most studies, albeit not all, have shown decreased activity in the
striatum (major source of dopamine output) and decreased activity
at one type of dopamine receptor in depressed people (Marchand
& Yurgelen-Todd, 2010; Savitz & Drevets, 2016)
Major Depressive Disorder

 People with depression have decreased levels of metabolic

breakdown products of dopamine (Kunugi, Hori, Ogawa,
2015; Pizzagalli, 2014)
 Most drugs that stimulate dopamine synapses are not
effective as an antidepressant, most antidepressants work on
other NT synapses
 Major Depressive Disorder
 Treating Depression
 Most common treatments are antidepressants and
psychotherapy
 Both equally effective, but not reliable
 Halfof patients on either treatment show
improvement, compared to 1/3 on placebo
(Hollon et al, 2012)
 Combiningboth treatments improves response for
some people, but does not greatly improve % of
people who respond at all (Hollon et al, 2014)
 Effectiveness might be overstated, since null
effects of treatments never published (Driessen et
al., 2015)
 Major Depressive Disorder

 First
antidepressants found by
accident when trying to treat
tuberculosis
Drugs used seemed to increase
activity at synapses using serotonin,
norepinephrine, sometimes
dopamine
Behavioural effect undependable,
uncorrelated with synapse activity
time courses
 Major Depressive Disorder
 Most common psychotherapy used is
cognitive therapy: an approach that seeks
to alter the explanatory styles and other
dysfunctional cognitive biases that
characterize disordered individuals
 Try to suggest other interpretations of
daily events/difficulties
 Invites client to consider other possibilities
and draw the most reasonable
conclusion, instead of presuming the
worst
 Major Depressive Disorder

 Seligman et al. (1999) found that

college students at risk for
depression that took a series of 8
workshops to combat negative
thoughts (vs. no treatment
group) had fewer episodes of
anxiety and depression over the
next 3 years
 Major Depressive Disorder
 Cognitive therapy also encourages
behavioural activation (i.e. more activity of any
kind)
 Depressed people lack motivation due to
both a lack of energy, and not expecting to
enjoy it
 Forcing someone to try something may make
them realise they enjoy it more than expected
 Found to be responsible for much of the
effectiveness of cognitive therapy (Jacobson et
al., 1996)
 Shown to be as effective as a stand-alone therapy as
any other therapy for depression (Ekers et al., 2014)
Major Depressive Disorder
 Ways to decrease risk of depression without
professional help
 1. Exercising consistently for 30-45 mins at least a
few times per week
 People who exercise less likely to be depressed, and
depressed people are less likely to exercise
 2. Maintaining regular sleep cycle helps alleviate
depression symptoms (Asarnow et al. 2014)
 Sleepdifficulties in adolescence predict increased
chance of depression later (Roane & Taylor, 2008)
 3. Eating seafood rich in omega-3 fatty acids is
correlated with decreased probability of
depression (Noaghiul & Hibbeln, 2003)
Mania and Bipolar Disorders

 Bipolar
disorder: mood disorder in
which someone alternates between
episodes of mania and depression
 Mania:state marked by relentless,
vigorous activity and extreme self-
confidence
 May be enjoyable for a while, but can
morph into irritability if it feels like the
rest of the world is slowing you down or
in your way
Mania and Bipolar Disorders

 DSMcriteria for mania include

impulsive, risky reward seeking
behaviours
 E.g. gambling, unsafe sex,
purchasing luxury items one can’t
afford, bad financial investments
 Aspect of mania most likely to cause
harm, as it damages oneself as well
as one’s relationships with
friends/family
Mania and Bipolar Disorders

 Hypomania: when symptoms of mania

are present but not extreme enough to
cause problems in the person’s life
 Bipolar disorder also involves disruption of
normal responses to rewarding stimuli
 Gruber and colleagues (2008) showed
positive, negative, and neutral film clips to
participants with hypomanic symptoms
 Increasedmanic predisposition =
increased positive emotion (and irritability)
to clips
Mania and Bipolar Disorders
 Gruber and Johnson (2009) found
greater tendency towards enthusiasm
and pride (both high in appetitive
motivation and behavioural
activation) is a risk factor for mania
 People may show heightened risk of
mania when their positive emotion is
insensitive to what is going on in their
environment (Gruber, 2011)
 Positiveemotion not on its own bad,
context matters
Mania and Bipolar Disorders
 Depression in bipolar disorder resembles
atypical depression
 Marked by low enjoyment, physical lethargy, and
excessive sleep (Akiskal & Benazzi, 2005)
 Oppositeof mania’s constant movement, activity,
and sleeplessness
 Exceptions
do exist, where individual alternate
between mania and agitated depression
 First comes 1+ episodes of major depression,
later changes to bipolar disorder diagnosis
 Treatment also changes, with people with bipolar
disorder generally responding best to either
lithium salts or certain antiseizure medications
Mania and Bipolar Disorders
 Defining feature of bipolar disorder is mood instability
– swings from feeling very low to very high
 Malik et al. (2014) found hypomanic adults had about
twice as many intrusive images than others over the
following 6 days after watching a film about traumatic
events
 Intrusive imagery one way to shift mood, in either
direction
 Bipolar diagnosis usually reserved for people with
extreme and obvious mood swings
 Now more common diagnosis because it is being
applied to people with milder symptoms (Medici et al.,
2015)
Anxiety Disorders

 Peoplevary in their reactions to

novel ambiguous situations
People with amygdala damage
have strong approach tendency
and hardly any avoidance
tendency
People with anxiety disorders
show fearful avoidance even in
familiar, harmless situations
Anxiety Disorders
 Post-traumatic stress disorder (PTSD):
condition marked by flashbacks and
nightmares about a traumatic event,
avoidance of reminders of it, and an
exaggerated startle reflex
 In military, “normal” to be constantly tense
with strong startle response
 Once discharged, tension felt is now
maladaptive as every sight and sound
seen as dangerous, unable to quickly
readjust
Anxiety Disorders
 Generalized anxiety disorder (GAD): disorder
characterized by almost constant
nervousness and a wide range of worries
 E.g.
worry about health, finances, job, or minor
matters like household chores or car repairs
 Sometime unsure about what they are nervous
about
 Worries make them irritable, restless, and fatigued
 Have trouble doing their jobs and getting along with
families
 Most with GAD qualify for additional mental
disorder diagnoses
Anxiety Disorders
 Panic disorder: disorder characterized by
repeated attacks of increased heart rate, rapid
breathing, noticeable sweating, trembling, and
chest pains
 Some people who get panic attacks are able to
shrug them off and go on with life
 People with panic disorders have frequent nervous
apprehension about the prospect of having another
attack
 Often leads to agoraphobia: an excessive avoidance of
public situations where a panic attack might be
embarrassing
 Often want to stay home as much as possible
Anxiety Disorders

 Appraisal of threat from a condition

stimulus (e.g. deep breathing from
regular exercise) can give rise to
further autonomic arousal, desire to
flee situation, then full blown panic
(Bouton et al., 2001; Hamm et al., 2014)
 Panic
disorders most common in
women than men, most prevalent in
adolescents and young adults
Anxiety Disorders
 Specific phobia: disorder
characterized by excessive fear Name Definition
of a particular object/situation Agoraphobia Fear of open, public place
 Most phobias pertain to things Glossophobia Fear of public speaking
that are dangerous (e.g. Acrophobia Fear of heights
snakes, spiders, lightning, falling
Social Phobia Extreme anxiety about being
from great height) with or observed by strangers
 Defining feature
is that the fear is Autophobia Fear of being alone
exaggerated and interferes with Arachnophobia Fear of spiders
one’s life
Ophidiophobia Fear of snakes
 E.g. can’t ride elevator because
of fear of enclosed spaces, can’t Blood phobia Fear of blood
enjoy nature because of fear of
snakes
Anxiety Disorders
 Fear occurs either in presence of
object/situation or even the Name Definition
thought/reminder Agoraphobia Fear of open, public place

 E.g. not wanted to watch movies, see Glossophobia Fear of public speaking

photos or hear stories about Acrophobia Fear of heights

object/situation Social Phobia Extreme anxiety about being
with or observed by strangers
 Fear are for evolutionarily dangerous Autophobia Fear of being alone
phenomena primarily, not what is Arachnophobia Fear of spiders
dangerous today
Ophidiophobia Fear of snakes
 E.g. cars and misuse of tools kill more Blood phobia Fear of blood
people than snakes and spiders in
modern day, but no car phobia
Anxiety Disorders
 Could also be that phobias are for
things that are uncontrollable Name Definition
 E.g. have more control over a car and Agoraphobia Fear of open, public place
tools than snakes and spiders Glossophobia Fear of public speaking
 Key characteristic of phobias are Acrophobia Fear of heights
that they dominate attention Social Phobia Extreme anxiety about being
with or observed by strangers
 Miltner et al. (2004) had normal and
arachnophobic individuals find a Autophobia Fear of being alone
mushroom among either pictures of Arachnophobia Fear of spiders
flowers, or pictures of flowers and one
picture of a spider Ophidiophobia Fear of snakes
Blood phobia Fear of blood
 Arachnophobic individuals had a harder
time finding the mushroom if a spider
picture was present, but no issues without
it
Anxiety Disorders
 Causes of Anxiety Disorders
 Suggested that anxiety may be due to a painful
experience
 John Watson believed classical conditioning was
the cause of phobias
Had “Little Albert” develop a phobia for white
rats by pairing the presence of the rat with a
frightening loud gong sound (Watson and
Rayner, 1920)
Not only unethical, but did not provide
convincing explanation for acquiring a phobia
Anxiety Disorders

Most people cannot trace phobias to

painful experiences
An identical twin of someone with a
phobia has an elevated risk of also
having a phobia regardless of whether
or not the first twin can identify a
frightening experience that started the
phobia (Kendler et al, 2002)
No apparent increased risk from experience
beyond genetic factors
Anxiety Disorders

Most people that have a

painful experience learn to be
more cautious, but most do not
develop a phobia
For PTSD, traumatic
experiences are necessary but
not alone enough to elicit it
Anxiety Disorders
 The severity of trauma and the intensity of
someone’s initial reaction are not good predictors of
who will or will not develop PTSD (Bryant et al., 2015)
 Better predictor for PTSD is emotional status before
the trauma
 People who have had abusive/neglectful experiences
in childhood, or who developed emotional difficulties
for other reasons are more likely than others to
develop PTSD (Berntsen et al., 2012)
 PTSD victims have fewer than normal recollections of
feeling in control over the events in their lives (Jobson
et al., 2014)
Anxiety Disorders
 Evidence of “pre-traumatic stress disorder” (Berntsen
& Rubin, 2015)
 Gave questionnaires to soldiers before, during and
after deployment to war zone in Afghanistan
 Many soldiers experienced anxiety symptoms before
deployment
 Reported disturbing dreams, intrusive images, attempted
to avoid any reminder of the events that might happen
 Soldiers with strongest “pre-trauma” had highest
probability for PTSD after war exposure
 Shows that not just the event, but predisposition
affecting PTSD
Anxiety Disorders

 Hereditary/Environmental Factors
contributing to anxiety disorders
 People with anxiety disorders likely to
have relatives with them as well
Overlap of incidence of anxiety
disorders higher for identical vs.
fraternal twins
Genetic influence not specific for a
specific anxiety disorder, any anxiety
disorder increases likelihood of any
other
Anxiety Disorders

 No common gene shown to

cause large or replicable effect
(Shimada-Sugimoto et al, 2015)
Could be epigenetic factors at
play instead, modulating
transcription of genes from
environmental factors (e.g. adding
methyl/acetyl groups to DNA to
block transcription)
Anxiety Disorders
 Possible that genes act through changes in brain
anatomy
 People with PTSD have smaller hippocampi
than normal (responsible for controlling stress
hormones and episodic memory) (Garfinkel &
Liberzon, 2009; Stein et al., 1997)
 Gilbertsonet al. (2002) evaluate the
hippocampi of one identical male twin with
PTSD from war, and the other without PTSD that
had not been in battle
 Both twins had smaller hippocampi than average,
suggesting it was predisposition and not caused by
the trauma of war
Anxiety Disorders
 Genes that regulate serotonin have major
influences on amygdala (Li et al., 2015)
 People with the short form of the serotonin
transporter gene (makes proteins to pull serotonin
back into axon after release) make less transporters
 Serotonin lasts in synaptic cleft longer before being
recycled
 People show increased responses to threat and
increased attention to threatening stimuli, especially
in social situations
 Showgreater amygdala responses to photos of
angry/fearful expressions (Hariri et al., 2002)
 Learnfear more quickly than average if a cue
predicts shock/danger (Lonsdorf et al., 2009)
Anxiety Disorders
 People with short gene thus more likely to
develop anxiety disorders and have
difficult social interactions (Disner et al.,
2013, Miu et al., 2013)
 Gene is not linked specifically to anxiety
 People with short form also shown bigger smiles
and more laughter in responses to amusement
(Hasse et al., 2015)
 Gene heightens emotional arousal of any
type
 Gene heightens attention to cues that elicit
emotion
Anxiety Disorders
 Children that have been sexually abused
or neglected are more likely than others to
develop fear-related disorders and
depression (Friedman et al, 2002; Nelson et
al., 2002; Berntsen et al., 2012)
 For both identical and fraternal twins, the
children of each twin had a risk of anxiety
that depended much more on parent’s
status than parent’s twin
 Ifonly genes mattered, parent and their twin
should be equally correlated with risk of anxiety
Anxiety Disorders
 Treating Anxiety Disorders
 Like for depression, anxiety disorders
treatments involve both talk therapy
and/or medication
 Common treatment is cognitive behaviour
therapy (CBT):
Treatment focusing on
reinterpreting/reappraising a situation,
solving problems, and relaxation
In most cases, provides help in reducing
anxiety, improving quality of life
Anxiety Disorders

E.g.
for GAD, therapist will
emphasize:
Identifyingfeelings of worry
Developing greater tolerance
for uncertainty
Learning to solve problems
constructively
Avoid ruminating on problems
Anxiety Disorders

 E.g.
for panic disorders, CBT may
involve an emphasis on reinterpreting
physiological symptoms so they are
perceived as less threatening and
more tolerable
 Specific
phobias are commonly
treated with exposure therapy:
 A.k.a systematic desensitization – utilizing
extinction in classical conditioning
Anxiety Disorders

 Client is exposed to the feared

object/situation under controlled
conditions that should minimize fear
 E.g.First imagine spider far away and close by,
then use toy spider far away and close by,
then real spider far away and close by
 Often times to simulate “real” conditions, will
use virtual reality
 Can have greater access to real objects,
can turn off at any point if client finds
situation intolerable
Anxiety Disorders
 Exposure therapy has a high levels of
success, but unfortunately phobia
sometimes return
 Becomes more effective with repetitions
 Drugs that relieve anxiety known as
anxiolytics (a.k.a. tranquilizers)
 Most common class called benzodiazepines
(e.g. diazepam (Valium), chlordiazepoxide
(Librium), and alprazolam (Xanax))
 Drugs can be given as injections, but most
common as pills
Anxiety Disorders
 Anxiolytics
facilitate the effectiveness of
GABA, main inhibitory NT in NS
 Suppress activity in amygdala, decreasing
response to threatening and emotional
stimuli
 Suppresses other brain regions, leads to
drowsiness, memory impairment, reduced
emotional processing
 On anxiolytics, people have trouble
identifying other’s facial expressions of
emotion (e.g. anger and fear) (Zangara et
al., 2002)
Anxiety Disorders

Although effective most

physicians discourage long
term use
Many side effects, repeated
use can be habit-forming
(addictive)
Will prescribe anti-depressants
for long-term use
Obsessive-Compulsive Disorder
 Obsessive-Compulsive Disorder:
 Obsessions: recurrent and persistent thoughts,
impulses and intrusive images that cause
distress
 Compulsions: repetitive behaviours (e.g. hand
washing, ordering) or repetitive mental acts
(e.g. counting things, repeating words) that a
person feels internal pressure to perform in
response to obsessive thoughts
Will feel distressed if prevented from doing
the compulsive act
Completing the act does not fully relieve the
distress
Obsessive-Compulsive Disorder

 Obsessions
and compulsions are
not appropriate to someone’s
situation
E.g. worrying about paying bills when
poor or washing hands a lot as a
physician are both reasonable
Repetitive thoughts/actions not
symptoms of disorder unless it causes
distress or difficulty
Obsessive-Compulsive Disorder

People with OCD are highly

prone to feeling disgust,
especially with regard to any
feeling of being contaminated
(Pauls et al., 2014)
E.g.fear of contamination leads
to excessive washing
Obsessive-Compulsive Disorder

 People with OCD also report stronger than

average guilt feelings
 fMRIfindings show intense brain responses to any
reminder of shame/guilt (Hennig-Fast et al., 2015)
 People with OCD believe that thinking about
shameful act is as bad as doing it (Coughtrey et
al., 2013)
 The
harder someone tries to avoid thought, the
more intrusive the thought becomes
 Person
engages in repetitive behaviour to
maintain rigid self-control
Antisocial Personality Disorder

 Antisocial Personality Disorder:

condition marked by deceitful,
impulsive, and aggressive behaviour,
with disregard for safety of self and
others and lack of remorse
 Overlap with characteristics of
psychopathy and sociopathy
 Willingness to harm or manipulate other
people, with no concern for their well-
being and no signs of remorse
Antisocial Personality Disorder

 Possess
empathic accuracy but not
emotional empathy (Dadds et al.,
2009)
 Lack tendency to imitate sight of sad or
frightened face (Lishner et al., 2015)
 Show relatively low response to seeing
someone suffer in the amygdala and
prefrontal cortex (Thompson et al., 2014)
 Can hurt people without feeling bad
about it
Emotional Disturbances as Transdiagnostic
Aspects of Disorders
 Disruption of emotions characterize many psychological
disorders
 Borderline personality disorder: show extreme emotional
volatility, impulsivity, poor emotional regulation skills (Lieb et
al, 2004)
 Autism: deficits in recognizing others’ emotional expressions
(Clark et al., 2008)
 Schizophrenia: often show flat affect (low emotional
expression) but report normal levels of subjective emotional
experience (Kring et al., 1993)
 Alcohol: used often to regulate emotions (Sher & Grekin,
2007)
 Alcoholism and drug abuse run in the same families as
depression (Dawson & Grant, 1998)
Emotional Disturbances as Transdiagnostic
Aspects of Disorders
 Traditionally investigate pathology by comparing people
with diagnosis to either control or another diagnosis
 Hard to have definitive conclusions since diagnoses based
on symptoms often shared across disorders
 Insel and colleagues (2010) argued that researchers
should instead measure psychopathology in terms of
continuous dimensions
 E.g. degrees of sad mood, reward insensitivity, anxiety, sleep
disturbance, inability to concentrate, disordered thinking
 Felt using dimensions, researchers would be able to better
determine causes for each aspect of dysfunction (Cuthbert
& Insel, 2013)
Emotional Disturbances as Transdiagnostic
Aspects of Disorders
 One theory is that disordered emotion stems in large
part from inadequate or improper emotion regulation
(Gross & Jazaieri, 2014)
 Very stressful situations interfere with most coping
strategies (Sheppes et al., 2011)
 Butin the aftermath of stressful events or lesser events,
most people can cope and maintain a positive outlook
 Depression seems linked to poor emotional regulation
 Show bias to be oversensitive to unpleasant and/or
undersensitive to positive events (Mehu & Scherer, 2015)
 People with poor emotional regulation skills more likely
to develop depression later on (Berking et al, 2014)
 Not clear if depression causes dysregulation or vice-versa
Emotional Disturbances as Transdiagnostic
Aspects of Disorders
 Depressed people are less likely than others to
look for a way to reappraise situation in more
positive way (Joormann & Vanderlind, 2014; Lee
et al., 2014)
 Also more likely to blame themselves, catastrophize
(expect worst outcome), and ruminate on issue
 Ruminating involves thinking repeatedly about unpleasant
event without looking for solution, prolonging unpleasant
emotional reaction
 Compared to men, women are more likely to ruminate and
also become depressed (Nolen-Hoeksema et al., 1999)
 Relationship between rumination and depression is correlation
not causation, directionality not clear
Emotional Disturbances as Transdiagnostic
Aspects of Disorders
 Role of emotional regulation complicated since it may be
used also by depressed people to remain sad
 Depressed people are more likely to listen to sad music when
given the choice between happy/neutral/sad music
 When given the choice to look at happy/neutral/sad
pictures, depressed people spend more time looking at sad
pictures
 After being taught to cognitive reappraise to control
emotions, responses to sad pictures increases (Millgram et al.,
2015)
 Could be that sad people feel comfortable with a sad
mood out of familiarity, or some people feel they deserve
to be sad
Emotional Disturbances as Transdiagnostic
Aspects of Disorders
 Emotion regulation influences other
disorders as well
 People with panic disorder produce
exaggerated responses to subtle signs of
increased heart rate, faster breathing or other
body indications of distress
Enhancing rather than soothe their
emotional responses (Sheppes et al., 2015)
 Some people with PTSD or bipolar disorder fail
to regulate responses to bad memories by self-
distancing (Kenny et al., 2009; Park et al, 2014)