Grunge (sometimes referred to as Seattle sound) is an alternative rock genre and subculture that originated in the mid-1980s in the American Pacific Northwest State of Washington, especially in Seattle and surrounding cities. Grunge combines elements of punk rock and heavy metal, but without the structure and speed of punk. This genre used distorted electric guitar sounds used in both genres, although some bands performed with more emphasis on one or the other. As with these genres, electric guitar, bass guitar, drums and vocals are commonly used in grunge. Grunge also includes influences from indie rock bands such as Sonic Youth. Lyrics tend to be filled with anxiety and introspective, often addressing topics such as social exclusion, self-doubt, abuse, neglect, betrayal, social and emotional isolation, psychological trauma, and the desire for freedom.