Citation

Haller SP, Stoddard J, Botz-Zapp C, Clayton M, MacGillivray C, Perhamus G, Stiles K, Kircanski K, Penton-Voak IS, Bar-Haim Y, Munafó M, Towbin KE, Brotman MA. J. Am. Acad. Child Adolesc. Psychiatry 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1016/j.jaac.2021.05.022

PMID

unavailable

Abstract

OBJECTIVE: Probing targeted, mechanism-based interventions is the next generation of treatment innovation. Biased threat labeling of ambiguous face emotions (interpretation bias) is a potential behavioral treatment target for anger, aggression, and irritability. Changing biases in face-emotion labeling may improve irritability-related outcomes. Here, we report the first randomized, double-blind, placebo-controlled targeted trial (RCT) of interpretation bias training (IBT) in youth with chronic, severe irritability.

METHOD: Patients with current Disruptive Mood Dysregulation Disorder (DMDD; N=44) were randomly assigned to complete four sessions of active (n=22) or sham (n=22) computerized IBT training within a one-week period. The first and last trainings were completed onsite, and two trainings were completed at home. We examined the effects of active IBT on labeling bias, primary outcome measures of irritability, and secondary outcome measures of anxiety, depression, and functional impairment. Follow-up assessments were completed immediately after the intervention and two weeks following the intervention.

RESULTS: We found that active IBT engaged the behavioral target in the active relative to the sham condition, shown by a significant shift toward labeling ambiguous faces as happy. However, there was no consistent clinical improvement in active IBT relative to the sham condition, immediately after, or two weeks following training in either primary or secondary outcome measures.

CONCLUSION: While this RCT of IBT in youth with DMDD engaged the proposed behavioral target, there was no statistically significant improvement on clinical outcome. Identifying and changing behavioral targets is a first step in novel treatment development; these results have broader implications for targeted-based intervention development.

Language: en

Keywords

children and adolescents; cognitive bias; face-emotion labeling; irritability; RCT