A Randomized Controlled Trial of Computerized Interpretation Bias Training for Disruptive Mood Dysregulation Disorder: A Fast-Fail Study

Abstract

To examine 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 of interpretation bias training (IBT) in youths with chronic, severe irritability. Method: Patients with current Disruptive Mood Dysregulation Disorder (DMDD; N ¼ 44) were randomly assigned to complete 4 sessions of active (n ¼ 22) or sham (n ¼ 22) computerized IBT training within a 1-week period. The first and last trainings were completed onsite, and 2 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 and 2 weeks after the intervention Q5 .Results: We found that active IBT engaged the behavioral target in the active relative to the sham condition, as 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 either immediately after or 2 weeks after training in either the primary or secondary outcome measure. Conclusion: Although this randomized controlled trial of IBT in youths 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. Clinical trial registration information: Psychological Treatments for Youth With Severe Irritability; https://clinicaltrials.gov/; NCT02531893.

Emotional Recognition Training Enhances Attention to Emotional Stimuli Among Male Juvenile Delinquents

“…Similarly, Wells et al 15 trained children with severe problem behaviours to improve their ability to recognize sad, fearful, angry, and neutral expressions and found that their behavioural problems subsequently decreased. In contrast, some studies have found that emotional recognition training had no evident effects on irritability symptoms 16 as well as state anger, aggression, and hostile attribution assessed in a game context. 17 The mixed results in previous studies suggest that emotional recognition training may affect behaviour indirectly.…”

Narrative Review: Impairing Emotional Outbursts: What They Are and What We Should Do About Them

“…116 Programs are also being designed to correct perceptual biases in youth that misinterpret ambiguous facial expressions as angry or threatening. 72 Effective intervention depends on a functional understanding of the behaviors, including factors that trigger, reinforce, or excuse the behavior, either in the present or historically. Once established, maladaptive coping strategies may persist even if they are no longer effective or if the environment has changed, unless patterns of reinforcement are addressed and the child or family system is taught new skills.…”

Mediating Effect of Amygdala Activity on Responses to Fear vs. Happiness in Youths with Disruptive Mood and Behavior Disorders

“…Contrarily, the recent study failed to nd the effectiveness of interpretation bias training, which was a signi cant shift toward labeling ambiguous faces as happy, on irritability improvement 14 . These Findings suggested the need to integrate multiple features (i.e., behavioral de cits, neural correlates, phenotypic speci city) to achieve comprehensive understanding of the underlying neurobiological mechanisms of irritability in youth.…”

“…These Findings suggested the need to integrate multiple features (i.e., behavioral de cits, neural correlates, phenotypic speci city) to achieve comprehensive understanding of the underlying neurobiological mechanisms of irritability in youth. Additionally, aberrant threat interpretation may be considered as one cognitive pathway to emotional problems across internalizing and externalizing phenotypes of which irritability can be a critical part 14 . Therefore, in this study, we identify how the behavioral phenotype (irritability severeness) and neural correlates in uence on aberrant threat interpretation in youths with DMBD.…”