Rapid-response impulsivity: Definitions, measurement issues, and clinical implications.

Abstract

Impulsivity is a multi-faceted construct that is a core feature of multiple psychiatric conditions and personality disorders. However, progress in understanding and treating impulsivity in the context of these conditions is limited by a lack of precision and consistency in its definition and assessment. Rapid-response-impulsivity (RRI) represents a tendency toward immediate action that occurs with diminished forethought and is out of context with the present demands of the environment. Experts from the International Society for Research on Impulsivity (InSRI) met to discuss and evaluate RRI-measures in terms of reliability, sensitivity, and validity with the goal of helping researchers and clinicians make informed decisions about the use and interpretation of findings from RRI-measures. Their recommendations are described in this manuscript. Commonly-used clinical and preclinical RRI-tasks are described, and considerations are provided to guide task selection. Tasks measuring two conceptually and neurobiologically distinct types of RRI, “refraining from action initiation” (RAI) and “stopping an ongoing action” (SOA) are described. RAI and SOA-tasks capture distinct aspects of RRI that may relate to distinct clinical outcomes. The InSRI group recommends that: 1) selection of RRI-measures should be informed by careful consideration of the strengths, limitations, and practical considerations of the available measures; 2) researchers use both RAI and SOA tasks in RRI studies to allow for direct comparison of RRI types and examination of their associations with clinically relevant measures; and, 3) similar considerations should be made for human and non-human studies in an effort to harmonize and integrate pre-clinical and clinical research.

A behavioral and cognitive neuroscience perspective on impulsivity, suicide, and non-suicidal self-injury: Meta-analysis and recommendations for future research

“…This distinction between these dimensions of impulsivity has been supported by the finding across multiple studies that they possess distinct underlying neural correlates (Hamilton et al, 2015a; van Gaalen et al, 2006a, 2006b; Whelan et al, 2012; Winstanley et al, 2006). Specifically, the orbitofrontal cortex (OFC) and basolateral amygdala (BLA) appear to be uniquely involved in cognitive impulsivity (Ouellet et al, 2015; Peters and Büchel, 2011; Winstanley et al, 2006, 2004), but not behavioral impulsivity (Bari and Robbins, 2013; Winstanley et al, 2006).…”

“…The study inclusion criteria were: (i) NSSI and/or any aspect of suicidal ideation or behavior (e.g., suicidal ideation [SI], suicide attempt) was assessed, with the distinction between NSSI and suicide attempts being observed in studies including at least one of these outcomes; (ii) the time frame covered by the measure of NSSI and/or suicidal ideation and behavior was consistent across all study participants; (iii) neurobehavioral or neurocognitive indices of impulsivity, consistent with conceptualizations of these constructs by the International Society for Research on Impulsivity (see Hamilton et al, 2015a, 2015b), were included; and (iv) quantitative data were presented on the association between any of these forms of impulsivity and NSSI and/or any aspect of suicidal ideation and behavior. In the case of studies where more information on the measurement of NSSI or suicidal ideation or behavior was needed to determine study eligibility, every effort was made to obtain additional details in other publications describing the measure (e.g., other publications based on the same dataset) and through direct contact with the corresponding authors.…”

“…Although the approaches adopted in these reviews are consistent with self-harm research in general, in that most studies of impulsivity and self-injurious thoughts and behaviors have utilized unidimensional measures of impulsivity without a clear conceptual framework for this construct, these reviews stand in contrast with the broader impulsivity literature, and addictions research particularly, wherein impulsivity has been recognized as a multidimensional construct, with important distinctions existing between different aspects of this construct (Cyders and Coskunpinar, 2011; Hamilton et al, 2015a, 2015b; Whiteside and Lynam, 2001; Winstanley et al, 2006). Indeed, several facets of impulsivity are believed to differ in their underlying neural basis (Hamilton et al, 2015a; Winstanley et al, 2006).…”

“…Indeed, several facets of impulsivity are believed to differ in their underlying neural basis (Hamilton et al, 2015a; Winstanley et al, 2006). Several researchers have therefore stated that observing the multidimensional nature of impulsivity is essential for its potential to provide a more sensitive means for studying suicide risk (Klonsky and May, 2010; Watkins and Meyer, 2013).…”

“…Cognitive impulsivity is characterized by the tendency to prefer small immediate rewards over larger delayed ones. In contrast, behavioral impulsivity refers to difficulty preventing the initiation of a behavior or stopping a behavior that has already been initiated (for thorough treatments by the International Society for Research on Impulsivity of these two forms of impulsivity, their respective underlying neural circuitry, and relevant measurement considerations, see Hamilton et al, 2015a, 2015b). Supporting the view that these two forms of impulsivity are distinct facets of the same construct, they have been found to be weakly correlated with each other (Hamilton et al, 2015a; Lane et al, 2003; Reynolds et al, 2006).…”