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

Simone P Haller, Joel Stoddard, Christian Botz-Zapp, Michal Clayton, Caroline MacGillivray, Gretchen Perhamus, Kelsey Stiles, Katharina Kircanski, Ian S Penton-Voak, Yair Bar-Haim, Marcus Munafò, Kenneth E Towbin, Melissa A Brotman

Research output: Contribution to journalArticle (Academic Journal)peer-review

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.

Original languageEnglish
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Early online date17 Jun 2021
DOIs
Publication statusE-pub ahead of print - 17 Jun 2021

Bibliographical note

Funding Information:
This research was supported by the Intramural Research Program of the National Institute of Mental Health (NIMH), National Institutes of Health (NIH; ZIAMH002778-17 and ZIAMH002786-15) and was conducted under NIH Clinical Study Protocols 15-M-0182 and 02-M-0021 (ClinicalTrials.gov ID: NCT02531893 and NCT00025935). J.S. was supported by a grant from NIH, NIMH, (K23MH113731) and the Pediatric Mental Health Institute at Children's Hospital Colorado and the Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Colorado School of Medicine. The funding source was not involved in study design; the collection, analysis, and interpretation of data; writing of the report; and the decision to submit the article for publication. M.M. and I.P.-V. are supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Bristol National Health Service (NHS) Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of NHS, NIHR, or the Department of Health and Social Care.Disclosure: Dr. Haller has received grant support through a Brain and Behavior Research Foundation (BBRF) Young Investigator Award. Dr. Stoddard has received grant or research support from NIMH. He has served as a DSMB committee member: Threat Interpretation Bias as Cognitive Marker and Treatment Target in Pediatric Anxiety (R61 Phase). Drs. Penton-Voak and Munaf? are co-directors of Jericoe Ltd., a company that licenses software for the assessment and modification of emotion recognition. Dr. Bar-Haim has received grant or research support from the Israel Science Foundation and the US Department of Defense. Dr. Brotman has served as a principal investigator (PI) on a Bench-to-Bedside grant from NIH. Drs. Kircanski and Towbin, Mr. Botz-Zapp, and Mss. Clayton, MacGillivray, Perhamus, and Stiles have reported no biomedical financial interests or potential conflicts of interest. Author Contributions Conceptualization: Stoddard, Penton-Voak, Bar-Haim, Munaf?, Towbin, Brotman Data curation: Haller, Stoddard, Botz-Zapp, Clayton, MacGillivray, Perhamus, Stiles Formal analysis: Haller, Stoddard, Brotman Funding acquisition: Brotman Investigation: Kircanski, Bar-Haim Methodology: Brotman Project administration: Haller, Botz-Zapp, Clayton, MacGillivray, Perhamus, Stiles, Kircanski, Towbin, Brotman Resources: Kircanski, Towbin Software: Haller, Stoddard, Penton-Voak, Munaf? Supervision: Kircanski, Bar-Haim, Munaf?, Towbin, Brotman Validation: Haller Visualization: Haller Writing ? original draft: Haller Writing ? review and editing: Stoddard, Botz-Zapp, Clayton, MacGillivray, Perhamus, Stiles, Kircanski, Penton-Voak, Bar-Haim, Munaf?, Towbin, Brotman

Funding Information:
This research was supported by the Intramural Research Program of the National Institute of Mental Health (NIMH), National Institutes of Health (NIH; ZIAMH002778-17 and ZIAMH002786-15 ) and was conducted under NIH Clinical Study Protocols 15-M-0182 and 02-M-0021 ( ClinicalTrials.gov ID: NCT02531893 and NCT00025935). J.S. was supported by a grant from NIH, NIMH, (K23MH113731) and the Pediatric Mental Health Institute at Children’s Hospital Colorado and the Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Colorado School of Medicine . The funding source was not involved in study design; the collection, analysis, and interpretation of data; writing of the report; and the decision to submit the article for publication. M.M. and I.P.-V. are supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Bristol National Health Service (NHS) Foundation Trust and the University of Bristol . The views expressed in this publication are those of the author(s) and not necessarily those of NHS, NIHR, or the Department of Health and Social Care.

Publisher Copyright:
© 2021

Keywords

  • RCT
  • face-emotion labeling
  • cognitive bias
  • irritability

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