Persistent Frustration-Induced Reconfigurations of Brain Networks Predict Individual Differences in Irritability

OBJECTIVE

Aberrant responses to frustration are central mechanisms of pediatric irritability, which is a common reason for psychiatric consultation and a risk factor for affective disorders and suicidality. This pilot study aimed to characterize brain network configuration during and after frustration and test whether characteristics of networks formed during or after frustration relate to irritability.

METHOD

During functional magnetic resonance imaging, a transdiagnostic sample enriched for irritability (N = 66, mean age = 14.0 years, 50% female participants) completed a frustration-induction task flanked by pretask and posttask resting-state scans. We first tested whether and how the organization of brain regions (ie, nodes) into networks (ie, modules) changes during and after frustration. Then, using a train/test/held-out procedure, we aimed to predict past-week irritability from global efficiency (E_glob) (ie, capacity for parallel information processing) of these modules.

RESULTS

Two modules present in the baseline pretask resting-state scan (one encompassing anterior default mode and temporolimbic regions and one consisting of frontoparietal regions) contributed most to brain circuit reorganization during and after frustration. Only E_glob of modules in the posttask resting-state scans (ie, after frustration) predicted irritability symptoms. Self-reported irritability was predicted by E_glob of a frontotemporal-limbic module. Parent-reported irritability was predicted by E_glob of ventral-prefrontal-subcortical and somatomotor-parietal modules.

CONCLUSION

These pilot results suggest the importance of the postfrustration recovery period in the pathophysiology of irritability. E_glob in 3 specific posttask modules, involved in emotion processing, reward processing, or motor function, predicted irritability. These findings, if replicated, could represent specific intervention targets for irritability.

Addressing defeatist beliefs in work rehabilitation

BACKGROUND

Adults with serious mental illness (SMI) may struggle with expectations of failure in vocational rehabilitation. These expectations can be global and trait-like or performance-specific and related to ability.

AIMS

To date, it has not been examined whether global or performance-specific defeatist beliefs are related to functional outcomes.

METHOD

The Indianapolis Vocational Intervention Program (IVIP) is a CBT intervention used to address expectations of failure and improve work performance. We examined the relationships between defeatist beliefs, self-esteem, social functioning, and work behaviors in 54 adults with SMI who completed IVIP within a work therapy program.

RESULTS

Baseline work-specific defeatist beliefs were related to baseline self-esteem, employment attitude, and work behaviors. Decline in work-specific defeatist beliefs was associated with better social functioning, self-esteem, and work behaviors. Decline in global defeatist beliefs was only associated with improvements in social functioning.

CONCLUSIONS

Performance-specific expectations about work may be an appropriate therapeutic target to enhance work outcome in SMI.