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Haller SP, Stoddard J, Botz-Zapp C, Clayton M, MacGillivray C, Perhamus G, Stiles K, Kircanski K, Penton-Voak IS, Bar-Haim Y, Munafò M, Towbin KE, Brotman MA. A Randomized Controlled Trial of Computerized Interpretation Bias Training for Disruptive Mood Dysregulation Disorder: A Fast-Fail Study. J Am Acad Child Adolesc Psychiatry 2022; 61:37-45. [PMID: 34147585 PMCID: PMC8678378 DOI: 10.1016/j.jaac.2021.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE 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 = 44) were randomly assigned to complete 4 sessions of active (n = 22) or sham (n = 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 the intervention as well as 1 and 2 weeks later. 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 measures. 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 target-based intervention development. CLINICAL TRIAL REGISTRATION INFORMATION Psychological Treatments for Youth With Severe Irritability; https://clinicaltrials.gov/; NCT02531893.
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Affiliation(s)
- Simone P. Haller
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
| | - Joel Stoddard
- University of Colorado, Anschutz Medical Campus, Aurora
| | - Christian Botz-Zapp
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
| | - Michal Clayton
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
| | - Caroline MacGillivray
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
| | - Gretchen Perhamus
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
| | - Kelsey Stiles
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
| | - Katharina Kircanski
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Kenneth E. Towbin
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
| | - Melissa A. Brotman
- National Institute of Mental Health, and National Institutes of Health, Bethesda, Maryland
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Haller SP, Stoddard J, Pagliaccio D, Bui H, MacGillivray C, Jones M, Brotman MA. Computational Modeling of Attentional Impairments in Disruptive Mood Dysregulation and Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:637-645. [PMID: 33242544 PMCID: PMC8096646 DOI: 10.1016/j.jaac.2020.08.468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/04/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Computational models provide information about cognitive components underlying behavior. When applied to psychopathology-relevant processes, they offer additional insight to observed differences in behavioral performance. Drift diffusion models have been successfully applied to investigate processing efficiency during binary choice tasks. Using these models, we examine the association between psychopathology (irritability and inattention/hyperactivity) and processing efficiency under different attentional demands. METHOD A total of 187 youths with attention-deficit/hyperactivity disorder (ADHD), disruptive mood dysregulation disorder (DMDD), both disorders, or no major psychopathology (age, mean ± SD, 13.09 ± 2.55 y, 34% female) completed an Eriksen Flanker task. Of these, 87 youths provided complete data on dimensional measures of the core symptom of DMDD (irritability) and those of ADHD (inattention and hyperactivity). RESULTS In a categorical diagnosis-based analysis (n = 187), we found significant interactive effects among ADHD, DMDD, and task condition on processing efficiency, whereby changes in processing efficiency between conflict and nonconflict conditions were larger in youths without psychopathology compared with patients. Analysis of symptom severity (n = 87) across diagnoses similarly revealed an interaction between symptom dimensions and task condition on processing efficiency. Irritability moderated the magnitude of association between inattention symptoms and difference in processing efficiency between conflict and nonconflict conditions. CONCLUSION Adapting processing efficiency to cognitive demands may represent a shared cognitive endophenotype for both ADHD and DMDD. Highly irritable and/or inattentive youth may have difficulty adjusting processing efficiency to changing task demands, possibly reflecting impairments in cognitive flexibility.
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Affiliation(s)
| | - Joel Stoddard
- University of Colorado, Aurora.; University of Colorado, Colorado
| | - David Pagliaccio
- New York State Psychiatric Institute, Columbia University, New York
| | - Hong Bui
- National Institute of Mental Health, Bethesda, Maryland
| | | | - Matt Jones
- University of Colorado Boulder.; University of Colorado, Colorado
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Haller SP, Stoddard J, MacGillivray C, Stiles K, Perhamus G, Penton-Voak IS, Bar-Haim Y, Munafò MR, Brotman MA. A double-blind, randomized, placebo-controlled trial of a computer-based Interpretation Bias Training for youth with severe irritability: a study protocol. Trials 2018; 19:626. [PMID: 30428909 PMCID: PMC6237001 DOI: 10.1186/s13063-018-2960-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/03/2018] [Indexed: 12/03/2022] Open
Abstract
Background Severe, chronic, and impairing irritability is a common presenting clinical problem in youth. Indeed, it was recently operationalized as disruptive mood dysregulation disorder (DMDD) in the DSM-5. However, to date, there are no evidence-based treatments that were specifically developed for DMDD. The current randomized controlled trial assesses the efficacy of a computer-based cognitive training intervention (Interpretation Bias Training; IBT) in youth with DMDD. IBT aims to reduce irritability by altering judgments of ambiguous face-emotions through computerized feedback. IBT is based on previous findings that youth with irritability-related psychopathology rate ambiguous faces as more hostile and fear producing. Methods/design This is a double-blind, randomized controlled trial of IBT in 40 youth with DMDD. Participants will be randomized to receive four IBT sessions (Active vs. Sham training) over 4 days. Active IBT provides computerized feedback to change ambiguous face-emotion interpretations towards happy interpretations. Face-emotion judgments are performed pre and post training, and for 2 weeks following training. Blinded clinicians will conduct weekly clinical ratings. Primary outcome measures assess changes in irritability using the clinician-rated Affective Reactivity Index (ARI) and Clinical Global Impressions-Improvement (CGI-I) scale for DMDD, as well as parent and child reports of irritability using the ARI. Secondary outcome measures include clinician ratings of depression, anxiety, and overall impairment. In addition, parent and child self-report measures of depression, anxiety, anger, social status, and aggression will be collected. Discussion The study described in this protocol will perform the first RCT testing the efficacy of IBT in reducing irritability in youth with DMDD. Developing non-pharmacological treatment options for youth suffering from severe, chronic irritability is important to potentially augment existing treatments. Trial registration ClinicalTrials.gov, ID: NCT02531893. Registered on 25 August 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2960-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simone P Haller
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892, USA.
| | - Joel Stoddard
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, USA
| | | | - Kelsey Stiles
- Department of Psychology, University of California, Los Angeles, USA
| | - Gretchen Perhamus
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892, USA
| | - Ian S Penton-Voak
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Marcus R Munafò
- School of Experimental Psychology, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, UK
| | - Melissa A Brotman
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892, USA
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Abstract
This report presents the results of commissioning, clinical implementation and quality assurance of Siemens Virtual Wedge. Our measurements show that: (1) wedge factors are within 2% of unity, (2) percentage depth doses are within 1% of open beam data, and (3) wedged beam profiles can be modeled similarly to a physical wedge and follow a well defined equation to facilitate modeling of an arbitrary wedge angle. The gantry angle dependence of wedge profiles is similar to open beam profiles. The output of wedged fields is linear with delivered monitor units within 1%. Quality assurance results indicate the wedge profiles are very stable over time. Day to day variations of two points measured along the wedge gradient direction are within 1.5%.
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Affiliation(s)
- S Rathee
- Medical Physics Department, Manitoba Cancer Treatment and Research Foundation, Winnipeg, Canada.
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