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.

中文翻译：

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一项针对破坏性情绪失调障碍的计算机化解释偏差训练的随机对照试验：一项快速失败研究

客观的

检查有针对性的、基于机制的干预措施是下一代治疗创新。模棱两可的面部情绪的偏见威胁标签（解释偏见）是愤怒、攻击性和易怒的潜在行为治疗目标。改变面部情绪标签的偏见可能会改善易怒相关的结果。在这里，我们报告了第一个针对患有慢性、严重易怒的青少年的解释偏差训练 (IBT) 的随机、双盲、安慰剂对照的靶向试验。

方法

当前患有破坏性情绪失调障碍 (DMDD；N = 44) 的患者被随机分配在 1 周内完成 4 次主动 (n = 22) 或假 (n = 22) 计算机化 IBT 训练。第一次和最后一次培训在现场完成，2次培训在家完成。我们检查了主动 IBT 对标记偏差、易怒的主要结果测量以及焦虑、抑郁和功能障碍的次要结果测量的影响。后续评估在干预后立即以及 1 周和 2 周后完成。

结果

我们发现积极的 IBT 在积极的情况下参与了行为目标，而不是在假的情况下，正如向将模棱两可的面孔标记为快乐的显着转变所表明的那样。然而，在主要或次要结果测量中，无论是在训练后立即还是训练后 2 周，与假条件相比，主动 IBT 没有一致的临床改善。

结论

尽管这项针对 DMDD 青少年的 IBT 随机对照试验采用了拟议的行为目标，但临床结果没有统计学上的显着改善。识别和改变行为目标是开发新疗法的第一步；这些结果对基于目标的干预措施开发具有更广泛的影响。

临床试验注册信息

严重烦躁青少年的心理治疗；https://clinicaltrials.gov/；NCT02531893。