Clinically impairing irritability and temper outbursts are among the most common psychiatric problems in youth and present transdiagnostically; however, few mechanistically informed treatments have ...been developed. Here, we test the acceptability, feasibility, and preliminary efficacy of a novel exposure-based treatment with integrated parent management skills for youth with severe irritability using a randomized between-subjects multiple baseline design.
N = 41 patients (Age, Mean (SD) = 11.23 years (1.85), 62.5% male, 77.5% white) characterized by severe and impairing temper outbursts and irritability were randomized to different baseline observation durations (2, 4, or 6 weeks) prior to active treatment; 40 participants completed the 12 session treatment of exposure-based cognitive-behavioral therapy for irritability with integrated parent management skills. Masked clinician ratings were acquired throughout baseline and treatment phases, as well as 3- and 6-months post-treatment. To examine acceptability and feasibility, drop-out rates and adverse events were examined. Primary clinical outcome measures included clinician-administered measures of irritability severity and improvement. Secondary clinical outcome measures included multi-informant measures of irritability, depression, anxiety, and attention-deficit/hyperactivity disorder symptoms.
No patients dropped out once treatment began, and no adverse events were reported. Irritability symptoms improved during the active phase of treatment across all measurements (all βs > -0.04, ps < .011, Cohen's d range: -0.33 to -0.98). Treatment gains were maintained at follow-up (all βs
(39)
< -0.001, ps > .400). Sixty-five percent of patients were considered significantly improved or recovered post-treatment based on the primary clinician-rated outcome measure.
Results support acceptability, feasibility, and preliminary efficacy of this novel treatment for youth with severe irritability. Limitations and future directions are also discussed.
Attention allocation to threat is perturbed in patients with posttraumatic stress disorder (PTSD), with some studies indicating excess attention to threat and others indicating fluctuations between ...threat vigilance and threat avoidance. The authors tested the efficacy of two alternative computerized protocols, attention bias modification and attention control training, for rectifying threat attendance patterns and reducing PTSD symptoms.
Two randomized controlled trials compared the efficacy of attention bias modification and attention control training for PTSD: one in Israel Defense Forces veterans and one in U.S. military veterans. Both utilized variants of the dot-probe task, with attention bias modification designed to shift attention away from threat and attention control training balancing attention allocation between threat and neutral stimuli. PTSD symptoms, attention bias, and attention bias variability were measured before and after treatment.
Both studies indicated significant symptom improvement after treatment, favoring attention control training. Additionally, both studies found that attention control training, but not attention bias modification, significantly reduced attention bias variability. Finally, a combined analysis of the two samples suggested that reductions in attention bias variability partially mediated improvement in PTSD symptoms.
Attention control training may address aberrant fluctuations in attention allocation in PTSD, thereby reducing PTSD symptoms. Further study of treatment efficacy and its underlying neurocognitive mechanisms is warranted.
Background
Irritability presents transdiagnostically, commonly occurring with anxiety and other mood symptoms. However, little is known about the temporal and dynamic interplay among ...irritability‐related clinical phenomena. Using a novel network analytic approach with smartphone‐based ecological momentary assessment (EMA), we examined how irritability and other anxiety and mood symptoms were connected.
Methods
Sample included 152 youth ages 8–18 years (M ± SD = 12.28 ± 2.53; 69.74% male; 65.79% White) across several diagnostic groups enriched for irritability including disruptive mood dysregulation disorder (n = 34), oppositional defiant disorder (n = 9), attention‐deficit/hyperactivity disorder (n = 47), anxiety disorder (n = 29), and healthy comparisons (n = 33). Participants completed EMA on irritability‐related constructs and other mood and anxiety symptoms three times a day for 7 days. EMA probed symptoms on two timescales: “since the last prompt” (between‐prompt) versus “at the time of the prompt” (momentary). Irritability was also assessed using parent‐, child‐ and clinician‐reports (Affective Reactivity Index; ARI), following EMA. Multilevel vector autoregressive (mlVAR) models estimated a temporal, a contemporaneous within‐subject and a between‐subject network of symptoms, separately for between‐prompt and momentary symptoms.
Results
For between‐prompt symptoms, frustration emerged as the most central node in both within‐ and between‐subject networks and predicted more mood changes at the next timepoint in the temporal network. For momentary symptoms, sadness and anger emerged as the most central node in the within‐ and between‐subject network, respectively. While anger was positively related to sadness within individuals and measurement occasions, anger was more broadly positively related to sadness, mood lability, and worry between/across individuals. Finally, mean levels, not variability, of EMA‐indexed irritability were strongly related to ARI scores.
Conclusions
This study advances current understanding of symptom‐level and temporal dynamics of irritability. Results suggest frustration as a potential clinically relevant treatment target. Future experimental work and clinical trials that systematically manipulate irritability‐related features (e.g. frustration, unfairness) will elucidate the causal relations among clinical variables.
Background
Emotional lability, defined as rapid and/or intense affect fluctuations, is associated with pediatric psychopathology. Although numerous studies have examined labile mood in clinical ...groups, few studies have used real‐time assessments in a well‐characterized transdiagnostic sample, and no prior study has included participants with disruptive mood dysregulation disorder (DMDD). The present study leverages ecological momentary assessment (EMA) to assess emotional lability in a transdiagnostic pediatric sample.
Methods
One hundred thirty participants ages 8−18 with primary diagnoses of DMDD, attention‐deficit/hyperactivity disorder (ADHD), an anxiety disorder (ANX), or healthy volunteers completed a previously validated 1‐week EMA protocol. Clinicians determined diagnoses based on semi‐structured interviews and assessed levels of functional impairment. Participants reported momentary affective states and mood change. Composite scores of fluctuations in positive and negative affect were generated. Affect fluctuations were compared between diagnostic groups and tested for their association with functional impairment.
Results
Diagnostic groups differed in levels of negative and positive emotional lability. DMDD patients demonstrated the highest level of labile mood compared with other groups. Emotional lability was associated with global impairment in the whole sample.
Conclusions
Both positive and negative emotional lability is salient in pediatric psychopathology and is associated with functional impairment, particularly in DMDD youth.
While attention bias modification (ABM) is a promising novel treatment for anxiety disorders, clinical trial data remain restricted to adults. The authors examined whether ABM induces greater ...reductions in pediatric anxiety symptoms and symptom severity than multiple control training interventions.
From a target sample of 186 treatment-seeking children at a hospital-based child anxiety clinic, 40 patients with an ongoing anxiety disorder who met all inclusion criteria were enrolled in the study. Children were randomly assigned to one of three conditions: ABM designed to shift attention away from threat; placebo attention training using stimuli identical to those in the ABM condition; and placebo attention training using only neutral stimuli. All participants completed four weekly 480-trial sessions (1,920 total trials). Before and after the attention training sessions, children's clinical status was determined via semistructured interviews and questionnaires. Reduction in the number of anxiety symptoms and their severity was compared across the three groups.
Change in the number of anxiety symptoms and their severity differed across the three conditions. This reflected significant reductions in the number of anxiety symptoms and symptom severity in the ABM condition but not in the placebo attention training or placebo-neutral condition.
ABM, compared with two control conditions, reduces pediatric anxiety symptoms and severity. Further study of efficacy and underlying mechanisms is warranted.
Threat monitoring facilitates survival by allowing one to efficiently and accurately detect potential threats. Traumatic events can disrupt healthy threat monitoring, inducing biased and unstable ...threat-related attention deployment. Recent research suggests that greater attention bias variability, that is, attention fluctuations alternating toward and away from threat, occurs in participants with PTSD relative to healthy comparison subjects who were either exposed or not exposed to traumatic events. The current study extends findings on attention bias variability in PTSD.
Previous measurement of attention bias variability was refined by employing a moving average technique. Analyses were conducted across seven independent data sets; in each, data on attention bias variability were collected by using variants of the dot-probe task. Trauma-related and anxiety symptoms were evaluated across samples by using structured psychiatric interviews and widely used self-report questionnaires, as specified for each sample.
Analyses revealed consistent evidence of greater attention bias variability in patients with PTSD following various types of traumatic events than in healthy participants, participants with social anxiety disorder, and participants with acute stress disorder. Moreover, threat-related, and not positive, attention bias variability was correlated with PTSD severity.
These findings carry possibilities for using attention bias variability as a specific cognitive marker of PTSD and for tailoring protocols for attention bias modification for this disorder.
Attention bias modification treatment (ABMT) and cognitive bias modification of interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each ...other, their combination, and with a combined control condition has not been studied. We examined their relative and combined efficacy compared to control conditions in a randomized controlled trial (RCT).
Ninety-five adults diagnosed with social anxiety disorder (SAD), were randomly allocated to 4 groups: ABMT + CBM-I control (hereafter ABMT; n = 23), CBM-I + ABMT control (hereafter CBM-I; n = 24), combined ABMT + CBM-I (n = 23), and combined control (n = 25). Treatment included eight sessions over four weeks. Clinician-rated and self-reported measures of social anxiety symptoms, functional impairment, and threat-related attention and interpretive biases were evaluated at baseline, post-treatment, and 3-month follow-up.
ABMT yielded greater symptom reduction as measured by both clinician-ratings (Cohen's ds = 0.57-0.70) and self-reports (ds = 0.70-0.85) compared with the CBM-I, the combined ABMT + CBM-I, and the combined control conditions. Neither of the other conditions demonstrated superior symptom change compared to the control condition. No group differences were found for functioning or cognitive biases measures.
Limitations mainly include the mix of active and control treatments applied across the different groups. Therefore, the net effect of each of the treatments by itself could not be clearly tested.
Results suggest superiority of ABMT compared to CBM-I and their combination in terms of symptom reduction. Possible interpretations and methodological issues underlying the observed findings are discussed.
•This study was a randomized controlled trial for social anxiety.•Efficacy of attention and interpretation bias modification treatments was evaluated.•Results showed some superiority of attention bias modification (ABMT) over other treatments.•ABMT yielded greater reduction in clinical and self-reported anxiety symptoms.•No group differences were found for functioning or cognitive biases measures.
Although initial findings indicated that threat‐related attention bias variability (ABV), an index designed to capture dynamic shifts in threat‐related attention over time, was positively correlated ...with the severity of posttraumatic stress disorder (PTSD) symptoms, a recent study relying on simulated data has raised questions regarding the validity and empirical utility of ABV. Specifically, the simulations suggested that core features of reaction time data distinct from threat‐related attention bias, such as the reaction time standard deviation and mean, could explicate the reported elevated ABV among samples with PTSD. In the present study, we evaluated these suggestions in 95 PTSD‐diagnosed participants. The results showed that ABV significantly and uniquely predicted PTSD symptom severity beyond the predictive value of core reaction time features, ΔR2 = .05–.23. Some of the predictions stemming from the simulated results were replicated, whereas others were not. Contrary to the conclusion drawn from the simulated data, the results from the current study suggest that ABV is a valid and replicable correlate of PTSD symptom severity.
Resumen
Spanish s by Asociación Chilena de Estrés Traumático (ACET)
La validez de los índices de variabilidad del sesgo de atención para la investigación del TEPT: Evidencia sobre los datos de los pacientes
VALIDEZ DE LA VARIABILIDAD DEL SESGO ATENCIONAL EN EL TEPT
Aunque los hallazgos iniciales indicaron que la variabilidad del sesgo de atención (ABV en su sigla en inglés) relacionada con la amenaza, un índice diseñado para capturar cambios dinámicos en la atención relacionada con la amenaza a lo largo del tiempo, que se correlacionó positivamente con la gravedad de los síntomas del trastorno de estrés postraumático (TEPT), un estudio reciente basado en datos simulados ha planteado preguntas sobre la validez y la utilidad empírica del ABV. Específicamente, las simulaciones sugirieron que las características centrales de los datos del tiempo de reacción distintas del sesgo de atención relacionado con la amenaza, como la desviación estándar y la media del tiempo de reacción, podrían explicar el aumento del ABV reportado entre las muestras con el TEPT. En el presente estudio, evaluamos estas sugerencias en 95 participantes con diagnóstico del TEPT. Los resultados mostraron que ABV predijo de manera significativa y única la gravedad de los síntomas del TEPT más allá del valor predictivo de las características centrales del tiempo de reacción, ΔR2 = .05 – .23. Algunas de las predicciones derivadas de los resultados simulados se replicaron, mientras que otras no. Contrariamente a la conclusión extraída de los datos simulados, los resultados del estudio actual sugieren que la ABV es un correlato válido y replicable de la gravedad de los síntomas del TEPT.
抽象
Traditional and Simplified Chinese s by the Asian Society for Traumatic Stress Studies (AsianSTSS)
簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯
Validity of Attention Bias Variability Indices for PTSD Research: Evidence from Patient Data
Traditional Chinese
標題: PTSD研究中, 注意力偏誤變異性指數的效度:患者數據提供的證據
撮要: 威脅相關的注意力偏誤變異性(ABV), 乃標示威脅相關的注意力隨時間所生的互動變化的指數。雖然初期的研究發現, ABV與創傷後壓力症(PTSD)症狀嚴重度有正向關連, 但近期一個採用模擬數據的研究卻令人質疑ABV的效度和實證功用。那些模擬數據特別地反映, 跟威脅相關的注意力偏誤相異的反應時間數據的核心特徵, 例如反應時間的標準差和中位數, 可以解釋患PTSD的樣本中ABV提升的情況。本研究透過95名被診斷出患PTSD的樣本, 檢視以上論點。結果顯示, ABV顯著而且獨特地預測到PTSD症狀嚴重度, 程度超越反應時間核心特徵的預測值(ΔR2 = .05–.23)。是次研究重複了部分早前基於模擬數據所得的預測。然而, 與從模擬數據所得的結論不同, 是次研究結果反映, ABV對PTSD症狀來說是有效及具可重複性的相關因素。
Simplified Chinese
标题: PTSD研究中, 注意力偏误变异性指数的效度:患者数据提供的证据
撮要: 威胁相关的注意力偏误变异性(ABV), 乃标示威胁相关的注意力随时间所生的互动变化的指数。虽然初期的研究发现, ABV与创伤后压力症(PTSD)症状严重度有正向关连, 但近期一个采用仿真数据的研究却令人质疑ABV的效度和实证功用。那些仿真数据特别地反映, 跟威胁相关的注意力偏误相异的反应时间数据的核心特征, 例如反应时间的标准偏差和中位数, 可以解释患PTSD的样本中ABV提升的情况。本研究透过95名被诊断出患PTSD的样本, 检视以上论点。结果显示, ABV显著而且独特地预测到PTSD症状严重度, 程度超越反应时间核心特征的预测值(ΔR2 = .05–.23)。是次研究重复了部分早前基于仿真数据所得的预测。然而, 与从仿真数据所得的结论不同, 是次研究结果反映, ABV对PTSD症状来说是有效及具可重复性的相关因素。
Transitioning out of the military can be a time of change and challenge. Research indicates that altered threat monitoring in military populations may contribute to the development of psychopathology ...in veterans, and interventions that adjust threat monitoring in personnel leaving the military may be beneficial. Australian Defence Force personnel (N = 59) transitioning from the military were randomized to receive four weekly sessions of either attention‐control training or a placebo attention training. The primary outcome was symptoms of posttraumatic stress disorder (PTSD), as measured using the PTSD Checklist for DSM‐5 (PCL‐5) at posttreatment. Following training, participants who received attention‐control training reported significantly lower levels of PTSD symptoms, Hedges’ g = 0.86, 95% CI 0.37, 1.36, p = .004, and significantly improved work and social functioning, Hedges’ g = 0.93, 95% CI 0.46, 1.39, p = .001, relative to those in the placebo condition. Moreover, no participants who received attention‐control training worsened with regard to PTSD symptoms, whereas 23.8% of those who received the placebo attention training experienced an increase in PTSD symptoms. The preliminary findings from this pilot study add to a small body of evidence supporting attention‐control training as a viable indicated early intervention approach for PTSD that is worthy of further research.
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