On Defining Irritability and its Relationship to Affective Traits and Social Interpretations

Concurrent and longitudinal neurostructural correlates of irritability in children

Irritability, or an increased proneness to frustration and anger, is common in youth; however, few studies have examined neurostructural correlates of irritability in children. The purpose of the current study was to examine concurrent and longitudinal associations between brain structure and irritability in a large sample of 9-10-year-old children. Participants included 10,647 children from the Adolescent Brain Cognitive Developmentsm Study (ABCD Study®). We related a latent irritability factor to gray matter volume, cortical thickness, and surface area in 68 cortical regions and to gray matter volume in 19 subcortical regions using structural equation modeling. Multiple comparisons were adjusted for using the false discovery rate (FDR). After controlling for age, sex, race/ethnicity, scanner model, parent's highest level of education, medication use, and total intracranial volume, irritability was associated with smaller volumes in primarily temporal and parietal regions at baseline. Longitudinal analyses showed that baseline gray matter volume did not predict irritability symptoms at the 3rd-year follow-up. No significant associations were found for cortical thickness or surface area. The current study demonstrates inverse associations between irritability and volume in regions implicated in emotional processing/social cognition, attention allocation, and movement/perception. We advance prior research by demonstrating that neurostructural differences associated with irritability are already apparent by age 9-10 years, extending this work to children and supporting theories positing socioemotional deficits as a key feature of irritability.

An evaluation of the Ultimatum Game as a measure of irritability and anger

The Ultimatum Game is an effective tool for understanding how social decision-making is influenced by emotions in both research and clinical settings. Previous findings have shown that the Ultimatum Game can evoke negative emotions, especially anger and aggression. In a sample of non-clinical adults (N = 143) we evaluated the sensitivity of an anger-infused version of the Ultimatum Game to individual differences in anger and irritability. Findings showed significant relationships between anger and aggressive behaviors in the Ultimatum game, but no association between irritability and aggressive behavior were observed. This indicates that the anger-infused Ultimatum Game is a promising method for studying individual differences in trait anger and anger expression. However, the relationship between decision-making in the anger-infused Ultimatum Game and irritability is less straight forward and needs further investigation. Therefore, when studying the behavioral responses of irritability, it would be beneficial to capture other behaviors beyond aggressive responses.

Differentiating neural sensitivity and bias during face-emotion processing in youth: a computational approach

The ability to interpret face-emotion displays is critical for the development of adaptive social interactions. Using a novel variant of a computational model and fMRI data, we examined behavioral and neural associations between two metrics of face-emotion labeling (sensitivity and bias) and age in youth. Youth and adults (n = 44, M age = 20.02, s.d. = 7.44, range = 8-36) completed an explicit face-emotion labeling fMRI task including happy to angry morphed face emotions. A drift-diffusion model was applied to choice and reaction time distributions to examine sensitivity and bias in interpreting face emotions. Model fit and reliability of parameters were assessed on adult data (n = 42). Linear and quadratic slopes modeled brain activity associated with dimensions of face-emotion valence and ambiguity during interpretation. Behaviorally, age was associated with sensitivity. The bilateral anterior insula exhibited a more pronounced neural response to ambiguity with older age. Associations between sensitivity and bias metrics and activation patterns indicated that systems encoding face-emotion valence and ambiguity both contribute to the ability to discriminate face emotions. The current study provides evidence for age-related improvement in perceptual sensitivity to facial affect across adolescence and young adulthood.

Aggression and Irritability in Middle Childhood: Between- and Within-Person Associations

OBJECTIVE

This study tested predicted bidirectional associations between irritability and physical and relational forms of aggression, disentangling theorized within- and between-person effects using latent curve models with structured residuals (LCM-SR) over one year in middle childhood. Gender differences and robustness of results when controlling for other externalizing problems (i.e., attention problems, delinquency) were also considered.

METHOD

Children in third, fourth, and fifth grade (N = 704, 49.9% female) were recruited from schools in a large midwestern city. The sample was diverse in regard to race/ethnicity (31% Black, 29% White, 13% Hmong, 14% Latinx, 4% Native American, 4% Asian, 5% other races/ethnicities). Irritability, attention problems, and delinquency were measured using teacher-report, and physical and relational aggression were measured using self-report at three time points over one calendar year.

RESULTS

At the between-person level, higher mean levels of irritability predicted higher initial levels of physical and relational aggression. Irritability continued to predict higher levels of physical aggression across the course of the study, whereas the effect of irritability on relational aggression diminished. Boys showed higher starting levels of physical aggression, but no other significant gender differences emerged. No significant within-person associations were found.

CONCLUSIONS

The present study suggests that irritability may represent a between-person risk factor for high levels of physical and relational aggression in middle childhood, although effects on physical aggression may be more persistent. This highlights the importance of considering affective processes to understand the development of aggression trajectories.

Associations between sleep quality and irritability: Testing the mediating role of emotion regulation

OBJECTIVES

Irritability and sleep problems are common symptoms that span a range of internalizing and externalizing mental health disorders. While poor sleep has been associated with symptoms related to irritability (e.g., anxiety and depression), few studies have directly tested the association between sleep quality and irritability and whether the association is direct or mediated by a separate mechanism.

METHOD

The present study used self-report measures to test whether sleep is associated with irritability in 458 adults aged 19-74 years (58 % female; 79 % White), and whether this association is mediated by emotion regulation. Confirmatory factor analyses were carried out to support the use of scores from these measures.

RESULTS

Controlling for anxiety and depression symptoms, results showed a direct association between poorer sleep quality and increased irritability (β = 0.25, p < .001) that was not mediated by emotion regulation.

CONCLUSIONS

Our findings underscore the important link between sleep and irritability, both of which are common features of mental health difficulties, prompting further inquiry into the directionality of the findings and potential mediators. This work has notable clinical implications for sleep as a possible intervention target for individuals with high irritability.

Irritability: A concept analysis

Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as 'unpredictability and lowered emotion control', 'lowered threshold for negative emotional stimuli', 'being manifested in response to frustrative situations or physiological needs' and 'experience of disproportionate and unjustified emotional irritation'. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations.

Validation of the Arabic version of the brief irritability test (Ar-BITe) in non-clinical adolescents

BACKGROUND

Despite the substantial clinical relevance of irritability in the development and maintenance of several mental disorders and its negative effects on functioning, no valid and reliable measures are available yet to identify the presence and consequences of irritability as a distinct construct among the Arabic-speaking populations. To bridge this gap, and help advance this field in the under-researched Arab region, we aimed to validate an Arabic-language version of the Brief Irritability Test (BITe).

METHODS

Eligible participants were native Arabic-speaking non-clinical adolescents from Lebanon; 527 participants aged 15.73 ± 1.81 years (56% females) completed the survey.

RESULTS

Utilizing the Confirmatory Factor Analysis approach, we found that the five items of the Arabic BITe loaded into a single factor structure. The scale showed excellent reliability, as both Cronbach's alpha and McDonald's omega coefficient values were of 0.88. Multi-group analyses showed invariance across sex groups in our sample at the configural, metric, and scalar levels. Female adolescents exhibited higher BITe scores than their male counterparts (14.01 vs. 13.25), but this difference did not reach the statistical significance. Good concurrent validity was supported based on positive correlations between irritability scores and measures of aggression, anger and hostility (r Pearson's coefficients ranging from 0.35 to 0.42), as well as positive correlations with insomnia symptoms scores.

CONCLUSION

The present findings allow us to conclude that the Arabic version of the BITe is a unidimensional, reliable, valid, brief, and economic self-report measure of the irritability construct for both male and female Arabic-speakers. Providing an Arabic validated version of the BITe will hopefully foster the research efforts of the Arab scientific community in this area, and promote the implementation of timely, evidence-informed and culturally-sensitive mental health interventions that appropriately address irritability-related problems and consequences among Arab young populations.

Associations between childhood irritability and neural reactivity to maternal feedback in adolescence

Early irritability, a transdiagnostic vulnerability for psychopathology, is associated with alterations in neural reactivity to emotional stimuli and reward; however, associations between childhood irritability and neural markers of risk may be mitigated by the quality of caregiving youth receive. We examined longitudinal relationships between irritability in childhood and young adolescents' neural activity of regions typically associated with emotion regulation and reward processing during processing of maternal feedback and tested whether these associations were moderated by youth's perceptions of the parent-child relationship quality. Eighty-one adolescents (Mage = 11.1 years) listened to maternal critical and praising feedback while undergoing functional magnetic resonance imaging. Age 3 irritability, assessed observationally, was negatively associated with age 11 neural reactivity to maternal criticism in a cluster in the right dorsolateral prefrontal cortex (dlPFC), particularly for youths who reported more positive maternal parenting. Given the role of the dlPFC activation in the effortful processing of emotional stimuli, decreased activation may reflect disengagement from negatively valenced interpersonal feedback in the context of a positive caregiving environment, thereby mitigating psychopathology risk associated with irritability.

Short-term effects of the "I Spy Feelings" program on emotion regulation in 5- to 6-year-old children

Introduction

Mental health difficulties in early childhood can have a debilitating and ongoing impact throughout an individual's life; emotion regulation can serve as a protective factor. Therefore, evidence-based prevention programs that teach children effective skills and strategies for emotion regulation are needed.

Methods

As part of the Aussie Optimism pilot study evaluating the "I Spy Feelings" program, this study aims to assess the short-term effects of the program on emotion regulation in pre-primary aged children after 2 months via a longitudinal cluster randomized controlled trial. Participants included parents (N = 73) of 5- to 6-year-old children attending four different Catholic primary schools. Children from two of the schools were allocated to the intervention group where they participated in the program (N = 33), while children from the other two schools were allocated to the control group where they did not (N = 40). At each time point, all parents completed abridged Children's Emotional Management Scales measuring how well parents believe their child is able to cope with anger, sadness and worry.

Results

A significant intervention effect 2 months after intervention was found for the outcome of anger coping such that parents whose children were in the intervention group reported significantly greater improvement in their children's ability to cope with anger compared to parents whose children were in the control group. No significant effect was found for the outcome of sadness, and results for the worry subscale were inconclusive due to unacceptable internal consistency.

Discussion

The present study provides insight into the benefit of programs designed to enhance the emotion regulation skills of very young children. Further follow-up is needed to assess whether the "I Spy Feelings" program has lasting effects.

The distinction between irritability and anger and their associations with impulsivity and subjective wellbeing

Irritability, anger, and impulsivity have important associations with psychological well-being. However, studying the internal relationships between such emotional constructs is challenging, largely because of the lack of precise operational definitions and extensively validated measurement tools. The aim of this study was to examine relationships between the above emotional constructs and how they relate to satisfaction with life and perceived negative impact on different life domains. Participants (N = 471) completed a self-report questionnaire online. Correlational analyses showed that higher levels of irritability and trait anger were associated with lower life satisfaction. Impulsivity displayed complex relationships with life satisfaction, with some aspects (sensation seeking) showing a positive relationship and others (urgency, lack of perseverance) showing a negative relationship. A two-factor Confirmatory Factor Analysis treating irritability and anger as separate constructs showed a better fit compared with a one-factor model, indicating that irritability and anger should be treated as separate constructs. An exploratory moderation analysis showed that higher irritability predicted increased anger only for participants scoring average to high on urgency (a facet of impulsivity). Our findings increase the understanding of the relationship between these dispositional constructs and supports the conceptualization of irritability and anger as related but distinct constructs.

Examining the indirect contributions of irritability and chronic interpersonal stress on symptoms of anxiety and depression in adolescents

BACKGROUND

Chronic interpersonal stress has been identified as predictive of anxiety and depression. However, more research is needed to understand predictors of chronic interpersonal stress and mediators of its relationship with anxiety and depression. Irritability, a transdiagnostic symptom closely related to chronic interpersonal stress, may provide more insight into this relationship. While some research has demonstrated that irritability is related to chronic interpersonal stress, directionality is unknown. A bidirectional relationship between irritability and chronic interpersonal stress was hypothesized, such that irritability mediates the relationship between chronic interpersonal stress and internalizing symptoms and chronic interpersonal stress mediates the relationship between irritability and internalizing symptoms.

METHODS

This study used three cross-lagged panel models to investigate the indirect effects of irritability and chronic interpersonal stress on anxiety and depression symptoms using data from 627 adolescents (68.9 % female, 57.7 % white) over a six-year period.

RESULTS

In partial support for our hypotheses, we found that the relationships between chronic interpersonal stress and both fears and anhedonia were mediated by irritability, and that the relationship between irritability and anhedonia was mediated by chronic interpersonal stress.

LIMITATIONS

Study limitations include some temporal overlap in symptom measurements, an irritability measure that has not been previously validated to measure the construct, and lack of a lifespan perspective.

CONCLUSIONS

More targeted approaches in intervention for both chronic interpersonal stress and irritability may improve prevention and intervention efforts to address anxiety and depression.

Neural Correlates of Antisocial Behavior: The Victim’s Perspective

Antisocial behavior involves actions that disregard the basic rights of others and may represent a threat to the social system. The neural processes associated with being subject to antisocial behavior, including social victimization, are still unknown. In this study, we used a social interaction task during functional magnetic resonance imaging to investigate the neural bases of social victimization. Brain activation and functional connectivity (FC) were estimated and correlated with the Big 5 Questionnaire, Temperament Evaluation in Memphis, Pisa and San Diego (TEMPS-M), and a Questionnaire of Daily Frustration scores. During social victimization, the right occipital and temporal cortex showed increased activation. The temporal cortex also had reduced FC with homotopic areas. Compared to the prosocial interaction, social victimization showed hyperactivation of the dorsomedial and lateral prefrontal cortex, putamen, and thalamus and increased FC of the medial-frontal–striatal–thalamic areas with the ventrolateral prefrontal cortex, insula, dorsal cingulate, and postcentral gyrus. Lastly, neuroticism, irritable temperament, and frustration scores were correlated with the magnitude of neural responses to social victimization. Our findings suggest that social victimization engages a set of regions associated with salience, emotional processing, and regulation, and these responses can be modulated by temperamental and personality traits.

Bullying Perpetration and Victimization in Youth: Associations with Irritability and Anxiety

Prior work on has demonstrated that irritability and anxiety are associated with bullying perpetration and victimization, respectively. Even though symptoms of irritability and anxiety often occur concurrently, few studies have tested their interactive effects on perpetration or victimization. The current study recruited 131 youths from a broader program of research that examines the pathophysiology and treatment of pediatric irritability and anxiety. Two moderation tests were performed to examine concurrent irritability and anxiety symptoms and their relation to perpetration and victimization of bullying. More severe anxiety was associated with greater victimization. However, more severe irritability was associated with, not just greater perpetration, but also greater victimization. An irritability-by-anxiety interaction demonstrated that youths with more severe irritability and lower levels of anxiety engaged in more perpetration. Our findings suggest a more nuanced approach to understanding how the commonly comorbid symptoms of irritability and anxiety interact in relation to peer-directed behavior in youths.

Pharmacotherapy of Disruptive Behaviors in Children with Intellectual Disabilities

Disruptive behaviors are a class of predominantly externalizing behaviors that include physical aggression, property destruction, temper outbursts, verbal aggression, and some forms of self-injurious behaviors. Externalizing behaviors are also major components of disruptive, impulse-control and conduct disorders, disruptive mood dysregulation disorder, trauma-related and stressor-related disorders, intermittent explosive disorder, personality disorders, and other neuropsychiatric and neurodevelopmental disorders. Disruptive behaviors and associated disorders are among the most frequent reasons for child behavioral health referrals and are the most common reason for referrals among children with intellectual disabilities. The focus of this paper is on the adjunctive role of integrated psychopharmacological treatment in the management of children with disruptive behaviors and co-occurring intellectual disabilities. The decision-making process for adding pharmacotherapy to a comprehensive treatment plan incorporates not only a working knowledge of basic behavioral neurobiology of disruptive behaviors but also an understanding of the strengths and weaknesses of various pharmacotherapies. Importantly, there is little evidence to support the use of psychopharmacologic agents in managing difficult behaviors in children with intellectual disabilities, but with that said, risperidone has the strongest evidence base for its use.

Understanding Irritability in Relation to Anger, Aggression, and Informant in a Pediatric Clinical Population

OBJECTIVE

Despite its clinical relevance to pediatric mental health, the relationship of irritability with anger and aggression remains unclear. We aimed to quantify the relationships between well-validated, commonly used measurements of these constructs and informant effects in a clinically relevant population.

METHOD

A total of 195 children with primary diagnoses of attention-deficit/hyperactivity disorder, disruptive mood dysregulation disorder, or no major disorder and their parents rate irritability, anger, and aggression on measures of each construct. Construct and informant relationships were mapped via multi-trait, multi-method factor analysis.

RESULTS

Parent- and child-reported irritability and child-reported anger are highly associated (r = 0.89) but have some significant differences. Irritability overlaps with outward expression of anger but diverges from anger in anger suppression and control. Aggression has weaker associations with both irritability (r = 0.56) and anger (r = 0.49). Across measures, informant source explains a substantial portion of response variance.

CONCLUSION

Irritability, albeit distinct from aggression, is highly associated with anger, with notable overlap in child-reported outward expression of anger, providing empirical support for formulations of clinical irritability as a proneness to express anger outwardly. Diagnostic and clinical intervention work on this facet of anger can likely translate to irritability. Further research on external validation of divergence of these constructs in anger suppression and control may guide future scale revisions. The proportion of response variance attributable to informant may be an under-recognized confound in clinical research and construct measurement.

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

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.

Research Audit on Clinical Utility of Dimensional Disruptive Mood and Behavior Psychopathologies in Child and Adolescent Psychiatry Practice

To investigate the utility of dimensional psychopathologies of disruptive mood and behavior disorders (DBDs) by applying latent profile analysis (LPA) for characterization of youth referred to the tertiary outpatient clinic of child and adolescent psychiatry clinic and pharmacological treatment choices. One hundred fifty-eight children and adolescents with significant DBDs symptoms participated. Core dimensional psychopathologies of DBDs (irritability, callous-unemotional trait, and reactive-proactive aggressive behavior), DSM diagnoses, prescribed medications, and behavioral and emotional problems (Child Behavior Checklist, CBCL) were measured at baseline (clinic intake) and at 3-month follow-up. Latent Profile Analysis (LPA) was applied to characterize the study population based on the levels and interrelations among the core dimensional DBDs psychopathologies. Following LPA, the differences in clinical and treatment features between the latent classes were analyzed. LPA revealed two latent classes based on severity of DBDs symptoms. Class 1 (the moderate group) was characterized by relatively low scores on all trans-diagnostic indicators, whereas class 2 (the severe/critical group) showed higher levels of the dimensional psychopathologies and the majority of CBCL subscales. In addition, the severe/critical group was more often prescribed antipsychotic medications, and also experienced more frequent medication changes (addition, increasing the dose, and trial of different medications). Our findings suggested that application of LPA to a cluster of dimensional DBDs psychopathologies may provide valuable characterization of the youths referred to a tertiary outpatient child and adolescent psychiatric clinic, and offer insight into the providers' decision making on psychotropic medications, by overall severity of these psychopathologies rather than by single categorical diagnosis or single externalizing psychopathology.

Covariance Between Parent and Child Symptoms Before and During the COVID-19 Pandemic

OBJECTIVE

COVID-19 has had unprecedented effects on American families, including increases in depression, anxiety, and irritability for both parents and children. While parents and children influence each other's psychological functioning during non-disaster times, this effect may be amplified during times of disaster. The current study investigated how COVID-19 influenced covariance of depressive symptoms and irritability in children and their parents.

METHODS

Three hundred and ninety-one parents and their 8- to 17-year-old children (Mage = 10.68 years old, 70% male, 86% White) from a large sample of children and parents, primarily from Southeastern Louisiana, completed self-report measures of depression and irritability approximately 6 weeks into the COVID-19 pandemic, as well as providing retrospective reports of their symptoms prior to the pandemic. Actor-partner interdependence models were used to measure the reciprocal effects of parent symptoms on children and vice versa, both before and during the pandemic.

RESULTS

Actor effects in both the depressive symptoms and irritability models suggested that pre-COVID-19 depressive symptoms and irritability were robust predictors of early-COVID-19 depressive symptoms and irritability for both parents and children. Partner effects were also detected in the irritability model, in that parental irritability prior to COVID-19 was associated with decreased child irritability during the pandemic. Both before and during the pandemic, associations between parent and child depressive symptoms and irritability scores were weaker in families evidencing greater dysfunction.

CONCLUSIONS

Results suggest that COVID-19-related stress is associated with increases in both parent and child symptomatology, and that family relationships likely influence associations between these symptoms.

Irritability in Mood Disorders: Neurobiological Underpinnings and Implications for Pharmacological Intervention

Feeling irritable is a common experience, both in health and disease. In the context of psychiatric illnesses, it is a transdiagnostic phenomenon that features across all ages, and often causes significant distress and impairment. In mood disorders, irritability is near ubiquitous and plays a central role in diagnosis and yet, despite its prevalence, it remains poorly understood. A neurobiological model of irritability posits that, in children and adolescents, it is consequent upon deficits in reward and threat processing, involving regions such as the amygdala and frontal cortices. In comparison, in adults with mood disorders, the few studies that have been conducted implicate the amygdala, orbitofrontal cortices, and hypothalamus; however, the patterns of activity in these areas are at variance with the findings in youth. These age-related differences seem to extend to the neurochemistry of irritability, with links between increased monoamine transmission and irritability evident in adults, but aberrant levels of, and responses to, dopamine in youth. Presently, there are no specific treatments that have significant efficacy in reducing irritability in mood disorders. However, treatments that hold some potential and warrant further exploration include agents that act on serotonergic and dopaminergic systems, especially as irritability may serve as a prognostic indicator for overall clinical responsiveness to specific medications. Therefore, for understanding and treatment of irritability to advance meaningfully, it is imperative that an accurate definition and means of measuring irritability are developed. To achieve this, it is necessary that the subjective experience of irritability, both in health and illness, is better understood. These insights will inform an accurate, comprehensive, and valid interrogation of the qualities of irritability in health and illness, and allow not only a clinical appreciation of the phenomenon, but also a deeper understanding of its important role within the development and manifestation of mood disorders.

Interpretation bias training for bipolar disorder: A randomized controlled trial

BACKGROUND

Bipolar disorder (BD) is associated with emotion interpretation biases that can exacerbate depressed mood. Interpretation bias training (IBT) may help; according to the "virtuous cycle" hypothesis, interpreting others' emotions as positive can lead to interactions that improve mood. Our goals were to determine whether IBT can shift emotion interpretation biases and demonstrate clinical benefits (lower depressed mood, improved social function) in people with BD.

METHOD

Young adults with BD were recruited for three sessions of computer-based IBT. Active IBT targets negative emotion bias by training judgments of ambiguous face emotions towards happy judgments. Participants were randomized to active or sham IBT. Participants reported on mood and functioning at baseline, intervention end (week two), and week 10.

RESULTS

Fifty participants (average age 22, 72% female) enrolled, 38 completed the week 10 follow-up. IBT shifted emotion interpretations (Hedges g = 1.63). There was a group-by-time effect (B = -13.88, p < .0001) on self-reported depression; the IBT group had a larger decrease in depressed mood. The IBT group also had a larger increase in perceived familial support (B = 3.88, p < .0001). Baseline learning rate (i.e., how quickly emotion judgments were updated) was associated with reduced clinician- (B = -54.70, p < 0.001) and self-reported depression (B = -58.20, p = 0.009).

CONCLUSION

Our results converge with prior work demonstrating that IBT may reduce depressed mood. Additionally, our results provide support for role of operant conditioning in the treatment of depression. People with BD spend more time depressed than manic; IBT, an easily disseminated intervention, could augment traditional forms of treatment without significant expense or side effects.

The Internal Structure of the Aberrant Behavior Checklist Irritability Subscale: Implications for Studies of Irritability in Treatment-Seeking Youth With Autism Spectrum Disorders

Given the prominence of the Aberrant Behavior Checklist (ABC), Irritability Subscale (ABC-I), in treatment outcome studies, we conducted a critical examination of its internal consistency and relationship to other measures of irritability in 758 psychiatrically hospitalized youth with autism spectrum disorder. In exploratory and confirmation samples, we conducted factor and bifactor analyses to describe the internal structure of the ABC-I. Our results suggest that the ABC-I roughly represents a unidimensional construct of irritability, as indicated by a general factor in bifactor analysis. In addition to irritability, subordinate factors are presented that represent tantrums, verbal outbursts, self-harm, and negative affect. Notably, self-harm items explain a large proportion of variance independent of irritability. Therefore, their contribution in analyses of treatment effects should be considered. Further study or revision of the ABC-I may improve convergent validity with transdiagnostic formulations of irritability as well as prevent confound from self-harm in treatment studies for irritability in ASD.

Getting irritable about irritability?

Despite irritability being considered a symptom of several psychiatric disorders, there is no standardised definition or measurement of the construct within psychiatry. This lack of definition is in part due to a fundamental lack of understanding of what it means to be irritable and the foundational mechanisms that lead to its manifestation. This then poses a cyclical problem, whereby because the concept of irritability is poorly defined and is defined variably in different contexts, research utilising these various definitions and measures is inherently inconsistent. Hence, a new approach to studying irritability is required, one that examines the construct as being a product of tensions that arise because of discrepancies between expectations and reality. This new bottom-up definition of irritability does not rely on phenomenology alone, and therefore can be neurocognitively mapped and tested experimentally with greater precision. By establishing more sophisticated terminology and progressing to a standardised definition, the examination of irritability can progress in a meaningful way. However, this progress cannot be achieved without collaboration and multifaceted efforts from all schools of thought. Therefore, by getting irritable about irritability ourselves, we hope that a more constructive dialogue concerning this pervasive and important concept can be instigated, involving researchers from all schools of thought.