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Ducharme P, Kahn J, Vaudreuil C, Gusman M, Waber D, Ross A, Rotenberg A, Rober A, Kimball K, Peechatka AL, Gonzalez-Heydrich J. A "Proof of Concept" Randomized Controlled Trial of a Video Game Requiring Emotional Regulation to Augment Anger Control Training. Front Psychiatry 2021; 12:591906. [PMID: 34539455 PMCID: PMC8440816 DOI: 10.3389/fpsyt.2021.591906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
Emotional dysregulation leading to clinically significant anger and aggression is a common and substantial concern for youth and their families. While psychotropic medications and cognitive behavioral therapies can be effective, these modalities suffer from drawbacks such as significant side effects, high rates of attrition, and lack of real-world skill translation. Regulate and Gain Emotional Control (RAGE-Control) is a video game designed as an engaging augment to existing treatments. The game facilitates emotional regulation skill building through practice modulating physiological arousal while completing a challenging inhibitory task. We compared reduction in anger, aggression, oppositionality, and global severity between two treatment conditions: Anger Control Training (ACT) augmented with RAGE-Control and ACT with a sham version of the game, in a pilot double-blind randomized controlled trial. To begin to understand mechanisms of change, we examined heart rate during game play over the course of the study and explored associations between symptom changes and heart rate changes. Materials and Methods: Forty youth with clinically significant anger dyscontrol (age 10-17) were randomly assigned to 10 sessions of ACT with RAGE-Control or ACT with sham video game. Results: Both treatments similarly reduced self-reported anger. However, ACT with RAGE-Control led to larger improvements in aggression (CI: -17 to -1.0, ES: 0.55, p = 0.015); oppositionality (CI: -9.0 to -7e-6, ES: 0.48, p = 0.032); and global severity (CI: -1.0 to -5e-6, ES: 0.51, p = 0.023) relative to sham. Participants in the RAGE-Control group saw a decrease in median heart rate during game play (β = 1.2, p < 0.001). Larger pre to post decreases in heart rate were significantly associated with larger pre to post decreases in aggression and oppositional behaviors. Discussion: Augmenting ACT with RAGE-Control reduced behavioral expression of anger, but not the experience of angry feelings, as compared to ACT with a sham version of the game. Increased heart rate control, demonstrated by reduction in median heart rate during gameplay, was associated with decreased aggression and oppositional behavior. Together these findings support that augmenting traditional treatment with technology facilitating heart rate control through skill practice translates to enhancements in real-life behavioral change. Therefore, further exploration into engaging skill-focused games such as RAGE-Control is warranted. Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT01551732.
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Affiliation(s)
- Peter Ducharme
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States
| | - Jason Kahn
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Neuromotion Labs, Boston, MA, United States
| | - Carrie Vaudreuil
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Michaela Gusman
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States
| | - Deborah Waber
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Abigail Ross
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States
| | - Alexander Rotenberg
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States.,Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Ashley Rober
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States
| | - Kara Kimball
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States
| | | | - Joseph Gonzalez-Heydrich
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Gonzalez-Heydrich J, Enlow MB, D’Angelo E, Seidman B LJ, Gumlak S, Kim A, Woodberry KA, Rober A, Tembulkar S, Graber K, O’Donnell K, Hamoda HM, Kimball K, Rotenberg A, Oberman LM, Pascual-Leone A, Keshavan MS, Duffy FH. Early auditory processing evoked potentials (N100) show a continuum of blunting from clinical high risk to psychosis in a pediatric sample. Schizophr Res 2015; 169:340-345. [PMID: 26549629 PMCID: PMC4821005 DOI: 10.1016/j.schres.2015.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 07/16/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The N100 is a negative deflection in the surface EEG approximately 100 ms after an auditory signal. It has been shown to be reduced in individuals with schizophrenia and those at clinical high risk (CHR). N100 blunting may index neural network dysfunction underlying psychotic symptoms. This phenomenon has received little attention in pediatric populations. METHOD This cross-sectional study compared the N100 response measured via the average EEG response at the left medial frontal position FC1 to 150 sinusoidal tones in participants ages 5 to 17 years with a CHR syndrome (n=29), a psychotic disorder (n=22), or healthy controls (n=17). RESULTS Linear regression analyses that considered potential covariates (age, gender, handedness, family mental health history, medication usage) revealed decreasing N100 amplitude with increasing severity of psychotic symptomatology from healthy to CHR to psychotic level. CONCLUSIONS Longitudinal assessment of the N100 in CHR children who do and do not develop psychosis will inform whether it predicts transition to psychosis and if its response to treatment predicts symptom change.
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Affiliation(s)
- Joseph Gonzalez-Heydrich
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA.
| | - Michelle Bosquet Enlow
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA
| | - Eugene D’Angelo
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA
| | - Larry J. Seidman B
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Commonwealth Research Center, 75 Fenwood Road, Boston, MA 02115, USA,Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street, Boston, MA 02114, USA
| | - Sarah Gumlak
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - April Kim
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kristen A. Woodberry
- Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA,Beth Israel Deaconess Medical Center, Department of Psychiatry, Commonwealth Research Center, 75 Fenwood Road, Boston, MA 02115, USA
| | - Ashley Rober
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Sahil Tembulkar
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kelsey Graber
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kyle O’Donnell
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Hesham M. Hamoda
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA
| | - Kara Kimball
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Alexander Rotenberg
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Neurology, 25 Shattuck Street, Boston, MA 02115, USA
| | - Lindsay M. Oberman
- E.P. Bradley Hospital and Warren Alpert Medical School, Brown University, Neuroplasticity and Autism Spectrum Disorder Program and Department of Psychiatry and Human Behavior, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Alvaro Pascual-Leone
- Harvard Medical School, Department of Neurology, 25 Shattuck Street, Boston, MA 02115, USA,Beth Israel Deaconess Medical Center, Division of Cognitive Neurology and Berenson-Allen Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Matcheri S. Keshavan
- Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA,Beth Israel Deaconess Medical Center, Department of Psychiatry, Commonwealth Research Center, 75 Fenwood Road, Boston, MA 02115, USA
| | - Frank H. Duffy
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Neurology, 25 Shattuck Street, Boston, MA 02115, USA
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Gonzalez-Heydrich J, Hsin O, Gumlak S, Kimball K, Rober A, Azeem MW, Hickory M, Mrakotsky C, Torres A, Mezzacappa E, Bourgeois B, Biederman J. Comparing stimulant effects in youth with ADHD symptoms and epilepsy. Epilepsy Behav 2014; 36:102-7. [PMID: 24907495 PMCID: PMC4109643 DOI: 10.1016/j.yebeh.2014.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/01/2014] [Accepted: 04/29/2014] [Indexed: 11/19/2022]
Abstract
To retrospectively examine response to stimulant treatment in patients with epilepsy and ADHD symptoms as predicted by seizure freedom for six months, use of methylphenidate (MPH) versus amphetamine (AMP) preparations, cognitive level, and medical records were searched for patients under the age of 18 with epilepsy and ADHD symptoms treated with MPH or AMP (n=36, age=10.4 ± 3.5; male=67%). "Responders" had a CGI-improvement score of ≤ 2 and did not stop medication because of adverse effects. "Worsened" patients discontinued medication because of agitation/emotional lability. Seizure freedom did not predict treatment response. Lower cognitive level was associated with increased rate of worsening (p=0.048). No patients who were seizure-free at the start of the medication trial experienced an increase in seizures. Of the patients having seizures at the start of trial, one patient on MPH and two patients on AMP had increased seizures during the trial. Seizures returned to baseline frequency or less after stimulant discontinuation or anticonvulsant adjustment. Methylphenidate was associated with a higher response rate, with 12 of 19 given MPH (0.62 ± 0.28 mg/kg/day) compared with 4 of 17 given AMP (0.37 ± 0.26 mg/kg/day) responding (p=0.03). Methylphenidate treatment and higher cognitive level were associated with improved treatment outcome, while seizure freedom had no clear effect. Confidence in these findings is limited by the study's small, open-label, and uncontrolled design.
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Affiliation(s)
| | - Olivia Hsin
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Gumlak
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kara Kimball
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley Rober
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Christine Mrakotsky
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alcy Torres
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Enrico Mezzacappa
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Blaise Bourgeois
- Department of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Biederman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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