Stoddard Joel, Sharif-Askary Banafsheh, Harkins Elizabeth A, Frank Heather R, Brotman Melissa A, Penton-Voak Ian S, Maoz Keren, Bar-Haim Yair, Munafò Marcus, Pine Daniel S, Leibenluft Ellen
1 Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health , Department of Health and Human Services, Bethesda, Maryland.
2 School of Experimental Psychology, University of Bristol , Bristol, United Kingdom .
J Child Adolesc Psychopharmacol. 2016 Feb;26(1):49-57. doi: 10.1089/cap.2015.0100. Epub 2016 Jan 8.
Irritability in disruptive mood dysregulation disorder (DMDD) may be associated with a biased tendency to judge ambiguous facial expressions as angry. We conducted three experiments to explore this bias as a treatment target. We tested: 1) whether youth with DMDD express this bias; 2) whether judgment of ambiguous faces can be altered in healthy youth by training; and 3) whether such training in youth with DMDD is associated with reduced irritability and associated changes in brain function.
Participants in all experiments made happy versus angry judgments of faces that varied along a happy to angry continuum. These judgments were used to quantify a "balance point," the facial expression at which a participant's judgment switches from predominantly happy to predominantly angry. We first compared balance points in youth with DMDD (n = 63) versus healthy youth (n = 26). We then conducted a double-blind, randomized controlled trial of active versus sham balance-point training in 19 healthy youth. Finally, we piloted open, active balance-point training in 14 youth with DMDD, with 10 completing an implicit functional MRI (fMRI) face-emotion processing task.
Relative to healthy youth, DMDD youth manifested a shifted balance point, expressed as a tendency to classify ambiguous faces as angry rather than happy. In both healthy and DMDD youth, active training is associated with a shift in balance point toward more happy judgments. In DMDD, evidence suggests that active training may be associated with decreased irritability and changes in activation in the lateral orbitofrontal cortex.
These results set the stage for further research on computer-based treatment targeting interpretation bias of angry faces in DMDD. Such treatment may decrease irritability and alter neural responses to subtle expressions of happiness and anger.
破坏性行为障碍情绪失调症（DMDD）中的易怒情绪可能与将模糊面部表情判断为愤怒的偏向性倾向有关。我们进行了三项实验来探究这种偏向性作为一个治疗靶点的情况。我们测试了：1）患有DMDD的青少年是否表现出这种偏向性；2）通过训练能否改变健康青少年对模糊面孔的判断；3）对患有DMDD的青少年进行此类训练是否与易怒情绪降低及脑功能的相关变化有关。
所有实验中的参与者对沿着从开心到愤怒连续变化的面孔做出开心与愤怒的判断。这些判断被用于量化一个“平衡点”，即参与者的判断从主要为开心转变为主要为愤怒时的面部表情。我们首先比较了患有DMDD的青少年（n = 63）与健康青少年（n = 26）的平衡点。然后我们对19名健康青少年进行了一项关于主动与假平衡点击训练的双盲、随机对照试验。最后，我们对14名患有DMDD的青少年进行了开放式主动平衡点击训练的试点，其中10人完成了一项内隐功能磁共振成像（fMRI）面部情绪处理任务。
相对于健康青少年，患有DMDD的青少年表现出平衡点的偏移，表现为将模糊面孔归类为愤怒而非开心的倾向。在健康青少年和患有DMDD的青少年中，主动训练都与平衡点向更倾向于开心判断的方向偏移有关。在DMDD中，有证据表明主动训练可能与易怒情绪降低以及外侧眶额皮质激活的变化有关。
这些结果为进一步研究针对DMDD中愤怒面孔解释偏向性的计算机辅助治疗奠定了基础。这种治疗可能会降低易怒情绪，并改变对开心和愤怒微妙表情的神经反应。
