Harvard University.
Seattle Children's Hospital and University of Washington School of Medicine.
Behav Ther. 2020 Mar;51(2):238-252. doi: 10.1016/j.beth.2019.05.006. Epub 2019 May 18.
Severe irritability is a common and clinically important problem longitudinally associated with internalizing and externalizing problems in children. To better understand these mechanisms and to inform treatment research, we tested cognitive-behavioral processes as candidate mediators in the paths from irritability to later problems. Methods: A school sample (N = 238, 48% female, ages 8-10) was assessed at ~6-month intervals in fall (T1) and spring (T2) of third to fourth grade, and again the following fall (T3). Measures assessed irritability (T1/predictor); anger and sadness coping, intolerance of uncertainty, and rumination; (T1-T2/mediators); and anxiety, depressive symptoms, reactive aggression, and oppositionality (T1-T3/outcomes). Focused cross-lagged panel models, controlling for gender and grade, were specified to examine full (X ➔ M ➔ Y) and half (X ➔ M; M ➔ Y) longitudinal mediation. Across one or more intervals, irritability predicted higher depressive symptoms, anxiety, reactive aggression, oppositionality, intolerance of uncertainty, and poor emotion coping. From T1 irritability to T2/T3 outcomes, mediation was found for poor sadness coping leading to reactive aggression and oppositionality; poor anger coping to anxiety, depressive symptoms, and oppositionality; and intolerance of uncertainty to anxiety. Results offer further evidence for internalizing and externalizing outcomes of youth irritability and new evidence suggesting underlying mechanisms. Irritability may confer risk for externalizing problems via poor sadness/anger coping, and for internalizing problems via poor anger coping and intolerance of uncertainty. Theoretical models and psychosocial treatment should consider addressing regulation of various unpleasant emotions as well as psychological flexibility and tolerating uncertainty.
严重的易怒是一个常见的、临床上很重要的问题，与儿童的内化和外化问题有着纵向关联。为了更好地理解这些机制，并为治疗研究提供信息，我们测试了认知行为过程，作为从易怒到后期问题的路径中的候选中介。
在三到四年级的秋季（T1）和春季（T2）以及次年秋季（T3），对一个学校样本（N=238，48%为女性，年龄 8-10 岁）进行了大约每 6 个月一次的评估。在 T1 时评估了易激惹；在 T1-T2 期间评估了愤怒和悲伤应对、不确定性容忍度和反刍；在 T1-T3 期间评估了焦虑、抑郁症状、反应性攻击和对立性。控制性别和年级，指定了焦点交叉滞后面板模型，以检查完全（X➔M➔Y）和半（X➔M；M➔Y）纵向中介。在一个或多个时间段内，易激惹预测了更高的抑郁症状、焦虑、反应性攻击和对立性、不确定性容忍度差和情绪应对不良。从 T1 的易激惹到 T2/T3 的结果，发现了不良的悲伤应对导致反应性攻击和对立性的中介作用；不良的愤怒应对导致焦虑、抑郁症状和对立性的中介作用；不确定性容忍度差导致焦虑的中介作用。结果为青少年易激惹的内化和外化结果提供了进一步的证据，也为潜在机制提供了新的证据。易激惹可能通过不良的悲伤/愤怒应对导致外化问题的风险，也可能通过不良的愤怒应对和不确定性容忍度差导致内化问题的风险。理论模型和心理社会治疗应该考虑解决各种不愉快情绪的调节，以及心理灵活性和容忍不确定性。
