Evans Spencer C, Wei Melissa A, Harmon Sherelle L, Weisz John R
Department of Psychology, Harvard University, Cambridge, MA, United States.
Department of Psychology, University of Miami, Coral Gables, FL, United States.
Front Psychiatry. 2021 Apr 16;12:618455. doi: 10.3389/fpsyt.2021.618455. eCollection 2021.
Severe irritability is a common, impairing problem among youth referred for mental health services, but evidence to guide care is limited. Treatment research can be advanced by adopting a transdiagnostic perspective, leveraging existing evidence-based treatment (EBT) techniques, and situating irritability within the context of emotion dysregulation. Accordingly, this study examined treatment outcomes for youth with different levels of irritability and dysregulation who received cognitive-behavioral therapy (CBT) or behavioral parent training (BPT) in a modular EBT framework. We analyzed data from a community-based implementation trial of a transdiagnostic youth psychotherapy. Two-hundred treatment-referred youths (7-15 years; 47% female; 33% White, 28% Black, 24% Latinx, 14% multiracial, 2% other) and their caregivers completed measures of clinical problems and emotion dysregulation at baseline, with repeated outcomes assessments over 18 months. First, latent profile analysis was applied to baseline irritability and emotion dysregulation data; then, latent growth curve models were used to examine outcome trajectories, controlling for covariates. A two-class solution fit well, differentiating youth with high ( = 54) vs. low ( = 146) levels of dysregulation and irritability at baseline. Nearly all high-dysregulation youth received either BPT ( = 26) or CBT-Depression ( = 23). Across measures, both groups showed statistically and clinically significant improvements over time. High-dysregulation youth had greater baseline severity than low-dysregulation youth, but otherwise their longitudinal trajectories were mostly similar, with few between-group slope differences. There was virtually no evidence of differential effects for BPT vs. CBT on clinical outcomes. Youth with severe irritability and dysregulation, treated with a transdiagnostic, modular, EBT approach, showed significant within-person improvements over time. Their outcome trajectories did not differ according to whether they received BPT or CBT. Findings extend the literature on modular, transdiagnostic, and EBT approaches for irritability and dysregulation, suggesting comparable benefits associated with BPT and CBT when treatment selection is guided by comprehensive assessment. www.ClinicalTrials.gov, identifier: NCT03153904.
严重易怒是寻求心理健康服务的青少年中常见的、有损害的问题，但指导治疗的证据有限。采用跨诊断视角、利用现有的循证治疗（EBT）技术，并将易怒置于情绪调节障碍的背景下，可以推动治疗研究的进展。因此，本研究考察了在模块化EBT框架下接受认知行为疗法（CBT）或行为家长培训（BPT）的不同易怒和调节障碍水平青少年的治疗结果。我们分析了一项基于社区的跨诊断青少年心理治疗实施试验的数据。200名寻求治疗的青少年（7 - 15岁；47%为女性；33%为白人，28%为黑人，24%为拉丁裔，14%为多种族，2%为其他）及其照顾者在基线时完成了临床问题和情绪调节障碍的测量，并在18个月内进行了重复的结果评估。首先，对基线时的易怒和情绪调节障碍数据应用潜在剖面分析；然后，使用潜在增长曲线模型来检查结果轨迹，并控制协变量。一个两类解决方案拟合良好，区分了基线时调节障碍和易怒水平高（n = 54）与低（n = 146）的青少年。几乎所有高调节障碍青少年都接受了BPT（n = 26）或CBT - 抑郁症（n = 23）。在各项测量中，两组随时间推移均显示出统计学和临床上的显著改善。高调节障碍青少年的基线严重程度高于低调节障碍青少年，但除此之外，他们的纵向轨迹大多相似，组间斜率差异很小。几乎没有证据表明BPT与CBT对临床结果有差异效应。采用跨诊断、模块化EBT方法治疗的严重易怒和调节障碍青少年随时间推移显示出显著的个体内改善。他们的结果轨迹不因接受BPT还是CBT而有所不同。研究结果扩展了关于易怒和调节障碍的模块化、跨诊断和EBT方法的文献，表明在综合评估指导治疗选择时，BPT和CBT具有相当的益处。ClinicalTrials.gov，标识符：NCT03153904。
