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

Simone P. Haller, Joel Stoddard, Christian Botz-Zapp, Michal Clayton, Caroline MacGillivray, Gretchen Perhamus, Kelsey Stiles, Katharina Kircanski, Ian S. Penton-Voak, Yair Bar-Haim, Marcus Munafò, Kenneth E. Towbin, Melissa A. Brotman

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)37-45
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number1
StatePublished - Jan 2022


  • RCT
  • cognitive bias
  • face-emotion labeling
  • irritability

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health
  • Developmental and Educational Psychology


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