title: An Open Pilot Study of Training Hostile Interpretation Bias to Treat Disruptive Mood Dysregulation Disorder.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Joel
authors.initials: J
authors.lastname: Stoddard
authors.affiliation: 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.
authors.forename: Banafsheh
authors.initials: B
authors.lastname: Sharif-Askary
authors.affiliation: 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.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Harkins
authors.affiliation: 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.
authors.forename: Heather R
authors.initials: HR
authors.lastname: Frank
authors.affiliation: 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.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Brotman
authors.affiliation: 2 School of Experimental Psychology, University of Bristol , Bristol, United Kingdom .
authors.forename: Ian S
authors.initials: IS
authors.lastname: Penton-Voak
authors.affiliation: 3 School of Psychological Sciences, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Keren
authors.initials: K
authors.lastname: Maoz
authors.affiliation: 3 School of Psychological Sciences, Tel Aviv University , Tel Aviv, Israel .|4 Sagol School of Neuroscience, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Yair
authors.initials: Y
authors.lastname: Bar-Haim
authors.affiliation: 2 School of Experimental Psychology, University of Bristol , Bristol, United Kingdom .|5 MRC Integrative Epidemiology Unit at the University of Bristol , Bristol, United Kingdom .|6 UK Centre for Tobacco and Alcohol Studies, University of Bristol , Bristol, United Kingdom .
authors.forename: Marcus
authors.initials: M
authors.lastname: Munafò
authors.affiliation: 7 Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health , Department of Health and Human Services, Bethesda, Maryland.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Pine
authors.affiliation: 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.
authors.forename: Ellen
authors.initials: E
authors.lastname: Leibenluft
mesh_terms: D000293:Adolescent; D002648:Child; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005149:Facial Expression; D005260:Female; D006791:Hostility; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects