CBT-Enhanced Emotion Regulation as a Mechanism of Improvement for Childhood Irritability

Abstract

Objective. Research supports the clinical importance of childhood irritability, as well as its developmental implications for later anxiety and depression. Appropriate treatment may prevent this progression; however, little evidence exists to guide clinician decision-making regarding treatment for chronic irritability symptoms. Given the empirical support for irritability as a dimension of oppositional defiant disorder (ODD), behavioral interventions that improve ODD symptoms, especially through emotion regulation training, are strong candidates for identifying effective treatment strategies for irritability. Method. Data from a randomized controlled effectiveness trial were used to assess hypotheses regarding irritability. The Stop Now and Plan (SNAP) Program was developed for pre-adolescent youths demonstrating clinically high rates of conduct problems. 252 boys ages 6 to 11 were assigned to participate in either SNAP or standard services; data were collected at four time points over 15 months. Results. Although lower irritability scores over time were seen for the SNAP group compared to standard services, the main effect for treatment was small and did not reach statistical significance. However, a significant indirect effect of SNAP treatment on irritability via improved emotion regulation skills was found; improved emotion regulation skills were associated with significant and substantial reduction in irritability. Conclusions. Specific effects of SNAP for the improvement of emotion regulation skills function as a mechanism for subsequent reductions in irritability, supporting the distinction between emotion regulation and irritability symptoms. Enhancing increased emotion regulation skills within existing evidence-based interventions for children with ODD should provide a strong foundation for treatments to target irritability symptoms.

Transdiagnostic trajectories of irritability and oppositional, depression and anxiety problems from preschool to early adolescence

“…To this effect, there are psychological programs that have proved effective for improving irritability. Derella, Johnston, Loeber, and Burke (2019) showed that the Stop Now and Plan program is effective for reducing irritability in boys with ODD via improved emotion regulation skills, a technique also used for depression and anxiety (Ehrenreich et al, 2009). In the same line, problem solving skills training is an effective technique commonly used for disruptive behavior disorders (Kazdin, 2018) and is also useful for depression and anxiety (Ugueto, Santucci, Krumholz, & Weisz, 2014).…”

Feasibility and acceptability of a brief cognitive-behavioral group intervention for chronic irritability in youth

“…The secondary analysis found that the full SNAP format had a trend-level main effect on reducing symptoms of CI. However, a significant indirect effect was evident, wherein SNAP treatment was associated with improvements in ER, and improved ER predicted significant reductions in CI (Derella, Johnston, et al, 2019). These results suggested that a CI-specific intervention might be developed using the framework of the SNAP model, with a refined focus on ER skills to help target specific feelings of anger and irritability.…”

“…The Stop Now And Plan (SNAP) Program is an evidence-based intervention developed to help children ages 6 to 11, and their families, to identify their emotions and cognitive distortions, learn coping strategies, and develop alternate behaviors to reduce problematic disruptive behaviors and enhance prosocial functioning (Augimeri et al, 2007;Burke & Loeber, 2016). Although SNAP was designed for children with clinically significant conduct problems who are at risk for serious delinquency, a secondary analysis of outcomes from a randomized controlled trial suggested the intervention might also improve CI symptoms (Derella, Johnston, et al, 2019). The SNAP treatment model includes 12 weekly concurrent caregiver and child group sessions to deliver core program components, followed by individualized treatments for specific child and family risks and needs.…”

Teaching Explicit Social-Emotional Skills With Contextual Supports for Students With Intensive Intervention Needs

“…Central to self-regulation is the ability to modify the physiological arousal and emotional states elicited by emotionally evocative events or situations (Gross & Thompson, 2007). Children who have difficulties regulating emotion show frequent displays of irritability and experience easily aroused feelings of anxiety, anger, or ambivalence, finding it difficult to calm down once upset (Derella et al, 2019). Emotion dysregulation is a common characteristic of children with or at risk of EBD, including those with autism spectrum disorders (Ratcliffe et al, 2014) and disruptive behavior disorders (Derella et al, 2019).…”