Modular Psychotherapy Outcomes for Youth With Different Latent Profiles of Irritability and Emotion Dysregulation

Abstract

Background: 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. Method: 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. Results: A two-class solution fit well, differentiating youth with high (n = 54) vs. low (n = 146) levels of dysregulation and irritability at baseline. Nearly all high-dysregulation youth received either BPT (n = 26) or CBT-Depression (n = 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. Conclusions: 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. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03153904.

Keywords: behavioral parent training; cognitive-behavior therapy; dysregulation; emotion regulation; irritability; modular; transdiagnostic; youth psychotherapy.

Conflict of interest statement

JW is a co-author of the treatment protocol (MATCH; Chorpita & Weisz, 2009) used in this study and receives some income from its sales. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Evans, Wei, Harmon and Weisz.

Figures

Figure 1

Two latent profiles: high dysregulation (n = 54) and low dysregulation (n = 146). Irr, irritability; ERC, Emotion Regulation Checklist; CEMS, Children's Emotion Management Scales; CBCL, Child Behavior Checklist; YSR, Youth Self-Report; TP, top problems.

Figure 2

(A) CBCL and YSR problem trajectories for youth in the high dysregulation (Red) and low dysregulation (Blue) groups over time (0 to 18 months). Models control for the covariates noted previously (Table 2). (B) Irritability and top problem trajectories for youth in the high dysregulation (Red) and low dysregulation (Blue) groups over time (0 to 18 Months). Models control for the covariates noted previously (Table 2).

Figure 3

Caregiver-rated internalizing problems by dysregulation group (HI vs. LO) and problem/protocol (CON vs. DEP). DEP, Depression problem focus, treated with CBT; CON, Conduct problems focus, treated with BPT.