The Effectiveness of Unified Transdiagnostic Treatment on Emotion Regulation and Improving Symptoms of Children with a Disruptive Mood Disorder

Pouladi, Shirin; Hasanshahi, Mohammad Mehdi; Rabiei, Mohammad; Baghery, Naser

doi:10.22055/psy.2022.41569.2896

Document Type : Research Article

Authors

¹ Ph.D. Student, Department of Psychology, َArsanjan Branch, Islamic Azad University, Arsanjan, Iran.

² Assistant professor, Department of Psychology, َArsanjan Branch, Islamic Azad University, Arsanjan, Iran

³ Associate Professor of Consulting, University of Shahrekord, Shahrekord

⁴ Assistant Professor Department of Psychology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.

10.22055/psy.2022.41569.2896

Abstract

Introduction
Disruptive Mood Dysregulation Disorder is a childhood condition characterized by extreme irritability, anger, and intense temper outbursts. This disorder significantly impacts a child's quality of life, school performance, and relationships with family and peers. Psychopathologists now recognize that emotion dysregulation plays a crucial role in DMDD. Scientific findings suggest that individuals with DMDD experience difficulties processing emotions. Despite increased research attention, treatment options for DMDD remain limited. Consequently, integrated approaches that consider etiology and transdiagnostic treatment represent promising avenues for further investigation. The central question of our current research is whether unified Transdiagnostic treatment effectively reduces irritability and improves emotional regulation in children with DMDD.

Method
This study employed a single-case experimental design using the multiple baseline design type with different subjects and continuous measurement. The statistical population consisted of children aged 8–10 years who sought therapeutic interventions from psychiatrists and psychologists in Shahrekord. Among them, three children met the criteria for a definitive diagnosis of DMDD based on multidimensional evaluations, structured diagnostic interviews, and emotional irritability scales. These three participants were purposefully selected and entered the treatment phase. We evaluated the subjects at various time points: baseline, during treatment, post-treatment, and two follow-up periods (2 months each). We used the Emotion Regulation Checklist (ERC) and the emotional irritability scale for assessment.

Results
Specifically, the percentage of recovery after the intervention in the emotion regulation subscale for the three subjects was as follows: Subject 1: 81.6%; Subject 2: 72.5%; and Subject 3: 58.2%. In the instability-negativity subscale: Subject 1: 53.8%, Subject 2: 52%, Subject 3: 54.7%. The recovery percentages after follow-up were as follows: Emotion regulation subscale: Subject 1: 77.7%, Subject 2: 65%, and Subject 3: 60.9%. Instability-negativity subscale: Subject 1: 54.8%, Subject 2: 50%, Subject 3: 51.1%.

Discussion
Our findings indicate that unified Transdiagnostic treatment effectively enhances emotion regulation, reduces emotional instability and negativity, and ameliorates the symptoms of disruptive mood disorder during the intervention phase. Furthermore, these positive effects persist over time, extending from the treatment period to the first (2 months) and second (4 months) follow-up assessments.

Keywords

References

Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55(11), 1247- 1263. https://doi.org/10.1037/0003-066X.55.11.1247

Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., ... & Cassiello-Robbins, C. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875-884 https://doi.org/10.1001/jamapsychiatry.2017.2164.gf

Benarous, X., Renaud, J., Breton, J. J., Cohen, D., Labelle, R., & Guilé, J. M. (2020). Are youths with disruptive mood dysregulation disorder different from youths with major depressive disorder or persistent depressive disorder? Journal of Affective Disorders, 265, 207-215. https://doi.org/10.1016/j.jad.2020.01.020

Blanchard, E. B., & Schwarz, S. P. (1988). Clinically significant changes in behavioral medicine. Behavioral Assessment, 10(2), 171-188. https://psycnet.apa.org/record/1989-19665-001

Bruno, A., Celebre, L., Torre, G., Pandolfo, G., Mento, C., Cedro, C., ... & Muscatello, M. R. A. (2019). Focus on Disruptive Mood Dysregulation Disorder: A review of the literature. Psychiatry Research, 279, 323-330. https://doi.org/10.1016/j.psychres.2019.05.043

Caprara, G. V., Barbaranelli, C., & Zimbardo, P. G. (1996). Understanding the complexity of human aggression: Affective, cognitive, and social dimensions of individual differences in propensity toward aggression. European Journal of Personality, 10(2), 133-155. https://doi.org/ 10.1002/(SICI)1099-0984(199606)10:2<133::AID-PER252>3.0.CO;2-E

Cassiello-Robbins, C., Southward, M. W., Tirpak, J. W., & Sauer-Zavala, S. (2020). A systematic review of Unified Protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review, 78, 101852. https://doi.org/10.1016/j.cpr.2020.101852

Cho, Y., Nam, S., Seo, W., & Kim, H. (2023). Effects of a Unified, Transdiagnostic Treatment for University Students with Emotional Disorders. Cognitive Behavior Therapy in Korea, 23(1), 123-152. https://doi.org/10.33703/cbtk.2023.23.1.123

Copeland, W. E., Angold, A., Costello, E. J., & Egger, H. (2013). Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder. American Journal of Psychiatry, 170(2), 173-179. https://doi.org/10.1176/appi.ajp.2012.12010132

Döpfner, M., Katzmann, J., Hanisch, C., Fegert, J. M., Kölch, M., Ritschel, A., ... & Görtz-Dorten, A. (2019). Affective dysregulation in childhood-optimizing prevention and treatment: protocol of three randomized controlled trials in the ADOPT study. BMC Psychiatry, 19(264), 1-20. https://doi.org/10.1186/s12888-019-2239-8

Ehrenreich-May, J., & Bilek, E. L. (2011). Universal prevention of anxiety and depression in a recreational camp setting: An initial open trial. Child & Youth Care Forum, 40(6), 435-455. https://doi.org/10.1007/s10566-011-9148-4

Ehrenreich-May, J., & Bilek, E. L. (2012). The development of a transdiagnostic, cognitive behavioral group intervention for childhood anxiety disorders and co-occurring depression symptoms. Cognitive and Behavioral Practice, 19(1), 41- 55.‏ https://doi.org/10.1016/j.cbpra.2011.02.003.

Fida, R., Paciello, M., Barbaranelli, C., Tramontano, C., & Fontaine, R. G. (2012). The role of irritability in the relation between job stressors, emotional reactivity, and counterproductive work behavior. European Journal of Work and Organizational Psychology, 23(1), 31-47. https:// doi.org/10.1080/1359432X.2012.713550.

Fonseca-Pedrero, E., Pérez-Albéniz, A., Al-Halabí, S., Lucas‐Molina, B., Ortuño-Sierra, J., Díez-Gómez, A., Pérez-Sáenz, J., Inchausti, F., Valero García, A.V., Gutiérrez García, A., Aritio Solana, R., Ródenas-Perea, G., De Vicente Clemente, M.P., Ciarreta López, A., & Debbané, M. (2023). PSICE Project Protocol: Evaluation of the Unified Protocol for Transdiagnostic Treatment for Adolescents with Emotional Symptoms in School Settings. Clínica y Salud, 34(1), 15-22. https://doi.org/10.5093/clysa2023a3

García-Escalera, J., Chorot, P., Valiente, R. M., Reales, J. M., & Sandín, B. (2016). Efficacy of transdiagnostic cognitive-behavioral therapy for anxiety and depression in adults, children and adolescents: A meta-analysis. Revista de Psicopatología y Psicología Clínica, 21(3), 147-175. https://doi.org/10.5944/rppc.vol.21.num.3.2016.17811

Hatchett, G. T. (2022). Treatment Planning Strategies for Youth With Disruptive Mood Dysregulation Disorder. Professional Counselor, 12(1), 36- 48. https://doi.org/10.15241/gth.12.1.36

Hubbard, J. A., Dodge, K. A., Cillessen, A. H., Coie, J. D., & Schwartz, D. (2001). The dyadic nature of social information processing in boys' reactive and proactive aggression. Journal of Personality and Social Psychology, 80(2), 268-280. https://doi.org/10.1037/0022-3514.80.2.268

Jun, C. H. E. N., Zuowei, W. A. N. G., & Yiru, F. A. N. G. (2016). The history, diagnosis and treatment of disruptive mood dysregulation disorder. Shanghai archives of psychiatry, 28(5), 289. https://doi.org/10.11919/j.issn.1002-0829.216071

Kennedy, S. M., Lanier, H., Salloum, A., Ehrenreich-May, J., & Storch, E. A. (2021). Development and implementation of a transdiagnostic, stepped-care approach to treating emotional disorders in children via telehealth. Cognitive and Behavioral Practice, 28(3), 350-363. https://doi.org/10.1016/j.cbpra.2020.06.001

Leibenluft, E., & Stoddard, J. (2013). The developmental psychopathology of irritability. Development and Psychopathology, 25(4), 1473-1487. https://doi.org/10.1017/S0954579413000722

Linke, J., Kircanski, K., Brooks, J., Perhamus, G., Gold, A. L., & Brotman, M. A. (2020). Exposure-based cognitive-behavioral therapy for disruptive mood dysregulation disorder: An evidence-based case study. Behavior Therapy, 51(2), 320-333. https://doi.org/10.1016/j.beth.2019.05.007

Loevaas, M. E. S., Sund, A. M., Lydersen, S., Neumer, S. P., Martinsen, K., Holen, S., & Reinfjell, T. (2019). Does the transdiagnostic EMOTION intervention improve emotion regulation skills in children? Journal of Child and Family Studies, 28(3), 805-813. https://doi.org/10.1007/s0826-018-01324-1

Mahmoudi, M., Borjali, A., Alizadeh, H., Ghobari-Bonab, B., Ekhtiari, H., & Akbari-Zardkhaneh, S. (2016). Emotion regulation in children with learning disorders and normal children. Journal of Research in School and Virtual Learning, 23(2), 33-46. https://doi.org/20.1001.1.23456523.1395.4.13.6.2 [Persian]

Martin, P., Murray, L. K., Darnell, D., & Dorsey, S. (2018). Transdiagnostic treatment approaches for greater public health impact: Implementing principles of evidence based mental health interventions. Clinical Psychology: Science and Practice, 25(4). https://doi.org/10.1111/cpsp.12270

Miller, L., Hlastala, S. A., Mufson, L., Leibenluft, E., Yenokyan, G., & Riddle, M. (2018). Interpersonal psychotherapy for mood and behavior dysregulation: A pilot randomized trial. Depression and Anxiety, 35(6), 574-582. https://doi.org/10.1002/da.22761

Mitchell, R. H., Timmins, V., Collins, J., Scavone, A., Iskric, A., & Goldstein, B. I. (2016). Prevalence and correlates of disruptive mood dysregulation disorder among adolescents with bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 26(2), 147-153. https://doi.org/10.1089/cap.2015.00

Molina, P., Sala, M. N., Zappulla, C., Bonfigliuoli, C., Cavioni, V., Zanetti, M. A., ... & Cicchetti, D. (2014). The Emotion Regulation Checklist–Italian translation. Validation of parent and teacher versions. European Journal of Developmental Psychology, 11(5), 624- 634.‏ https://doi.org/10.1080/17405629.2014.898581

Mürner-Lavanchy, I., Kaess, M., & Koenig, J. (2021). Diagnostic instruments for the assessment of disruptive mood dysregulation disorder: A systematic review of the literature. European Child & Adolescent Psychiatry, 30(7), 1-23. https://doi.org/10.1007/s00787-021-01840-4

Nargesi, F., Fathi-Ashtiani, A., Davoudi, I., & Ashrafi, E. (2019). The effect of unified transdiagnostic treatment on anxiety sensitivity, distress tolerance and obsessive-compulsive symptoms in individuals with obsessive-compulsive disorder. Journal of Psychological Achievements, 26(2), 49-66. https://doi.org/10.22055/psy.2019.26369.2121 [Persian]

Nasri, M., Ahadi, H., & Dortaj., F. (2017). The effectiveness of transdiagnostic treatment on cognitive flexibility, emotion regulation and Hb factor in patients with type 2 diabetes. Journal of Psychological Achievements, 24(2), 81-100. https://doi.org/10.22055/psy.2018.20969.1741 [Persian]

Osmani, H., & Shokri, L. (2019). Effectiveness of unified trans-diagnostic treatment on emotion’s cognitive regulation and cognitive empathy of students with externalized behavior disorder. Journal of Empowering Exceptional Children, 10(1), 125-136. https://doi.org/10.22034/CECIRANJ.2019.91938 [Persian]

Perepletchikova, F., Nathanson, D., Axelrod, S. R., Merrill, C., Walker, A., Grossman, M., ... & Walkup, J. (2017). A randomized clinical trial of dialectical behavior therapy for preadolescent children with disruptive mood dysregulation disorder: Feasibility and outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), 832-840. https://doi.org/10.1016/j.jaac.2017.07.789

Pourmaveddat, Kh., Neshat Doost, H. T., Kajbaf, M. B., & Talebi, H. (2021). Comparison of social information processing based on Crick & Dodge's social cognitive model in children with and without disruptive mood dysregulation disorder. Journal of Advances in Cognitive Sciences, 12(2), 41-50. https://doi.org/‎10.30514/icss.23.2.3. [Persian]

Sabri, Y. (2022). Diagnosis of disruptive mood dysregulation disorder in offsprings of bipolar parents. Middle East Current Psychiatry, 29(20), 1-7. https://doi.org/10.1186/s43045-022-00186-0

Sakiris, N., & Berle, D. (2019). A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation-based intervention. Clinical Psychology Review, 72, 101751. https://doi.org/10.1016/j.cpr.2019.101751.

Sanchis-Sanchis, A., Grau, M. D., Moliner, A. R., & Morales-Murillo, C. P. (2020). Effects of age and gender in emotion regulation of children and adolescents. Frontiers in Psychology, 11, 1-13. https://doi.org/10.3389/fpsyg.2020.00946.

Sheybani, H., Mikaeili, M., & Narimani, M (2020). The effectiveness of cognitive-behavioral therapy and emotion regulation training on irritability, depression, anxiety, and emotion regulation in adolescents with disruptive mood dysregulation disorder. Journal of Clinical psychology, 12(2), 41-50. https://doi.org/10.22075/JCP.2020.19250.1778 [Persian]

Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology, 33, 906-916. https://doi.org/10.1037/00121649.33.6.906.

Stringaris, A., Goodman, R., Ferdinando, S., Razdan, V., Muhrer, E., Leibenluft, E., & Brotman, M. A. (2012). The Affective Reactivity Index: A concise irritability scale for clinical and research settings. Journal of Child Psychology and Psychiatry, 53(11), 1109-1117.‏ https://doi.org/10.1111/j.1469-7610.2012.02561.x

Thompson R. A. (1991). Emotional regulation and emotional development. Educational Psychology Review, 3, 269-307. https://doi.org/10.1007/BF01319934

Tudor, M. E., Ibrahim, K., Bertschinger, E., Piasecka, J., & Sukhodolsky, D. G. (2016). Cognitive-behavioral therapy for a 9-year-old girl with disruptive mood dysregulation disorder. Clinical Case Studies, 15(6), 459-475. https://doi.org/10.1177/153465011666943

Vidal Ribas, P., Brotman, M. A., Salum, G. A., Kaiser, A., Meffert, L., Pine, D. S., ... & Stringaris, A. (2018). Deficits in emotion recognition are associated with depressive symptoms in youth with disruptive mood dysregulation disorder. Depression and Anxiety, 35(12), 1207-1217. https://doi.org/10.1002/da.22810

Waxmonsky, J. G., Waschbusch, D., Babocsai, L., & Belin, P. (2017). Assessment and treatment of hostile attribution bias in children with disruptive mood dysregulation disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), S246. https://doi.org/10.1016/j.jaac.2017.09.267

The Effectiveness of Unified Transdiagnostic Treatment on Emotion Regulation and Improving Symptoms of Children with a Disruptive Mood Disorder

References

References

Volume 31, Issue 1 - Serial Number 31May 2024Pages 207-230

Volume 31, Issue 1 - Serial Number 31
May 2024
Pages 207-230