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

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. Data from a randomized controlled effectiveness trial were used to assess hypotheses regarding irritability. The Stop Now and Plan (SNAP) Program was developed for preadolescent youths demonstrating clinically high rates of conduct problems. Participants (252 boys, ages 6-11) were assigned to participate in either SNAP or standard services; data were collected at 4 time points over 15 months. 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 reductions in irritability. 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.