Effects of Standard and Modular Psychotherapies in the Treatment of Youth With Severe Irritability

Objective: To examine the preliminary effectiveness of a modular, transdiagnostic, behavioral/cognitive-behavioral intervention (MATCH) compared with standard manualized treatments (SMT) and usual care (UC) for treating youth with severe irritability. Method: We analyzed data from an effectiveness trial in which treatment-referred youths (N = 174; Mage = 10.6 years; 70% boys) were randomized to receive MATCH, SMT, or UC (ns = 53-62). Masked assessments of irritability, diagnoses, impairment, and internalizing, externalizing, total, and top problems were collected from caregivers and youths at pre- and posttreatment, weekly during treatment, and quarterly through 2-year follow-up. Baseline measures of irritability and impairment were used to identify a subsample characterized by severe irritability and mood dysregulation (SIMD; n = 81; Mage = 10.2 years; 69% boys; ns = 24-31 across conditions). Longitudinal multilevel models and ANOVAs were estimated to examine numerous clinical outcomes within and between conditions. Results: Among youth with SIMD, MATCH produced faster improvements than UC and SMT, with medium or large effect sizes in two thirds of all comparisons tested (Mdn ES = 0.60). Although SIMD youths in all conditions showed reductions in DSM diagnoses, only MATCH predicted significantly fewer posttreatment diagnoses than UC (averaging 1.0 fewer; ES = 0.93). Finally, among the entire sample, MATCH and SMT equivalently outperformed UC in reducing irritability (ES = 0.49) and the effects of each treatment condition on other outcomes were not moderated by baseline irritability. Conclusions: Extant behavioral/cognitive-behavioral psychotherapies-already well-established and widely used-may be helpful for treating youths with severe irritability. A transdiagnostic, modular format showed the most consistently favorable pattern of results across multiple outcomes, informants, and measurement schedules. What is the public health significance of this article? This study suggests that existing therapies for common youth emotional and behavioral problems are likely to also be effective for treating youth with severe irritability and mood dysregulation. These treatment strategies include behavioral parent training (BPT) and cognitive-behavioral therapy (CBT). Results also indicate that BPT and CBT may be most effective for severe irritability when delivered in a modular, transdiagnostic format, as in the Modular Approach to Therapy for Children with Anxiety,