Received: 14 July 2017 Revised: 18 January 2018 Accepted: 8 March 2018
Interpersonal psychotherapy for mood and behavior
dysregulation: Pilot randomized trial
Leslie Miller MD
Stefanie A. Hlastala PhD
Laura Mufson PhD
Ellen Leibenluft MD
Gayane Yenokyan MD, MPH, PhD
Mark Riddle MD
Department of Psychiatry and Behavioral
Sciences, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
Department of Psychiatry and Behavioral
Sciences, University of Washington Medical
Center, Seattle, WA, USA
Department of Psychiatry, Columbia University
College of Physicians and Surgeons and New
York State Psychiatric Institute, New York, NY,
Emotion and Development Branch, National
Institute of Mental Health, Bethesda, MD, USA
Department of Biostatistics, Johns Hopkins
Bloomberg School of Public Health, Baltimore,
Leslie Miller, Department of Psychiatry and
BehavioralSciences, Johns Hopkins University
School of Medicine, 5500 East Lombard Street,
Baltimore, MD 21224, USA.
National Institute of Mental Health,
Grant/Award Number: K23MH090246; National
Center for Research Resources; National
Center for Advancing Translational Sciences,
Grant/Award Number: 1UL1TR001079
Background: Youth with chronic irritability and excessive reactivity, diagnosed as disruptive mood
dysregulation disorder (DMDD), have social impairment in multiple settings (i.e., peers, school, and
home). This paper presents a pilot randomized trial assessing the feasibility, acceptability, and pre-
liminary efficacy of interpersonal psychotherapy (IPT) for mood and behavior dysregulation (IPT-
MBD), an adapted version of IPT for depressed adolescents. IPT-MBD focuses on decreasing out-
bursts and irritability and improving interpersonal interactions.
Methods: Nineteen adolescents (aged 12–17) with DMDD or its research precursor, severe mood
dysregulation, were randomly assigned to IPT-MBD (n = 10) or treatment-as-usual (TAU, n = 9) in a
24-week psychosocial intervention study. Assessments of mood symptoms and overall functioning
were conducted by an independent evaluator, blinded to treatment, every 4 weeks. Parent and
self-report irritability measures were collected every 4 weeks.
Results: Eighty percent of participants randomized to the IPT-MBD arm completed the study.
Also, participants enrolled in the IPT-MBD arm attended >80% of therapy sessions. Parents and
teens agreed that the frequency and duration of therapy were appropriate and were satisfied with
IPT-MBD treatment. Clinical global impression scales for severity and improvement showed sta-
tistically greater improvement in the IPT-MBD group compared to TAU.
Conclusions: In this small pilot randomized trial, IPT-MBD was feasible and acceptable to parents
and teens. There was significantly more improvement in the IPT-MBD group compared to TAU.
IPT-MBD holds promise as a potentially effective psychosocial intervention for clinically impaired
youth with DMDD and warrants further investigation in a larger randomized trial.
adolescent, disruptive mood dysregulation disorder, interpersonal psychotherapy, irritability
Debate in child and adolescent mental health has centered on the
conceptualization of pediatric bipolar disorder (PBD). Central to the
debate is whether PBD is characterized by a chronic course (Bieder-
man et al., 2005) or by distinct episodes of mania (Leibenluft, 2011).
This issue is clinically important because the conceptualization of PBD
drives treatment recommendations. For this reason, researchers at
NIMH created a clinical construct labeled severe mood dysregula-
tion (SMD; Leibenluft, Charney, Towbin, Bhangoo, & Pine, 2003) to
study chronic irritability and compare them to youth with bipolar dis-
order (i.e., youth with episodic irritability). Based on numerous studies
comparing youth with chronic versus episodic irritability, researchers
determined that chronic irritability in youth is not a developmental
phenotype of PBD but a distinct construct (Brotman et al., 2006, 2007;
Leibenluft, Cohen, Gorrindo, Brook, & Pine, 2006; Rich et al., 2008).
The culmination of this research is the Diagnostic and Statistical Man-
ual of Mental Disorders 5th Edition's (DSM-5) inclusion of a new mood
disorder, disruptive mood dysregulation disorder (DMDD; American
Psychiatric Association, 2013).
Prevalence rates of DMDD range from 1 to 3% (Copeland,
Angold, Costello, & Egger, 2013). Childhood DMDD is associated
with increased rates of anxiety and depression in young adulthood
(Copeland, Shanahan, Egger, Angold, & Costello, 2014). DMDD in child-
hood is also associated with high levels of social impairment, including
in parent, teacher, sibling (Copeland et al., 2013), and peer relation-
ships (Mulraney et al., 2016). Long-term outcomes of childhood irri-
tability include low educational attainment, financial impoverishment,
2018 Wiley Periodicals, Inc. Depress Anxiety. 2018;35:574–582.wileyonlinelibrary.com/journal/da