Psychophysiological Correlates of Cognitive Bias Modification in Intermittent Explosive Disorder

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PROJECT SUMMARY/ABSTRACT Intermittent Explosive Disorder (IED) is the only disorder in the DSM-5 for which the cardinal symptom is recurrent aggressive outbursts. IED is a common and multidetermined mental illness, which, if left untreated, has a chronic and debilitating course that often involves interpersonal, occupational, and legal consequences, as well as adverse physical health outcomes. IED also is associated with a number of cognitive biases related to socioemotional information processing. Over-attentiveness to threatening information (attention bias) and the tendency to attribute hostile intent to others (interpretation bias) are known correlates of aggression more broadly, and aggressive behavior in IED specifically. Additionally, hyperarousal of the autonomic nervous system (ANS) following provocation has been demonstrated in aggressive individuals; however, this phenomenon has not yet been investigated in IED, nor has it been linked with the biased cognitive processing seen in the disorder. Understanding the biological correlates of such cognitive biases is crucial to developing an integrated biopsychosocial framework for IED. Further, understanding the mechanisms of cognitive bias modification (CBM) could advance targeted interventions for IED that address both cognitive and physiological dysfunction. Leveraging an existing randomized controlled trial led by my primary sponsor, the present study proposes to examine the relationship between cognitive (attentional and interpretive) biases and physiological reactivity following provocation both before and after a CBM intervention among individuals diagnosed with IED. At pre- treatment, both IED (n = 48) and non-aggressive personality disorder controls (PD; n = 48) will complete computerized measures of attention and interpretation biases, along with an aggression-provocation task (TAP; Taylor Aggression Paradigm), during which psychophysiological data (i.e., heart rate, respiratory sinus arrhythmia and electrodermal activity) will be collected. Following the pre-treatment assessment, participants in the IED group will be randomized into either (1) a four-week (8-session) computerized cognitive bias modification intervention (CBM; n = 24) or (2) a dose equated computerized placebo control (placebo, n = 24). In the CBM condition, the tasks are aimed at modifying the aforementioned attention and interpretation biases using corrective feedback between trials, whereas in the placebo condition, corrective feedback will not favor “non- hostile” responses, presumably leaving any existing cognitive biases unaffected. Post-treatment procedures will be identical to those at pre-treatment, in which cognitive biases are again measured via computerized tasks, and psychophysiological data are collected during the TAP. Results of this study will provide further insight into the pathophysiology of reactive aggression, the efficacy of CBM interventions for IED, and the development of novel interventions for IED that address cognitive and psychophysiological dysfunction that characterize the disorder. A training plan was designed to develop the applicant's expertise in the conceptual and methodological areas relevant to the proposed study and professional development toward becoming an independent researcher.